Metal exposure in heart disease.

Association of Smoking, Smoking Cessation, and Genetic Susceptibility With Chronic Kidney Disease Risk.

Tobacco-cannabis co-use is associated with increased psychosocial and health harms; however, the treatment literature assessing the impact of co-use has been mixed and suffers from critical limitations. To date, no prospective studies have evaluated the degree to which cannabis co-use affects tobacco cessation, nor are there treatment recommendations for those who co-use. The goal of this study was to evaluate and quantify the impact of cannabis co-use on tobacco cessation through a 12-week prospective tobacco cessation trial. This was a multi-site, non-randomized trial. Inverse probability weighted modified Poisson regression models were used to assess the probability of tobacco abstinence between tobacco-only and tobacco-cannabis co-use cohorts. Enrollment occurred at three sites across South Carolina, USA: The Medical University of South Carolina (MUSC) Charleston, Behavioral Health Services of Pickens County and MUSC Florence. Enrolled participants were adults (n = 181; ages 18-40) who (1) smoked tobacco cigarettes and used cannabis regularly (co-use cohort; oversampled) or (2) smoked tobacco cigarettes daily (tobacco-only cohort). Across 3 sites, 181 adults (110 co-using cannabis; 71 tobacco-only) were enrolled (49% female; 19% Black/African American; 6% Hispanic/LatinX). All participants received 12 weeks of first-line tobacco treatment (varenicline, incentives for tobacco abstinence, counseling), while cannabis use was not addressed as part of treatment. The primary outcome was biochemically confirmed 7-day point prevalence tobacco abstinence (PPA) at end of treatment (EOT; Week 12 post-enrollment). Average baseline reported cigarettes per day were not different between tobacco-only or cannabis co-use cohorts [14.9, (standard deviation, SD =7.2) versus 13.4 (SD =7.8); P = 0.25]. Among the co-use cohort, days of cannabis use in the past month at baseline was 23.7 (SD =9.5). In imputed analyses, EOT 7-day PPA tobacco abstinence was achieved in 59% of tobacco-only participants and 33% of the cannabis co-use cohort [Imputed data: relative risk (RR) =1.63, 95% confidence interval (CI) = 1.14-2.33]. Neither baseline daily cannabis use [adjusted relative risk (RRadj) =1.05, 95% CI= 0.63-1.77] nor within-treatment cannabis use frequency (RRadj=0.51, 95% CI = 0.25, 1.06) was associated with EOT PPA for tobacco in the cannabis co-use cohort. This is the first prospective study designed to compare tobacco cessation outcomes by cannabis co-use status. Regular cannabis co-use had a negative impact on tobacco abstinence among younger to middle-aged adults. Addressing cannabis use should be incorporated into standard tobacco treatment to improve cessation outcomes.

Tobacco smoking disproportionately affects people experiencing socioeconomic disadvantage. Improving access to effective smoking cessation programmes and medications is crucial to reducing this gap. Here, we report on a programme trialling the provision of free nicotine replacement therapy to priority populations through community pharmacies. This study evaluates the engagement and acceptability of this approach using a multiphase mixed methods design. Two groups were involved in the programme: community pharmacists (n = 8) and people who smoke cigarettes (n = 55). At the conclusion of the programme, 7 pharmacists and 10 smokers completed semi-structured interviews. Qualitative data collected through interviews were analysed using a hybrid approach of inductive and deductive thematic analysis. An inductive reflexive thematic analysis was performed first, followed by a deductive thematic analysis to code the data into the seven constructs of the Theoretical Framework of Acceptability. Analyses revealed pharmacists and smokers were mostly positive about the pilot programme. Although the burden was perceived to be considerable by pharmacists, and the self-efficacy and opportunity costs appear to have limited the engagement of some smokers in the programme. This evaluation provides insights into what works to support people from priority populations who want to quit smoking. It highlights that both engagement with and acceptability of smoking cessation support are influenced by practical considerations and the service setting. Furthermore, it highlights the important role that existing health destinations, such as community pharmacies, can play in the delivery of public health interventions.

Unsaturated fatty acids mediate the bidirectional link between psoriasis and depression: Evidence from observational and mendelian randomization studies.

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation. Despite the availability of comprehensive, evidence-based guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD), utilization of these recommendations remains limited in clinical practice. COPD contributes substantially to global morbidity, mortality, and economic burden and is projected by the World Health Organization to become the third leading cause of death worldwide by 2030. Early recognition and diagnosis, adherence to guideline-based pharmacologic management, smoking cessation, vaccination, and pulmonary rehabilitation are mainstay strategies to slow disease progression and prevent exacerbations. Understanding the pathophysiology and systemic complications is essential for improving outcomes and enhancing quality of life in patients with COPD.

Cancer survivorship is increasingly characterized by long-term treatment sequelae, including cardiometabolic disease, fatigue, sleep disturbance, psychological distress, and risk of second malignancies. As survivorship populations expand, there is growing recognition that traditional symptom-focused follow-up does not adequately address modifiable drivers of long-term morbidity. This review evaluates lifestyle medicine as a structured framework integrating physical activity, nutrition, sleep health, psychological well being, and substance cessation to improve survivorship outcomes across solid tumors and hematologic malignancies. Evidence from randomized trials, cohort studies, and consensus guidelines demonstrates that lifestyle interventions influence systemic inflammation, immune function, metabolic regulation, and functional capacity. Physical activity improves fatigue, cardiorespiratory fitness, and quality of life, while plant-forward dietary patterns are associated with improved survival outcomes. Sleep optimization and stress reduction interventions improve inflammatory signaling and psychological outcomes. Tobacco cessation and alcohol reduction reduce recurrence risk and mortality. Emerging literature highlights the relevance of cardiometabolic pathways and behavioral interventions as modifiable determinants of survivorship trajectories. Lifestyle medicine provides a biologically plausible and clinically actionable framework to address shared mechanisms underlying cancer recurrence, treatment toxicity, and chronic disease risk. Integration of multidisciplinary interventions and digital health tools may enable scalable survivorship models focused on prevention, functional recovery, and long-term health optimization. Future research should prioritize mechanistic studies and pragmatic trials evaluating multimodal interventions across diverse cancer populations.

How effective are national tobacco prevention and cessation campaigns in reaching youth? Population assessment of tobacco and health, Wave 7 insights.

Objectives. To examine the association between system alignment among Nurse-Family Partnership (NFP) home visitors and other community service providers and maternal behaviors and birth outcomes among NFP clients. Methods. NFP implementation data from 2015 to 2021 were matched to the 2018 to 2021 NFP Collaboration Panel Survey (n = 102 690). We used Poisson-based general estimating equations to examine a measure of cross-sector collaboration (based on relational coordination and structural integration) and the relationship with prenatal smoking cessation, breastfeeding, low birth weight, and preterm birth after adjustment for client-, nurse-, and agency-level covariates. Results. Stronger coordination with women's care providers (relative risk [RR] = 1.010; 95% confidence interval [CI] = 1.00, 1.02) and greater integration with mental health providers (RR = 1.002; 95% CI = 1.00, 1.00) were slightly positively associated with initiation of breastfeeding. The slight positive association with greater integration with mental health providers was sustained for continued breastfeeding at 6 months postpartum (RR = 1.004; 95% CI = 1.00, 1.01). System alignment was not related to prenatal smoking cessation, low birth weight, or preterm birth. Conclusions. Future implementation studies should explore whether strategies to increase system alignment result in changes in quantitative measures of cross-sector collaboration and meaningful improvement in maternal and child outcomes at a population level. (Am J Public Health. 2026;116(S3): S181-S191. https://doi.org/10.2105/AJPH.2026.308457).

Association of childhood maltreatment with risk of lung cancer: A mediation analysis from the UK biobank.

The association between neighborhood socioeconomic status and lung cancer incidence and mortality risk: A systematic review and meta-analysis of cohort studies from North America, Europe, and Asia.

Environmental and lifestyle factors affecting nickel concentrations in human colostrum: A cross-sectional study in Poznań, Poland.

The association between timing of tobacco smoking cessation and breastfeeding initiation.

While smoking is a well-established risk factor for various cardiovascular diseases, its association with intracerebral haemorrhage (ICH) remains controversial. Cerebral microbleeds (CMBs) are markers of haemorrhage-prone small vessel disease, but ICH can also occur without detectable CMBs. Therefore, we investigated the association between smoking and ICH according to CMB status. Single-centre retrospective case-control study. A tertiary stroke centre in Osaka, Japan (2017-2021). 487 patients with ICH as their first stroke (female sex 41.5%) and 322 controls with non-stroke neurological conditions (female sex 47.5%) were included. Patients with missing CMB evaluation or smoking status data were excluded. The primary outcome was ICH status, analysed according to CMB status, with current smoking as the primary exposure. Secondary analyses evaluated the association between smoking cessation duration and the odds of ICH, using current smoking as the reference. Patients with ICH (median age, 70.0 years; presence of CMBs, 53.6%) and controls (median age, 71.0 years; presence of CMBs, 13.4%) were analysed. Among individuals without CMBs, current smoking was more frequently observed in patients with ICH than in controls (25.7% vs 14.0%, p<0.001) and was independently associated with ICH following adjustment for potential confounders (adjusted OR (aOR) 1.84, 95% CI 1.02 to 3.31, p=0.042). Long-term smoking cessation (>10 years) was associated with lower odds of ICH than current smoking (aOR 0.31, 95% CI 0.14 to 0.67, p=0.003), whereas short-term cessation (≤10 years) showed no significant difference. Among individuals with CMBs, no significant association was observed between smoking status and ICH. Current smoking was associated with higher odds of ICH among individuals without CMBs, whereas long-term cessation was associated with lower odds. These findings suggest that the absence of CMBs should not be interpreted as the absence of modifiable ICH risk, highlighting the clinical relevance of smoking history in this population. NCT02251665.

BackgroundYoung-onset type 2 diabetes mellitus is associated with prolonged disease duration and early development of complications such as diabetic retinopathy. Smoking is a modifiable risk factor, but longitudinal evidence in this population remains limited.ObjectiveTo evaluate the association between long-term smoking and the risk of diabetic retinopathy, including earlier-occurring cases, in young-onset type 2 diabetes mellitus.MethodsThis retrospective cohort study used electronic medical records and a diabetic complication database from Pu'er People's Hospital, this retrospective cohort study included 488 patients aged 18-39 with type 2 diabetes (2023-2025) and no DR at baseline. Patients were followed from diabetes diagnosis until DR, last fundus exam, death, or June 30, 2025. Smoking status and cumulative exposure were assessed, and patients were followed until incident diabetic retinopathy or censoring. Kaplan-Meier analysis, Cox regression, restricted cubic splines, and sensitivity analyses were performed.ResultsDuring follow-up, 92 patients developed diabetic retinopathy, including 61 earlier-occurring cases. Smokers had a significantly higher cumulative incidence of diabetic retinopathy. Adjusted analyses showed that smoking was associated with increased risk of diabetic retinopathy (hazard ratio 1.78, 95% confidence interval 1.18-2.69) and earlier-occurring diabetic retinopathy (hazard ratio 1.92, 95% confidence interval 1.21-3.05). A nonlinear dose-response relationship was observed, with greater cumulative exposure associated with earlier onset.ConclusionLong-term smoking is associated with higher risk and earlier occurrence of diabetic retinopathy in young-onset type 2 diabetes mellitus, supporting early screening and smoking cessation strategies in this high-risk population.

Despite the availability of effective interventions for cancer prevention, Japan faces substantial evidence-practice gaps, such as in the low utilization of smoking cessation treatments, HPV vaccination, and cancer screening. Implementation research plays a critical role in bridging this gap by promoting the uptake of effective interventions in real-world settings. Globally, however, prioritization of the implementation of these various interventions remains unclear. To address this need, we conducted a structured priority-setting exercise using the CHNRI method and incorporating perspectives from diverse stakeholders, including citizens. We conducted a four-phase research prioritization process using the CHNRI method to identify which effective interventions for cancer prevention should be prioritized for implementation in Japan. The process included listing effective interventions for cancer prevention, surveying stakeholders, conducting a web-based survey among researchers, and calculating priority scores. Among 215 invited researchers, 92 (42.8%) and 67 (31.2%) researchers responded to the first and second surveys, respectively. In both surveys, physicians accounted for the largest proportion of respondents. Across both surveys, HPV vaccination for females, cervical cancer screening, fecal occult blood testing (FOBT), mammography, and tobacco control policies were identified as top priorities. Priorities for implementing effective interventions for cancer prevention were set through collaboration with researchers and citizens, providing a foundation for future research and progress.

Smoking is a modifiable risk factor for Alzheimer's disease, yet the temporal pattern of risk reduction following smoking cessation remains unclear. We investigated whether Alzheimer's disease risk declines according to the duration of sustained smoking cessation in a large nationwide cohort. Using the Korean National Health Insurance Service database (2002-2023), we identified 1,403,636 adults with stable longitudinal smoking patterns based on repeated biennial health examinations. Smoking status was classified as never smokers, current smokers, or sustained quitters, with cessation duration categorised into 2-year intervals (< 2, 2-3, 4-5, 6-7, ≥ 8 years). Incident Alzheimer's disease was defined as at least two separate NHIS insurance claims. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, adjusting for demographic, lifestyle, and metabolic factors. During a mean follow-up of 10.5 years, 58,519 incident Alzheimer's disease cases were identified. Compared with current smokers, sustained quitters exhibited progressively lower hazards of Alzheimer's disease with increasing duration of abstinence, demonstrating a dose-response pattern. Individuals who had quit for < 2 years showed a risk reduction relative to current smokers (adjusted HR 0.899; 95% CI 0.819-0.986), while those with ≥ 8 years of abstinence had substantially lower risk (adjusted HR 0.582; 95% CI 0.423-0.801). When referenced to never smokers, those with < 2 years of abstinence retained excess risk, whereas cessation for ≥ 2 years was associated with Alzheimer's disease risk approaching that of never smokers. Sustained smoking cessation was associated with a graded reduction in Alzheimer's disease risk, with approximately 2 years of abstinence needed to approach never-smoker risk.

Smoking cessation following a cancer diagnosis is critical for improving prognosis. For this reason, substantial efforts have been made to increase tobacco treatment in cancer care settings. The purpose of the present study is to provide an up-to-date estimate of tobacco/nicotine product use (inclusive of non-combustible products such as e-cigarettes and oral nicotine pouches) and cessation strategy uptake among individuals recently diagnosed with cancer. Data were derived from the Population Assessment of Tobacco and Health study, a large, nationally representative survey. Weighted frequencies estimated tobacco/nicotine product use (e.g., cigarettes, cigars, e-cigarettes, oral pouches) and cessation strategy prevalence (e.g., nicotine replacement therapies, prescription medications, e-cigarettes, oral pouches). Logistic regressions evaluated associations between cancer diagnosis and cancer type (e.g., tobacco related vs. non-tobacco related cancers) on tobacco use and cessation strategy outcomes. Individuals with cancer used tobacco/nicotine products at similar rates as those without cancer. Individuals with cancer were more likely to use evidence-based cessation strategies (e.g., pharmacotherapy and counseling; AOR=2.36 [95% CI 1.30-4.27], p<.01), but appeared less likely to successfully quit (17.27% [5.42-29.13]) with cancer quit vs 31.16% [28.39-33.93] without cancer). Similarly, those with tobacco-related cancers appeared to have higher engagement with cessation strategies (11.90% [5.95 - 17.84]) than those with non-tobacco-related cancers (2.35% [0.74 - 3.95]). Efforts to increase reach and access to evidence-based cessation support in cancer settings have been fruitful; however, more work is needed to improve treatment effectiveness. Continued monitoring of the use of non-combustible products is warranted.

Smokeless tobacco products and areca nut, widely used in Uttar Pradesh, are strongly associated with oral cancer, which ranks among the top three cancers in India. Data from the Population-Based Cancer Registry, Varanasi, highlights one of the highest oral cancer burdens across India. Despite the availability of national guidelines, frontline health workers (ASHAs) remain underutilised for tobacco cessation counselling and oral cancer symptom-based screening. This study assessed the impact of a structured training intervention on their knowledge, practices, and legal awareness. A pre-post intervention study was conducted in one rural block of Varanasi district between January and May 2023. A total of 202 ASHAs were enrolled through purposive sampling. The one-day training, based on Government of India modules, covered epidemiology, clinical features, determinants of tobacco use, cessation counselling, symptom-based oral cancer screening, and relevant legislation. Data were collected using a validated questionnaire before and after training. Descriptive statistics, Stuart-Maxwell tests, and Spearman's correlations were applied for analysis. Baseline scores revealed substantial knowledge and practice gaps: 45.6% of ASHAs had poor epidemiological awareness, 56.9% poor clinical knowledge, and 81.7% poor understanding of determinants of tobacco use. Only 19.8% reported routinely performing symptom-based screening for oral cancer, and while 64.8% "always" provided counselling, legal literacy was limited (only 38.1% aware of the COTPA Act). Following the intervention, significant improvements were observed across all domains (p < 0.01). Post-intervention most ASHAs reported willingness for oral cancer screening (64.8%) and provide tobacco cessation counselling (75.7%). Awareness of the COTPA Act increased to 65.4%. Strong positive correlations were observed between knowledge domains, suggesting synergistic gains. A structured, government-endorsed training programme significantly improved ASHAs' knowledge, attitudes, and practices related to tobacco cessation and oral cancer screening, demonstrating the feasibility of leveraging frontline workers for community-based cancer prevention. However, achieving higher competency levels requires more intensive, competency-based training with supportive supervision. Integration within routine health systems and further research on long-term impact are warranted. Trial registration Clinical Trials Registry India CTRI/2021/02/031306. Date of registration 16/02/2021.

Tobacco use increases risk for serious pregnancy complications, increasing infant and maternal morbidity and mortality. Cessation treatments are safe during pregnancy, increase the likelihood of successfully quitting, and decrease risk of negative neonatal health outcomes. All Florida Medicaid plans cover evidence-based cessation treatments. This study analyzed Medicaid claims to better understand cessation treatment utilization for pregnant people enrolled in Florida Medicaid. We analyzed Florida Medicaid claims from 2018-2021 to assess utilization of tobacco cessation services among Medicaid beneficiaries with a delivery during the study period. We identified tobacco use status and perinatal episodes using diagnostic and procedural codes; we identified treatment utilization (counseling, pharmacotherapy) using procedural and prescription drug claims. We identified 46 512 deliveries for people who use tobacco during the study period, making up 17.5% of all deliveries; among them, 6.3% received Medicaid covered tobacco cessation treatment during pregnancy and 2.4% postpartum. Among those treated, counseling was the most prevalent treatment during pregnancy (61.2%) and pharmacotherapy (NRT and cessation medication) was the most prevalent treatment (75.8%) postpartum. Best practices indicate that clinicians should ask pregnant patients about tobacco use at every visit, document their status, and offer brief counseling and cessation treatment. Despite cessation treatment coverage by Medicaid, our analysis indicates that few clinicians and beneficiaries are using Medicaid coverage for cessation treatment during the perinatal period. These findings suggest an opportunity to increase utilization of covered cessation services for individuals who use tobacco who are pregnant/postpartum, reducing risk factors for morbidity and mortality.