Daily Smokers Research Articles

Daily cigarette smoking among inpatients for substance use disorders in France, 2010-2020: Commonalities and specificities across substances.

This study aims to estimate the prevalence and factors associated with cigarette smoking among patients in treatment for substance use disorders (SUD) in France. We analyze a nation-wide dataset retrieving information on patients entering treatment for alcohol, opioid and stimulant use disorders between 2010 and 2020. We conduct multilevel Poisson regressions to determine the main factors associated with daily cigarette smoking among all patients who entered treatment for alcohol (n=607122), opioid (n=283381) or stimulant (n=57189) use disorders, and zero-truncated negative-binomial regressions to predict the average number of cigarettes per day. Daily cigarette smoking remains a widespread behavior among patients with SUD (overall prevalence: 72.2%, 95% CI: 72.1-72.3), with lower prevalence of daily cigarette smoking among patients treated for alcohol use disorders (69.9%, 95% CI: 69.8-70.0), and higher for patients treated for opioid (78.8%, 95% CI: 78.6-79.0) or stimulant use disorders (75.8%, 95% CI: 75.4-76.2). There was an overall increase in daily cigarette smoking over time (69.9%, 95% CI: 69.8-70.0 in 2010 vs 76.8%, 95% CI: 76.5-76.9 in 2020); however, the average number of cigarettes per day decreased (17.8 per day, 95% CI: 17.7-17.9 in 2010 vs 16.3 per day, 95% CI: 16.2-16.4 in 2020). The higher the education level, the fewer number of cigarettes per day; conversely, the higher the occupational status, the higher the number of cigarettes. The high prevalence of smoking among patients treated for SUD in France departs from the decreasing trend observed in the general population and remains a source of concern. It is necessary to implement tailored prevention strategies that target specific patient subgroups and increase staff awareness.

Cost-utility analysis of provision of e-cigarette starter kits for smoking cessation in emergency departments: An economic evaluation of a randomized controlled trial.

To assess the cost-effectiveness of the Cessation of Smoking Trial in Emergency Department (COSTED) intervention compared with signposting to local stop smoking service (SSS) from the National Health Service (NHS) and personal social services (PSS) perspective. This was a two-group, multi-centre, pragmatic, individually randomized controlled trial set in six Emergency Departments (EDs) in urban and rural areas in the United Kingdom. Adult (≥ 18 years) daily smokers (at least one cigarette or equivalent per day) but not daily e-cigarette users, with carbon monoxide reading ≥8parts per million, attending the ED (n= 972) were included. The intervention consisted of provision of an e-cigarette starter kit plus brief smoking cessation advice and referral to a local SSS. Control was an information card on how to access local SSS. Intervention costs included costs of training and delivery. Control costs included costs of printing information cards. Costs of smoking cessation and health-care services were estimated based on quantities reported by participants and unit costs extracted from secondary sources. The effects were measured by quality-adjusted life years (QALYs) derived from EQ-5D-5L. Other outcomes were smoking cessation measures. The primary outcome was incremental cost-effectiveness ratio (ICER), which was calculated by dividing the difference in costs by the difference in QALYs between groups. The mean intervention costs were £48 [standard error (SE) = £0] per participant and the mean control costs were £0.2 (SE = £0) per participant. Using regression estimates, total costs were £31 [95% confidence interval (CI) = -£341 to £283] higher and 6-month QALYs were 0.004 (95% CI = -0.004 to 0.014) higher in the intervention group than in the control group. The ICER was calculated at £7750 (probability of cost-effective at range £20 000-30 000: 72.2-76.5%). The UK Cessation of Smoking Trial in Emergency Department (COSTED) intervention (provision of an e-cigarette starter kit plus brief smoking cessation advice) was cost-effective compared with signposting to local stop smoking services under the current recommendations of the maximum acceptable thresholds.

Prevalence Rates and Predictors for Smoking Cigarettes Among Adolescents Attending School in Bissau, Guinea-Bissau

Substance use is a growing problem among young people in sub-Saharan Africa who increasingly adopt the habit of smoking cigarettes. The aim was to analyse prevalence rates and identify predictors for cigarette smoking among school-attending adolescents in Bissau, Guinea-Bissau. In June 2017, a survey questionnaire was implemented in 16 schools in a class-based, random sample of 2039 adolescents aged 14–19 (52% girls). The chi-square (p < 0.05) and odds ratios (OR) were calculated with 95% confidence intervals (CI). Potential explanatory variables for the dependent variables were introduced into a multinomial logistic regression model, and p-values were transformed to LogWorth values. The prevalence rate for lifetime smoking experience was 14.8%, 4.0% for occasional smoking (<30 days), and 2.4% for daily smoking. The most significant predictors for cigarette smoking included having friends who smoke, being a boy, attending a private school, smoking initiation at a young age, other substance use, and violent behaviour. It is imperative to initiate preventive actions against smoking and other use of tobacco in Guinea-Bissau. Considering the significant impact of the peer group, policymakers need to engage young people in developing primary prevention strategies to curb the use of tobacco and other substances.

Sociodemographic inequalities in smoking cessation: a population survey from Flanders, Belgium

Abstract Background Flanders’ decline in daily tobacco use will not reach the aim of a 5% prevalence by 2040. A faster reduction necessitates, especially among low-educated and socially vulnerable groups, as in these groups the decline goes slower. Towards future smoking cessation interventions within these specific target groups, this study examined prevalence and sociodemographic inequalities in different indicators of smoking cessation in Flanders. Methods Data from the 2022 Prevention Barometer, a probability-based survey from Flanders, were used (N = 4011, 18+). Prevalence in ever smokers was calculated overall and by age, sex, educational attainment, making ends meet and employment status. Daily smokers reported their past-year quit smoking attempts, upcoming-year quit smoking intentions and intentions to use cessation aids. Former smokers reported successful cessation and use of cessation aids. Multivariate logistic regressions, including all demographic variables, aimed to uncover inequalities. Results Quit smoking attempts in daily smokers (26.5%) were lower for low education (vs. middle and high education). Quit smoking intentions in daily smokers (41.0%) were lower for low vs. middle and low vs. high education. Daily smokers had lower intentions to use cessation aids (48.5%) when having difficulties in making ends meet. Among ever smokers, being older, having high education (vs. middle and low education), having no difficulties in making ends meet and being retired (vs. working and not working) was associated with higher odds for successful quitting (73.2%). Among former smokers, people being retired (vs. working and not working) had higher odds of using cessation aids (15.3%). Conclusions Low educated daily smokers are less likely to quit smoking. Former smokers limitedly use cessation aids to quit smoking and the use varies regarding one’s sociodemographic profile. Encouraging quit attempts and equitable access to cessation aids are public health priorities. Key messages • Low-educated smokers in Flanders face barriers in quitting, highlighting the need for targeted cessation support. • Socioeconomic disparities impact cessation aid utilization, underlining the importance of equitable access to aid for all demographics.

The interplay between healthy lifestyle and body mass index in metabolic syndrome

Abstract The prevalence of metabolic syndrome (MS) tends to increase as body mass index (BMI) increases. However, the interplay between BMI and overall healthy lifestyle in MS remains unclear. We aimed to examine the association between healthy lifestyle and MS in BMI categories. Data comprised participants aged 30-64 years from the Healthy Finland Survey representing the Finnish adults (n = 2027). Information was collected through health examination measurements, blood sampling and questionnaires in 2023. Healthy Lifestyle Score (HLS) was defined as: 1) vegetables and fruits several times/day; 2) adherence to physical activity recommendations; 3) sufficient sleep duration; 4) no current daily smoking; 5) no risky alcohol drinking. Total score ranged 0-5; categorized as 0-2 (unhealthiest), 3, 4-5 (healthiest). MS was defined as exceeding risk limit in ≥ 3 of the following conditions: waist circumference, fasting glucose, triglycerides, blood pressure and HDL-cholesterol. BMI (kg/m2) was categorized as normal weight (<25), overweight, and obesity (≥ 30). Weighted prevalence and 95% confidence intervals (CIs) stratified by sex were calculated considering sampling design and non-response. In both sexes, the prevalence of MS was lowest in those with normal weight and healthiest lifestyle (men 7%; 95% CI 2-11; women 9%; 6-13) and highest in those with obesity and unhealthiest lifestyle (m 86%; 80-92; w 67%; 56-78). In men, the prevalence of MS decreased within each BMI class as HLS scores increased, but the difference between healthiest and unhealthiest lifestyle was greatest in those with normal weight (7% vs. 26%) and lowest in those with obesity (71% vs. 86%). In women, the differences were greatest among those with overweight. Obesity and unhealthy lifestyle together form a major risk factor for MS. Differences in the prevalence of MS according to lifestyle were evident especially in men with normal weight or overweight, but decreased when the obesity threshold was exceeded. Key messages • Obesity is strongly linked to the high prevalence of metabolic syndrome but maintaining a healthy lifestyle is important regardless of body mass index. • The results indicate the importance of multifaceted prevention influencing lifestyle factors and supporting weight management to enhance the cost-effective prevention of metabolic risk accumulation.

Development of a first intervention for tobacco cessation for sexual and gender minority individuals in Romania

Abstract Background Data on tobacco use among SGM in Romania indicate high use rates, yet tailored smoking cessation efforts do not exist. We collected data from SGM individuals in Romania on tobacco use and cessation attitudes, facilitators and barriers to quitting, and intervention components acceptability to inform the first smoking cessation intervention for SGM in Romania, adapted from a U.S.-based intervention with mobile app support. Methods SGM individuals (≥ 18 years old, current smokers) recruited through community outreach in March 2024 completed a brief assessment and participated in a focus group regarding tobacco use, attitudes, norms, risks knowledge, facilitators and barriers to quitting, and intervention acceptability. Results Focus groups were held with 36 participants characterized as 45% cis male, 40% gender-diverse, 15% cis female; 40% gay, 33% bisexual, 10% queer, 8% pansexual; 6% lesbian, 3% heterosexual; M age=27, SD = 7.62. 70% smoked daily; median age of first cigarette was 17. Participants reported smoking up to 2 packs a day, with 50%-98% of people in their circles being smokers. Common reasons for smoking included to alleviate stress and “fit in.” Most did not receive support to quit from their social circles or within healthcare. While smoking was communal, quitting was individual and siloed, suggesting a preference for a group-based intervention, along with robust strategies to replace the function of smoking with adaptive habits. The app was evaluated positively, especially for its daily smoking tracking, reminders for alternative healthy activities, positive achievements, and forum for support. Conclusions Findings provide a solid platform for creating a first smoking cessation intervention for SGM individuals in Romania. Next steps include iterative testing of the mobile app to examine comprehension, usability, and satisfaction with content and functionality, in preparation for a randomized controlled trial testing the intervention’s efficacy.

Long-Term Effectiveness of a Quitline for Smoking Cessation: Results of a Randomized Controlled Trial

Plain Language SummarySmoking is a major global health problem, causing many preventable deaths and disabilities each year. Telephone counselling is a recommended method to help people quit smoking because it provides accessible support. This study examined the long-term effectiveness of the national German Smokers Quitline. Daily smokers who wanted to quit smoking were divided into two groups. One group received up to six phone calls from the national German Smokers Quitline, the other group received a self-help brochure. We measured how many participants stopped smoking for at least 7 days 12 months after the start of the intervention (7-day point prevalence of abstinence). We assessed long-term cigarette and tobacco abstinence, i.e., how many participants abstained from cigarettes/tobacco for a period of 9 months after the start of the intervention. We also examined the use of other cessation aids. A total of 905 participants took part in the study. The telephone counselling group had higher rates of long-term cigarette (31.7% vs. 17.8%) and tobacco abstinence (30.8% vs. 15.2%) compared to the other group. The odds of quitting were significantly higher in the telephone counselling group. However, the 7-day point prevalence of abstinence did not differ between the groups. Many participants used additional cessation aids, with e-cigarettes being the most common. In conclusion, telephone counselling provided by the national German Smokers Quitline is effective in helping people quit smoking long term. Increasing its awareness could improve smoking cessation rates in Germany. Counselling should include information about the risks and benefits of new nicotine consumer products.

Mapping Obesity Trends in Saudi Arabia: A Four-Year Description Study.

Our study aims to map the trends in obesity prevalence over the past four years and to describe the health, behavior, and psychological factors of people living with obesity in Saudi. This is a secondary data analysis using the Sharik Health Indicators Surveillance System (SHISS) from 2020 to 2023. The SHISS dataset comprises cross-sectional telephone interviews carried out quarterly across all administrative regions of Saudi Arabia. Recruitment of participants was restricted to Saudi resident adults only. The study analyzed data from 92,137 participants, with a balanced region and gender distribution. The average age of participants was 36.83 ± 13.68 years. The prevalence of obesity showed minor fluctuations over four years, with the highest at 22.2% in 2020 and lowest at 21.4% in 2023. This study showed that a slight decline in daily smoking rates was observed from 2020 to 2023 across all categories. Participants living with obesity reported a higher consumption of fruits and vegetables compared to their not with obesity counterparts. In addition, participants living with obesity engaged less frequently in physical activities compared to those without obesity. Moreover, people living with obesity have higher incidence rates of depression and anxiety, as well as various of chronic diseases. This study highlights the complex factors affecting obesity prevalence in Saudi Arabia. Despite progress, ongoing health promotion and disease prevention are crucial to address the persistent challenges driven by behavioral and socio-economic factors. Continued surveillance and longitudinal studies are essential to track trends in obesity, smoking, and physical activity, ensuring that health initiatives align with population needs.

The more smoking the more cataract: A study on smoking, snus use and cataract in a Swedish population.

To examine the prevalence of self-reported cataract and cataract surgery, and the incidence of cataract surgery, in relation to smoking and use of the moist smokeless tobacco product snus. In 2014/2015, individuals born in 1951 (n = 18 055) in the Västra Götaland County, Sweden, were invited to participate. Of these, 9743 (54%) accepted participation and 9316 (52%) remained after exclusion criteria were applied. Participants answered a questionnaire with items about eye conditions, smoking, snus, gender, education, asthma, chronic obstructive pulmonary disease, corticosteroid use, diabetes mellitus, weight and height. Prevalence ratios (PRs) for self-reported cataract and cataract surgery were calculated. The incidence of cataract surgery was assessed, and hazard ratios (HRs) were presented. Having ever smoked was associated with a higher prevalence ratio of self-reported cataract (PR 1.19, 95% confidence interval [CI] 1.04-1.35) and cataract surgery (PR 1.27, 95% CI 1.06-1.53), compared to those who had never been daily smokers. Currently, a smoker was associated with a higher HR of cataract surgery (HR 1.34, 95% CI 1.04-1.74), as well as having been a former smoker (HR 1.27, 95% CI 1.03-1.56). Total years of smoking were associated with an increased risk for cataract surgery (HR 1.05, 95% CI 1.02-1.08 for 5 years of smoking). Snus use was not associated with an increased prevalence of cataract or incidence of cataract surgery, except among women who were current snus users (HR for cataract surgery 2.04, 95% CI 1.16-3.60 n = 108). Smoking is associated with a higher prevalence of cataracts, and a higher incidence of cataract surgery, indicating a dose-response relationship. However, there was no firm association between snus use and cataract.

Dyspnea, respiratory muscle strength, cough capacity, and sleep quality in individuals with substance use disorder

There is evidence that substance use and smoking cause some adverse effects on the respiratory system. The aim of this study was to assess dyspnea severity, respiratory muscle strength, cough capacity, and sleep quality in people with substance use disorder (SUD). Forty eight individuals with SUD and 28 active cigarette smokers participated in the study. Participants’ dyspnea severity was assessed using the Modified Medical Research Council Scale, respiratory muscle strength was measured with a portable electronic mouth pressure device, peak cough flow was assessed with a Peak Flow Meter, and sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI). The amount of daily cigarette smoking and dyspnea severity were significantly higher in individuals with SUD (p < .001). Peak cough flow values, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), MIP (%predicted), and MEP (%predicted) were not significantly different between the SUD patients and the active cigarette smokers (p > .05). However, PSQI sub-parameters such as subjective sleep quality, sleep latency, habitual sleep efficiency, use of sleeping medication, and total scores showed significant differences between the SUD patients and the active cigarette smokers (p < .05, p < .001, p = .03, p < .001, p < .001, respectively). Individuals with SUD were found to have higher dyspnea and poorer sleep quality than active smokers. However, respiratory muscle strength and cough capacities were similar.

Patient-provider communication about cigarette and e-cigarette use during pregnancy: Adaptation and validation of frequency and quality of communication measures among a sample of pregnant patients.

Quality of patient-provider communication regarding tobacco use may encourage cessation that could lead to improved health outcomes for mothers and children. However, currently there are no validated measures of frequency and quality of patient-provider communication about cigarettes and e-cigarettes. The objective of this study was to adapt and validate measures of frequency and quality of patient-provider communication about smoking and e-cigarette use among a sample of pregnant mothers who currently smoked. An online sample of US pregnant women who reported past 30-day smoking were recruited to complete a cross-sectional, online survey (n=267). An exploratory factor analysis examined the factor structure of four measures of frequency and quality of patient-provider communication about cigarettes and e-cigarettes among those who reported prior communication with their provider about cigarettes and e-cigarettes (n=170). Relationships between measures were explored, and a logistic regression explored each measure's association with intention to switch from cigarettes to e-cigarettes. Items measuring the frequency of communication loaded onto one factor for both cigarettes and e-cigarettes (α=0.88). Quality of communication loaded onto two factors for both cigarettes and e-cigarettes, termed active communication and internalized perception. Internalized perceptions of communication quality about cigarettes (β= -0.32, p<0.002), active communication (β=0.46, p<0.02), and internalized perceptions of communication about e-cigarettes (β= -0.36, p<0.001) were related to intention to switch, in separated models. Quality conversations between healthcare providers and pregnant patients is likely more important for behavioral decision-making than the frequency of communication.

Assessing the Association Between Respiratory Symptoms and Nicotine and Cannabis Use Through Traditional and E-Product Devices in the U.S.

PurposeTo assess the association between past 30-day cigarette smoking, nicotine use with an e-product device (e.g., vape), cannabis smoking, cannabis use with an e-product device, and other forms of cannabis use and past-year respiratory symptoms in a nationally representative sample of people aged 12 and older in the U.S. during 2021. MethodsData from Wave 6 (2021) of the Population Assessment of Tobacco and Health (PATH) Study was used, a national probability sample of adolescents (ages 12-17; n=5,652) and adults (ages ≥18; n=30,516). Logistic regression was used to assess the association of past 30-day cigarette smoking, nicotine use with an e-product, cannabis smoking, cannabis use with an e-product, and other forms of cannabis use with past-year respiratory symptoms (a past-year respiratory symptom index was constructed and ranged 0-9; an index of 2+ was flagged as having functionally important respiratory impairment). ResultsThe odds of a past-year respiratory index score of 2+ was greater among respondents who indicated either past 30-day cigarette or cannabis smoking compared to respondents who did not use any nicotine or cannabis during the past 30 days. Past 30-day nicotine and cannabis use with an e-product device was not associated with a respiratory symptom index of 2+. The combination of past 30-day cigarette smoking and cannabis smoking had one of the strongest associations with experiencing a respiratory index score of 2+ among dual users of nicotine and cannabis. ConclusionsPast 30-day cigarette smoking and cannabis smoking was associated with higher odds of functionally important respiratory impairment. Additionally, this study provides robust evidence regarding the potential respiratory harms of single or dual nicotine and cannabis smoking as it relates to respiratory health.

Shifts in motivation to quit cigarette smoking associated with IQOS use

IntroductionIQOS, a heated tobacco product (HTP), is among a growing number of noncombustible nicotine delivery alternatives marketed to people who smoke combustible cigarettes and are interested in less harmful alternatives. Little is known regarding whether IQOS use and IQOS-associated effects impact motivation to quit cigarette smoking. MethodsNon-treatment-seeking adult daily smokers (n = 87) completed a within-subjects study consisting of a baseline ad-lib smoking period (days 1–5), two laboratory visits (days 6–7) involving IQOS exposure, and a two-week period where participants were instructed to switch from smoking cigarettes to using IQOS (days 8–21). Motivation to quit smoking was measured on days 1 and 22. ResultsA generalized linear model revealed a significant increase in motivation to quit smoking across the 14-day switch phase with an increase of 1.47 ladder steps (Δ=1.47, sd = 1.98, t(86) = 6.92, p < 0.0001), increasing from 5.30 to 6.80. Candidate predictors were identified through a stepwise selection procedure, which resulted in a final model with two predictors, the standardized HeatStick substitution rate (b = 0.54, (CI95% 0.13–0.95), p = 0.01) and standardized relative risk perception score (b = 0.45, (CI95% 0.04–0.85) p = 0.03), ConclusionsAmong those uninterested in quitting cigarette smoking within the next month, IQOS use was associated with increased motivation to quit. Motivation to quit smoking may not be a necessary prerequisite for promoting smoking behavior change but rather bolstered by smoking behavior change in the context of HTP use. Greater perceptions of risk reduction may ultimately aid the transition from combustible to noncombustible tobacco products.

Clustering of restorative sleep and lifestyle habits in Japanese male working population

Non-restorative sleep (NRS) affects not only individuals’ health, but also company productivity, highlighting the importance of measures in the workplace to improve sleep. This study aimed to examine the clustering of the presence of restorative sleep (RS) and lifestyle habits in a Japanese working population and to explore the characteristics of these clusters. The subjects were 58,150 Japanese working men aged 40−59 years who underwent health check-ups across the country from April 2015 to March 2016. Data for the presence of RS, the frequency and amount of drinking, smoking/exercise habits, and body mass index obtained from health check-ups were clustered with latent class analysis. In addition, the characteristics of each cluster were examined from the perspectives of lifestyle-related disease-associated blood test results obtained from health check-ups and the status of medical treatment at medical institutions as determined from medical claims data. Consequently, RS and lifestyle habits were found to form five clusters. The “NRS, no exercise, drinkers” cluster showed the highest probability of not achieving RS. An “Obese, occasional binge drinkers” cluster with a higher percentage of patients with sleep-apnea syndrome and a “Nondrinkers” cluster with proportions of those taking sleeping pills/anxiolytics and antidepressants/antipsychotics were observed. Furthermore, the “Daily smokers and drinkers” and “RS and drinkers” clusters showed a relatively high probability of achieving RS. These findings suggest that some individuals may not be aware of the sleep disorders caused by their drinking and smoking habits. Measures to improve sleep must be tailored to the characteristics of each cluster.

Use of Routine Dual-Energy X-Ray Absorptiometry-Based Bone Mineral Density Measurement in Individuals with Self-Reported Falls within 1 Year as a Warning Sign of Sarcopenia Assessment

This study evaluated the association between self-reported falls within 1 year and fragility fracture among patients who underwent dual-energy X-ray absorptiometry (DXA)-based bone mineral density (BMD) measurement. This retrospective cross-sectional analytic study included 1,283 women and men aged 40–90 years who underwent BMD measurement using DXA. The variables assesses were age, sex, body mass index, self-reported falls within 1 year, fragility fractures and bone site, parental hip fracture, current history of daily smoking and daily excess alcohol consumption, long-term steroid use, rheumatoid arthritis, secondary osteoporosis, BMD and BMD T-scores of the lumbar spine and hip, vertebral fracture assessment results, and diagnostic classifications of osteoporosis. The participants were divided into the faller group (those with at least one fall incident within 1 year) and the non-faller group. Overall, 375 (29.2%) patients reported history of falls within 1 year. A previous history of hip fracture (aOR = 7.674, 95% CI: 3.96– 14.86, P = 0.000), previous non-vertebral fracture (aOR = 6.305, 95% CI: 3.41–11.66, P = 0.000), previous vertebral fracture (aOR = 2.466, 95% CI: 1.61–3.78, P = 0.000), and parental hip fracture (aOR = 2.354, 95% CI: 1.46–3.80, P = 0.000) was associated with self-reported falls within 1 year. In conclusion, self-reported falls within 1 year were strongly associated with fragility fracture. The simultaneous testing of DXA- based appendicular skeletal mass and hand grip strength is recommended for diagnosing coincident sarcopenia on routine DXA- based BMD measurement.

Historical trends in daily smoking and quitting by relationship status in Norway, 1973-2022.

This study aims to investigate trends in self-reported daily smoking and quitting by relationship status in 1973-2022. Repeated and representative cross-sectional tobacco surveys of the adult population in Norway were analysed in the age group 25-74 years. Logistic regression was used to estimate the adjusted predicted probability of daily smoking and former smoking for persons in a formalised relationship (married or cohabitant) and persons not in a formalised relationship. Since the 1970s, the decline in daily smoking has been present for men regardless of relationship status, but with more smoking among men not in a relationship from the 2000s onward. For women not in a relationship, daily smoking increased among those not in a relationship from the mid-1980s, surpassing the smoking rate among men in a relationship. From the 1990s, daily smoking was higher in women not in a relationship compared with women in a relationship. In the past decade (2013-2022), the adjusted odds ratio of daily smoking was 0.49 for people in a relationship compared with those not in a relationship. Downward trends in daily smoking have been substantial the past 50 years, but differences by relationship status persist. Continued monitoring of smoking behaviour at the population level is crucial to uncover which demographic groups are lagging in the last phase of the tobacco epidemic.

Approach Bias and Tobacco Craving as Mechanisms of the Effect of Approach Bias Retraining on Smoking Cessation.

Approach bias, the automatic tendency to advance toward, rather than move away from appetitive cues, has been associated with greater tobacco cravings, dependence, and likelihood of smoking relapse. Approach bias retraining (ABR) has emerged as one way to reduce approach bias and promote avoidance toward smoking cues. Yet, additional research is needed to identify the mechanisms that may help explain the effect of ABR on smoking cessation. The current study uses data collected as part of a randomized controlled trial to test two unique mechanisms of action ([1] approach bias and [2] tobacco craving) for the efficacy of standard smoking cessation treatment (ST) augmented by ABR on smoking abstinence. Participants were 96 adult daily smokers (Mage=43.1, SD=10.7) motivated to quit smoking. Results showed that lower approach bias and lower cravings at a treatment session were significantly related to next session smoking abstinence (p's<.018). Further, deviations in approach bias partially mediated the effect of ABR on smoking abstinence (ab=-12.17, 95%CI: [-29.67, -0.53]). However, deviations in tobacco craving did not mediate this relation (ab=.40, 95%CI: [-.27, 1.34]). The current findings add to extant literature by identifying approach bias as a mechanism of action of the effect of ABR on smoking abstinence during smoking cessation treatment. The current study adds to our knowledge on the effectiveness of approach bias retraining (ABR) as a part of smoking cessation treatment. Results indicate that reductions in approach bias partially mediate the effect of ABR on smoking abstinence. These findings are consistent with previous research on alcohol-dependent adults and underline the potential of ABR to reduce approach bias and promote smoking cessation among smokers. Such findings could inform the development of future research exploring more targeted and effective smoking cessation interventions, ultimately improving outcomes for individuals attempting to quit smoking.

Effectiveness of mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling at outdoor smoking hotspots: A cluster randomized controlled trial.

To evaluate the effectiveness of mobile smoking cessation (SC) treatment with 1-week nicotine replacement therapy (NRT) sampling on recruitment and quitting outcomes. Two-arm cluster RCT (1:1 ratio), single-blinded, at 244 recruitment sessions in Hong Kong outdoor smoking hotspots from October 2018-December 2019. Participant were recruited by ambassadors and treated at the mobile SC truck. 834 adult (≥18 years, male 81.3%) daily smokers, Chinese-speaking, non-NRT users in the past month, consented after nurse-led intervention in mobile SC truck were randomized to the experimental (n = 482 male 79.5%) and the control group (n = 352, male 83.8%). The experimental group received a 1-week free NRT sample, an NRT instruction card, and mobile SC treatment including onsite nurse-led brief medication advice (about 15 minutes) and referral to SC clinics. The control group received the same mobile SC treatment. Primary outcome was self-reported quit attempts at 1-month follow-up. Secondary outcomes included SC service use at 1month, and biochemically validated abstinence (exhaled carbon monoxide < 4ppm; or saliva cotinine < 10ng/ml) at 6-month follow-up. Additionally, a post-hoc cost analysis was conducted. By intention-to-treat, the two groups showed similar prevalence of quit attempts (44·4% versus 43·5%, risk ratio (RR) = 1·04, 95% confidence interval (CI) = 0·79-1·37, P = 0·79). Compared with the control group, the experimental group showed lower SC service use at clinics (32·4% versus 44·9%, RR = 0·72, 95%CI = 0·57-0·91, P = 0·006), but no significant difference in validated abstinence (4·6% versus 2·8%, RR = 1·64, 95%CI = 0·76-3·50, P = 0·21). The experimental recruitment sessions recruited more smokers for onsite medication advice than the control session (mean 6·7 vs 5·0, adjusted incident rate ratio = 1·30, 95%CI = 1·08-1·56, P = 0·005). Mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling did not increase quit attempts or abstinence outcomes among recruited daily smokers in Hong Kong. The intervention increased smokers' uptake of onsite medication advice but reduced subsequent smoking cessation service use at clinics.

Smoking, all-cause, and cause-specific mortality in individuals with diabetes in Mexico: an analysis of the Mexico city prospective study

ObjectiveEvidence from low- and middle-income countries regarding the effect of smoking in people with diabetes is lacking. Here, we report the association of smoking with mortality in a large cohort of Mexican adults with diabetes.MethodsParticipants with diabetes mellitus (self-reported diagnosis, use of antidiabetic medications or HbA1c ≥ 6.5%) aged 35–74 years when recruited into the Mexico City Prospective Study were included. Cox regression confounder-adjusted mortality rate ratios (RRs) associated with baseline smoking status were estimated.ResultsAmong 15,975 women and 8225 men aged 35–74 years with diabetes but no other comorbidities at recruitment, 2498 (16%) women and 2875 (35%) men reported former smoking and 2753 (17%) women, and 3796 (46%) men reported current smoking. During a median of 17 years of follow-up there were 5087 deaths at ages 35–74 years. Compared with never smoking, all-cause mortality RR was 1.08 (95%CI 1.01–1.17) for former smoking, 1.11 (95%CI 1.03–1.20) for current smoking, 1.09 (95%CI 0.99–1.20) for non-daily smoking, 1.06 (95%CI 0.96–1.16) for smoking < 10 cigarettes/day (median during follow-up 4 cigarettes/day), and 1.28 (95% CI 1.14–1.43) for smoking ≥ 10 cigarettes/day (median during follow-up 15 cigarettes/day). Mortality risk among daily smokers was greatest for COPD, lung cancer, cardiovascular diseases, and acute diabetic complications.ConclusionIn this cohort of Mexican adults with diabetes, low-intensity daily smoking was associated with increased mortality, despite observing smoking patterns which are different from other populations, and over 5% of total deaths were associated with smoking.

Ranking of Modifiable Lifestyle Risk Factors for Breast Cancer in Saudi Women: Population Attributable Risk and Nomogram.

Breast cancer is the most common cancer among women in the Saudi Arabia, and over 50% of the cases are detected at a late stage. This study aimed to estimate population attributable risk percentage (PAR%) of modifiable lifestyle risk factors for breast cancer in Saudi Arabia. A secondaryanalysis of previously published papers was performed . Relative risks (RR) and odds ratios (OR) were obtained from published international epidemiological studies, and the prevalence of each risk factor in Saudi Arabia was obtained from various sources (eg, national surveys and published literature) to calculate PAR%. A nomogram was used to visually translate the RRs/ORs and their prevalence into PAR% using a practical tool. Seven modifiable lifestyle risk factors for breast cancer were identified in Saudi Arabia. The identified risk factors included lack of physical activity (sedentary lifestyle), oral contraception (current use), obesity (postmenopausal), hormone replacement therapy (current use), passive smoking, age at first birth (≥ 35 years), and tobacco smoking (current or daily smoking). The PAR% for these risk factors ranged from 0.5% for tobacco smoking to 23.1% for a lack of physical activity. Few modifiable lifestyle risk factors were excluded from this study, due to limited nor unavailable data in Saudi Arabia (eg, alcohol consumption, breastfeeding patterns and childbearing patterns, obesity according to menopausal status, and night-shift work). Physical inactivity has the most significant modifiable health impact and is a major risk factor for breast cancer. Removing this risk factor would reduce the prevalence of breast cancer in the Saudi population by 23%. There is an immense need to prioritize cancer control strategies based on local needs, current data on cancer risk factors, and the disease burden.