Smoking Cessation Research Articles

Smoking Cessation Treatment in Primary Care

Smoking Cessation Treatment in Primary Care

Exploring Gender Differences in Receipt of the 5As for Smoking Cessation for Recently-Diagnosed Cancer Patients (ECOG-ACRIN EAQ171CD).

Smoking cessation is important for men and women diagnosed with cancer. Oncology clinicians should encourage all patients to quit and offer resources to help them do so, following the 5As framework (Ask, Advise, Assess, Assist, and Arrange follow-up). This study tests gender differences in self-reported receipt of the 5As by an oncology provider among 306 recently-diagnosed male and female cancer patients. Receipt of praise for quitting efforts was also assessed as an indicator of empathic communication. Participants completed baseline surveys as part of a larger clinical trial focused on smoking cessation (NCT03808818), reflecting on pre-trial interactions with their oncology clinicians. Most male and female patients received "Ask," "Advise," and "Assess" (i.e., asking patients if they smoke, advising them to quit, and assessing their interest in doing so), though significant gender differences emerged in receiving "Assist" and "Arrange follow-up." Women were less likely to receive assistance (e.g., medication or counseling referral; 85.25% versus 93.18%, respectively) or a follow-up appointment to discuss their progress (28.11% versus 40.91%, respectively). Approximately half of men and women were praised for their quitting efforts. In exploratory sensitivity analyses, gender differences in arrange-follow-up were attenuated when adjusting for cancer location (smoking-related or not), self-reported distress, and self-reported coping ability. Women may be at risk for suboptimal smoking-related support during cancer care, as assistance and follow-up are essential to sustained abstinence. Clinicians should consistently deliver each of the 5As to all cancer patients who smoke, regardless of cancer type or expressed distress/coping difficulty. The current study findings add to the growing literature describing gender disparities in tobacco treatment access. Findings highlight an addressable gap in access to tobacco treatment for a group of women who have cancer. Advancements in the equitable delivery of smoking cessation counseling have the potential to improve cessation outcomes for women with cancer who smoke.

Cigarette Smoking Trajectories of US Young Adults by Sex.

While cigarette smoking is the leading cause of preventable morbidity and mortality in the United States (US), nearly one-fifth of young adults continue to smoke cigarettes, however, the prevalence remains higher in males than females. The restricted panel data from the Monitoring the Future (MTF) study from 1976-2020 (n=24,293) was used. A group-based trajectory model (GBTM) was fit to the data for each sex (male/female), where groups were determined by cigarette smoking (yes/no) from the base year through the six biennial follow-up questionnaires. The analysis was then repeated overall and by decade. Four trajectory groups of cigarette smoking emerged for both sexes (male/female). Group 1 (60.8/62.0%) included participants with non-use of cigarettes. Group 2 (13.1/14.2%) captured individuals with moderate probability of use of cigarettes at baseline that decreased over time. Group 3 (7.1/5.5%) was the opposite of Group 2, where participants had low/moderate probability of cigarette smoking at baseline that increased over time. Group 4 (19.0/18.3%) captured individuals with high/moderate to high use of cigarettes throughout the study period. Overall and by decade analyses produced similar results. Almost one quarter of the sample had increasing or high cigarette smoking, which suggests prioritizing interventions on recent high school graduates, regardless of sex, who begin with low cigarette smoking and increase over time and those with consistently high cigarette smoking. Future research will examine how different cigarette smoking trajectories relate to substance use and mental health outcomes. This study provides a novel viewpoint on cigarette trajectory analysis among the adolescent and young adult population, stratified by sex. This stratification showed that regardless of sex, the same four distinct trajectory groups were present. This result was somewhat unanticipated as there are known discrepancies in both cigarette smoking initiation and cessation between the sexes.

Method for determination of cytisine in post-mortem biological matrices and its application to two forensic cases.

Cytisine is the active ingredient in preparations used for smoking cessation. Its popularity is attributed to its low cost, efficacy, and low incidence of adverse effects. Additionally, its easy over-the-counter availability is also significant. This accessibility makes it a potential substance for use in suicidal attempts. The aim of this study was to develop a method for the determination of cytisine in biological material for use in clinical and forensic toxicology, and to apply this method in authentic cases. Biological samples were subjected to liquid-liquid extraction using cytisine-d4 as an internal standard. Analyses were performed using a Hydrophilic Interaction Liquid Chromatography (HILIC) column with the technique of ultra-high-performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry. For both matrices (blood and urine), the linear concentration range was 5-1000ng/mL. The method met all validation requirements. The concentration of cytisine in a man taking it for smoking cessation in post-mortem materials was 21.4ng/mL in blood, 958.9ng/mL in urine, ca. 30ng/mL in vitreous humor, and ca. 40ng/mL in bile. In contrast, for a man with cytisine intoxication, the concentration was 174.6ng/mL in blood and > 10,000ng/mL in urine. In both cases, no N-methylcytisine was detected. The developed method can be used for the determination of cytisine in post-mortem biological matrices as well as for clinical purpose. We presented the concentrations of cytisine in the post-mortem biological samples of a man taking cytisine for smoking cessation and of a man with suicidal cytisine poisoning.

The Role of Cardiac Rehabilitation in Promoting Lifestyle Modification Among Cardiovascular Patients: A Nationwide Cohort Study

Background: Cardiac rehabilitation (CR) is crucial for the secondary prevention of cardiovascular disease, primarily by promoting lifestyle modifications. However, its impact on lifestyle changes in the Korean population has not been well studied. This study analyzed data from the National Health Insurance Database to evaluate the effect of CR on lifestyle improvement in patients with cardiovascular disease. Methods: Patients who underwent coronary revascularization in 2017 were included. This study investigated whether the lifestyle habits of patients with cardiovascular disease who were physically inactive, obese, and smoked improved after coronary revascularization. To analyze whether CR affected each lifestyle factor, multiple regression analysis was performed, adjusting for socioeconomic and medical conditions as covariates. Results: CR had a significant effect on the acquisition of regular physical activity among physically inactive patients before revascularization (odds ratio [OR]: 1.205, 95% confidence interval [CI]: 1.046–1.389). However, CR did not have a significant impact on smoking cessation in smokers (OR: 1.172, 95% CI: 0.890–1.545) and weight reduction in patients with obesity (OR: 1.104, 95% CI: 0.977–1.248). Conclusion: This nationwide study showed that CR after coronary revascularization significantly improved physical activity in patients with cardiovascular disease. However, CR had no significant effect on smoking cessation or weight reduction, indicating a need for more comprehensive approaches to address these lifestyle factors.

Early Online

Background. The personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There is limited evidence on the prevalence of modifiable NCD risk factors among medical students in South Africa (SA). Objectives. To determine the prevalence of modifiable behavioural and metabolic NCD risk factors in first-year medical students at a SA university. Methods. This cross-sectional observational study included 256 first-year students. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep quality). NCD-related metabolic markers including body composition, blood pressure, total cholesterol and random glucose concentrations, were measured. The prevalence of risk factors was calculated using internationally accepted criteria, and sex differences were reported using one-way ANOVA or χ2 test (p<0.05). Results. The prevalence of poor sleep quality was 79.7%, followed by low-to-moderate diet quality (66.8%), low levels of physical activity (64.1%), overweight/ obesity (26.2%), current/past smoking (13.3%) and harmful use of alcohol (12.5%). Most (88.3%) participants had two or more NCD-related risk factors. The prevalence of multiple NCD risk factors differed significantly between male and female participants, with more male participants having ≥2. Conclusions. This study found that first-year medical students at a South African university have a high prevalence of lifestyle-related risk factors, specifically poor sleep quality, low levels of physical activity and low-to-moderate diet quality. Sleep hygiene, regular activity and good nutrition should be promoted, and interventions focusing on nutrition, smoking cessation and alcohol consumption could be targeted by sex.

Beyond CPAP for Cardiovascular Risk Reduction in Patients with OSA

Abstract An accumulating body of evidence suggests a bidirectional relationship between sleep and cardiovascular (CV) health. A high level of evidence has linked obstructive sleep apnea (OSA) with cardiovascular disease (CVD). Accordingly, clinical sleep medicine emphasizes the diagnosis and treatment of obstructive sleep apnea (OSA) in the context of promoting CV health. While continuous positive airway pressure (CPAP), the main stay treatment for OSA, is effective in improving several sleep-related quality-of-life outcomes and leads to modest reductions in blood pressure, there is currently insufficient evidence to justify using CPAP alone for improving CVD outcomes in OSA. Sleep physicians are uniquely positioned to expand their focus beyond the evaluation of OSA and administering CPAP, in efforts to enhance the CV health of sleep patients. Herein, we suggest the role of sleep physicians as CV preventionists. Key focus areas for managing CV risk beyond CPAP therapy in OSA include identifying comorbid disorders that are vital for optimizing CV health. This involves risk-stratifying patients and providing appropriate counseling, referrals, and treatment as appropriate for comorbid sleep conditions such as insomnia and insufficient sleep, comorbid CV risk factors including hypertension, dyslipidemia, metabolic dysfunction-associated steatohepatitis, as well as counseling for weight management programs, smoking and alcohol cessation. We urge sleep clinicians to play an active and integral role in optimizing CV health of patients with sleep disorders.

Reducing the Cardiovascular Risks of Smoking: Insights From the European Society of Cardiology (ESC) Congress 2024 and Two Key Opinion Leaders

Smoking is a major risk factor for cardiovascular disease (CVD) and responsible for around 25% of all CVD-related deaths worldwide. Cigarette combustion releases nicotine and produces thousands of chemicals, many of which are toxic. Complete cessation of smoking is the most effective way of reducing the associated CVD risk. However, many people find it difficult to quit smoking due to nicotine’s addictive nature and the ritualistic aspect of smoking. The European Society of Cardiology Congress (ESC) 2024, held in London, UK, between 30th August–2nd September, included several sessions discussing tobacco harm reduction in relation to CVD, with a particular focus on e-cigarettes and heat-not-burn products (HNBP) as alternatives to cigarettes. EMJ interviewed two key opinion leaders (KOL), who had attended ESC 2024, to obtain their insights into tobacco harm reduction in Europe: Vincenzo Montemurro, Professor and Consultant Cardiologist at the Scilla Hospital of America, Reggio Calabria, Italy; and Emil Toldy-Schedel, Professor, Consultant Cardiologist, and General Director of the St. Francis Hospital, Budapest, Hungary. Montemurro explained that switching from cigarettes to alternative products that generate fewer toxins would likely reduce CVD risk in people who are unable to quit smoking, which would benefit public health and decrease healthcare expenditure in Europe. Toldy-Schedel agreed with this view but called for well-designed studies to fully characterise the risk profile of these newer products so that healthcare professionals can be better equipped to answer patients’ questions about possible long-term effects.

A comparative perception and impact of pictorial warnings on cigarette packaging among Malaysian smokers and non-smokers

Introduction In 2003, the World Health Organization (WHO) recommended that pictorial warnings on tobacco products be used to educate consumers on the negative health impacts associated with tobacco use. This study aimed to assess the effectiveness of pictorial warnings on cigarette packaging among smokers and non-smokers. Methods A cross-sectional study using a self-administered questionnaire was conducted in Kuala Lumpur. Four components assessed the respondents’ socio-demographics, smoking status, perceptions, and impact of pictorial warnings. Six standard cigarette pictorial warning images were included in the questionnaire. Data collected were analysed using SPSS version 29.0. Frequencies and percentages were used for categorical data, while means and standard deviations were used for continuous data. Statistically significant results were set at p-value < 0.05. Non-parametric tests, the Chi-square test and the One-Way ANOVA test were used to calculate the differences between the variables, as the data was not normally distributed. Results Three hundred seventy-eight respondents participated in this study, with smokers and non-smokers divided equally, 189. Most respondents were 20–29 years old (n = 223, 59.0%) and had tertiary education (n = 207, 54.8%). Most smokers were male (n = 172, 91.0%), and most non-smokers were female (n = 119, 63.0%). Most respondents (n = 364, 96.3%, p = 0.276) noticed the pictorial warnings on cigarette packs. Nevertheless, significantly (p < 0.001) more smokers (n = 73, 38.6%) seldomly read the content compared to non-smokers (n = 57, 30.2%). Most smokers (n = 48, 12.7%) sometimes consider quitting smoking upon exposure to pictorial warnings on cigarette packs. However, most non-smokers (n = 161, 42.6%) never had the urge to smoke upon looking at the pictorial warnings. The most impactful image on cigarette packs among smokers was ‘Lung cancer’ (n = 74, 39.2%), while for non-smokers was ‘Mouth cancer’ (n = 59, 31.2%) with p < 0.001. Conclusion While non-smokers demonstrated greater engagement with and emotional responses to the warnings, smokers showed less frequent interaction and a tendency toward desensitisation. Although pictorial warnings play a vital role in raising awareness of the health risks of smoking, particularly lung and mouth cancer, their effectiveness in encouraging smoking cessation among smokers remains limited.

Assessing the effects of Enhanced Multicomponent Proactive Navigator-Assisted Cessation of Tobacco Use within a federally qualified health center (EMPACT-Us): a protocol study

BackgroundCalifornia’s relatively low smoking rate (10.1% in 2019–2020) (About CHIS, UCLA Center for Health Policy Research, 2024) masks deep disparities among low-income populations, where smoking rates are nearly double that of their middle- to upper-income peers. Low-income smokers report a similar desire to quit and similar rates of recent quit attempts as smokers from other groups; yet, they often face barriers in accessing effective resources to facilitate successful cessation.MethodsOur team will conduct a pragmatic stepped-wedge cluster, randomized controlled trial of Enhanced Multicomponent Proactive Navigator-Assisted Cessation of Tobacco Use (EMPACT-Us), a suite of tobacco cessation services supported by patient navigators, designed in close partnership with patients, providers, and community stakeholders. The study will take place at Family Health Centers of San Diego (FHCSD), the largest federally qualified health center (FQHC) in San Diego. Eight primary care clinics are included, where 70% (n = 13,496) of smokers at FHCSD receive care.DiscussionWe hypothesize that multiple points of engagement and integration of navigation services into the workflow of existing staff will improve utilization and cessation success. This study will examine if the enhanced suite of services offers insights on how to best integrate evidence-based tobacco treatment services into usual care.Trial registrationClinicalTrials.gov, NCT05750537, Registered on March 1, 2023.https://clinicaltrials.gov/study/NCT05750537.

Motivators and barriers for smoking cessation in people with multiple sclerosis: a qualitative study to inform the design of a tailored intervention

BackgroundTobacco smoking is a relevant determinant of multiple sclerosis (MS) onset, and smokers have increased risk for faster progression of MS compared to non-smokers. While the smoking prevalence is high in Germany, no smoking cessation programs have been developed specifically in MS populations to date, and only little is known about the motivators and barriers influencing smoking cessation in people with MS (pwMS) in Germany. This study aims to identify these factors to inform the design of a tailored smoking cessation intervention.MethodsAs part of a larger program of work, we conducted semi-structured interviews in people with MS (pwMS) to explore their needs, motivators and barriers regarding smoking cessation. We recruited via MS-websites and the email-newsletter of our institution at the University Medical Centre Hamburg-Eppendorf. Participants were eligible if they had a self-reported MS-diagnosis and currently smoked or quit smoking within the last two years but after their MS-diagnosis. Interviews were conducted online and via telephone during May and June 2023. Data were analysed using thematic analysis based on a realistic approach.ResultsEight women and seven men participated in our interviews. Eleven were current, four were former smokers. Median time since diagnosis was 4 years (range: 1–26). Interviews identified MS-diagnosis, concerns about general health, and social factors as relevant motivators to stop smoking. Furthermore, worries about negative consequences when quitting (e.g. fear of missing out on social interactions or weight gain) were identified as a great barrier to smoking cessation. Knowledge about the connection between MS and smoking, and satisfaction with communication with MS clinicians were low. PwMS expressed a need for better conversations with neurologists and expert-led smoking cessation interventions. Additionally, we found that the wish for peer-exchange and the willingness to participate in smoking cessation programs was high.ConclusionOur results confirm findings of previous studies from other countries, identifying lack of knowledge, unsatisfactory communication with MS clinicians, and worries about negative consequences when quitting as barriers, and the MS-diagnosis as a motivator for smoking cessation. In a next step, we will use our findings for the development of an MS-specific online smoking cessation program.

The role of executive functioning in smoking cessation: A scoping review.

Creating and implementing a plan to successfully quit smoking likely requires executive function (EF) skills such as inhibition, cognitive flexibility, attention and working memory. This scoping review consolidates the research evidence evaluating the role of EF in smoking cessation. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), researchers and a medical librarian searched PubMed, EMBASE, ERIC, CINAHL and PSYCINFO in June 2022, hand-search in September 2022 using relevant MeSH terms, and an updated search was completed in August 2024. Fifteen articles were included. Self-regulation was the most frequently evaluated EF across all studies. Performance on measures of impulsivity was most frequently related to successful smoking cessation. Across studies, performance on measures in areas of attention, working memory, cognitive flexibility and higher-level EF was variable as it relates to smoking cessation success. There was considerable variability in the measures used to evaluate EF and definitions of cessation success. Across studies, very little research evaluates higher-level EF. Differences in EF and cessation measures make comparisons across studies difficult. Future work is needed utilising common assessment and outcome measures that will improve our understanding of the complex cognitive skills needed for successful cessation. Particular consideration should be given to higher-level EFs including reasoning, planning, problem-solving and decision-making.

Evaluating the Impact of Multimodal Prehabilitation with High Protein Oral Nutritional Supplementation (HP ONS) with Beta-Hydroxy Beta-Methylbutyrate (HMB) on Sarcopenic Surgical Patients—Interim Analysis of the HEROS Study

Background: Multimodal prehabilitation programs, which may incorporate nutritional supplementation and exercise, have been developed to combat sarcopenia in surgical patients to enhance post-operative outcomes. However, the optimal regime remains unknown. The use of beta-hydroxy beta-methylbutyrate (HMB) has beneficial effects on muscle mass and strength. However, its effect on muscle quality in the perioperative setting has yet to be established. This study aims to explore the impact of a multimodal prehabilitation program using a bundle of care that includes high-protein oral nutritional supplementation (HP ONS) with HMB and resistance exercise on muscle quality and functional outcomes in sarcopenic surgical patients. Methods: Sarcopenic adult patients undergoing elective major gastrointestinal surgeries were recruited for this pilot interventional cohort study. They were enrolled in a 2–4-week multimodal prehabilitation program comprising resistance exercise, nutritional supplementation, vitamin supplementation, comorbid optimization and smoking cessation. Participants were provided three units of HP ONS with HMB per day pre-operatively. The primary outcome was changes in intramuscular adipose tissue (IMAT) as a proxy of muscle quality, assessed using Artificial Intelligence (AI)-aided ultrasonography. Secondary outcomes include changes in anthropometric measurements and functional characteristics. Outcomes were measured before prehabilitation, after prehabilitation and 1 month post-operatively. Results: A total of 36 sarcopenic patients, with a median age of 71.5 years, were included in this study. There was an increase in the IMAT index after two weeks of prehabilitation (p = 0.032) to 1 month after surgery (p = 0.028). Among functional parameters, improvement was observed in gait speed (p = 0.01) after two weeks of prehabilitation, which returned to baseline post-operatively. The median length of hospital stay was 7 (range: 2–75) days. Conclusions: The increase in the IMAT index in a sarcopenic surgical cohort undergoing prehabilitation may be due to altered muscle metabolism in elderly sarcopenic patients. A prehabilitation regime in sarcopenic patients incorporating HP ONS with HMB and resistance exercise is feasible and is associated with increased gait speed.

Therapeutic vapes for smoking cessation and nicotine dependence

Therapeutic vapes for smoking cessation and nicotine dependence

Don't Forget the Humble Text Message: 25 Years of Text Messaging in Health.

Since the early studies exploring the use of SMS text messaging for health intervention, text messaging has played a pivotal role in the advancement of mobile health. As an intervention modality, text messaging has provided vital learnings for the design and delivery of interventions, particularly in low-resource settings. Despite the advances in technology over the last 25 years, text messaging is still being used in largely the same way to deliver health information, behavior change interventions, and support. The strong, consistent evidence for the benefits of this type of intervention has made text messaging a routine part of health interventions around the world. Key to its success is its simplicity, alongside the benefit of being arguably the most accessible form of consumer digital health intervention. Text message interventions are well suited for public health interventions due to their low cost, vast reach, frequent use, high read rates, and ability to be tailored and personalized. Furthermore, the nature of text messaging interventions makes them ideal for the delivery of multilingual, culturally tailored interventions, which is important in the context of increasing cultural diversity in many countries internationally. Indeed, studies assessing text message-based health interventions have shown them to be effective across sociodemographic and ethnic groups and have led to their adoption into national-level health promotion programs. With a growing focus on artificial intelligence, robotics, sensors, and other advances in digital health, there is an opportunity to integrate these technologies into text messaging programs. Simultaneously, it is essential that equity remains at the forefront for digital health researchers, developers, and implementers. Ensuring digital health solutions address inequities in health experienced across the world while taking action to maximize digital inclusion will ensure the true potential of digital health is realized. Text messaging has the potential to continue to play a pivotal role in the delivery of equitable digital health tools to communities around the world for many years to come. Further new technologies can build on the humble text message, leveraging its success to advance the field of digital health. This Viewpoint presents a retrospective of text messaging in health, drawing on the example of text message-based interventions for smoking cessation, and presents evidence for the continued relevance of this mobile health modality in 2025 and beyond.

A randomized trial for combination nicotine replacement therapy for smoking cessation among people with HIV in a low-resourced setting.

The purpose of this study was to evaluate the efficacy of combination nicotine replacement therapy (c-NRT) for smoking cessation among people with HIV (PWH) in South Africa. We conducted an open label, individually randomized clinical trial. Using a two-armed approach, PWH who smoke were randomized to receive either 1) intensive anti-smoking behavioral counseling (BC) or 2) intensive anti-smoking BC plus c-NRT (nicotine patches augmented by nicotine gum). Self-reported smoking abstinence was biochemically validated with exhaled breath carbon monoxide (CO) and urine cotinine at six months. Recruitment, provision of trial interventions, and follow-up of participants took place March 2014 through June 2016. We randomly assigned 280 participants to the BC arm and 281 participants to the BC + c-NRT arm. 438 (78%) participants were male and 123 (22%) were female. For our primary outcome of biochemically verified abstinence at six months, 41 (15%) were quit in the BC + c-NRT arm versus 28 (10%) in the BC arm, resulting in a 5% (95% CI -1%, 10%) absolute difference in relative risk and an adjusted odd ratio of 1.47 (95% CI: 0.86, 2.52) comparing the BC + c-NRT to the BC arm. Although our results did not reach statistical significance, we found augmentation of BC with c-NRT to increase smoking abstinence at six months, which is consistent with performance in the general population. PWH in low-resource settings may benefit from the addition of c-NRT to existing tobacco cessation interventions.

Insights into the paradoxical effect of smoking on vasculitis: a comprehensive review.

Vasculitis is a group of uncommon diseases characterized by inflammation of blood vessels, which contributes to the organ ischemia and damage. Cigarette smoke contains a high concentration of various toxins, which have the potential to affect the immune response and development of autoimmune/autoinflammatory rheumatic diseases including vasculitis. Smoking influences both innate and adaptive immune systems and plays binary functions in modulating immunity by either aggravating pathogenic immune responses or attenuating defensive immunity. Smoking contributes to the pathogenesis of autoimmune diseases by various mechanisms including induction of tissue damage and apoptosis, changes in innate immune function and production of proinflammatory cytokines, changes in humoral immunity and T cell responses and anti-estrogen effects. In this review, we considered the available evidence on the association between smoking with the risk, clinical manifestations, response to treatment and outcomes of vasculitis, and the effect of smoking cessation on these parameters. In conclusion, despite inconclusive evidence of an increased risk of giant cell arthritis and anti-neutrophil cytoplasmic autoantibody associated vasculitis (AAV) in smokers, there is strong evidence that smokers have a lower risk of Behcet's disease (BD). Furthermore, smoking changes the clinical picture and outcomes of BD and AAV.

Sun protection behaviors, healthcare access, and smoking among melanoma survivors.

Based on current clinical practice guidelines, melanoma survivors should be advised on the need for sun protection and regular healthcare, as well as smoking cessation, but differences from adults without cancer history are unclear. We pooled data from the National Health and Nutrition Examination Survey (2003-2006, 2009-2018), matching 249 melanoma survivors with 498 adults without a cancer history. Adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI) were calculated. One-third of melanoma survivors used multiple sun protection methods, slightly more than adults without cancer. Both groups had < 50% overall sun protection use with long sleeves being the least used. Melanoma survivors who were male (aPOR = 2.91; CI = 1.05-8.06) or had lower education (aPOR = 4.12; CI = 1.65-10.29) were more likely to be current smokers. Older survivors (aPOR = 1.07; CI = 1.03-1.11) were more likely to have health insurance. Our findings highlight the relatively low use of sun protective practices for melanoma survivors and suggest the need for better counseling on sun protection and smoking cessation, especially for lower education levels and males. These findings underscore the importance of enhancing counseling services for sun protection among melanoma survivors and prioritizing smoking cessation support, especially for males and individuals with lower education levels among this population.

Smoking-Related Tear Film Abnormalities and Dry Eye Disease: A Meta-Analysis

Dry eye disease (DED) is a prevalent ocular condition characterized by tear film instability and ocular surface inflammation. Smoking has been identified as a potential risk factor for DED, but the impact of different smoking modalities (active, passive, and e-cigarette) on tear film and DED remains unclear. This meta-analysis aimed to evaluate the association between various forms of smoking and tear film abnormalities leading to DED. A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for studies published between 2013 and 2024 investigating the effects of active smoking, passive smoking, and e-cigarette use on tear film parameters and DED diagnosis. Data extracted included tear film break-up time (TBUT), Schirmer's test results, tear osmolarity, and DED diagnostic criteria. Pooled effect estimates were calculated using random-effects models. Eight studies met the inclusion criteria, comprising 4 on active smoking, 2 on passive smoking, and 2 on e-cigarette use. Active smoking was significantly associated with reduced TBUT (standardized mean difference [SMD] = -2.87; 95% CI: -3.12 to -2.62; p&lt;0.00001), lower Schirmer's test scores (SMD = -2.79; 95% CI: -3.23 to -2.35; p&lt;0.00001), and increased tear osmolarity (SMD = 12.55; 95% CI: 8.17 to 16.93; p&lt;0.00001). Passive smoking and e-cigarettes showed a similar trend but with less pronounced effects. In conclusion, this meta-analysis provides evidence that active smoking significantly impairs tear film stability and contributes to DED. Passive smoking may also have detrimental effects, while the impact of e-cigarettes requires further investigation. These findings underscore the importance of smoking cessation in DED management and public health strategies for eye health.

Smoking status and edentulism among older Chinese: a cohort study.

The harmful impact of tobacco smoke on health is widely recognized, linking it to various diseases. However, the link between tobacco smoke and edentulism in China's population hasn't been fully investigated. This study aims to fill this gap by exploring smoking habits and the possible connection between tobacco smoke and edentulism in a nationally representative Chinese cohort. This study used data from the 2011 China Longitudinal Study of Health and Retirement (CHARLS) and included 17,705 participants aged 45years and older, and linked with follow-up data (2018). Smoking status (non-smoker, ex-smoker, smoker, pack-years of smoking, age at starting and ceasing smoking) was used as an independent variable, and edentulism was used as a dependent variable. Multivariable logistic regression analysis and curve fitting were used to evaluate the association between smoke status and edentulism. Subgroup analyses were then employed to examine the impact of subgroup factors on the link between smoking status and edentulism. A total of 13,720 people were included in the study, 2,029 of whom were edentulism patients. The association between smoking duration (OR = 1.038, 95%CI = 1.031, 1.045) /Age at quitting smoking (OR = 1.026, 95%CI = 1.013, 1.039)/Smoking pack years (OR = 1.005, 95%CI = 1.002, 1.007) and risk of edentulism was significant, while Age start smoking (OR = 1.003, 95%CI = 0.995, 1.012) and Cigarettes consumed per day (OR = 0.998, 95%CI = 0.991, 1.006) was not associated with risk of edentulism. Compared with non-smokers, current smoker had a higher risk of edentulism (OR 1.274, 95% CI = 1.108, 1.465). Additionally, our results also revealed that there was a nonlinear trend between Smoking duration/Cigarettes consumed per day/Age at quitting smoking/ Age at starting smoking/pack-years of smoking and edentulism (P > 0.05). The research found a significant link between smoking habits and edentulism in nationally representative Chinese population. This study in China found a complex link between tobacco use and tooth loss among middle-aged and elderly individuals, highlighting the need for personalized smoking cessation strategies to improve dental health in this population.