Onset Of Smoking Research Articles

Efficacy of digital interventions for smoking prevention among children: a systematic review

Abstract Background Smoking remains a leading preventable cause of morbidity and mortality globally, with initiation often occurring in childhood. Early smoking onset is linked to increased difficulty in quitting and higher risk of long-term health complications. Traditional prevention strategies have not fully succeeded in curbing youth smoking rates, highlighting the need for innovative approaches. Digital interventions (DI), such as gamified education, social media campaigns, and virtual reality, offer a novel avenue for engagement and education. This systematic review aims to assess the efficacy of DI in preventing smoking, and improving knowledge and awareness about smoking damages, among children. This review is part of the PRIN project, whose goal is to evaluate the effectiveness of a DI aimed at school-aged children, intended to increase knowledge about the negative effects of smoking and prevent its use. Methods On the 18th of March 2024, PubMed, Scopus, and PsycINFO were surfed for trials and observational studies evaluating DI for smoking prevention among children aged 6-12 years. Study quality will be evaluated using the Cochrane Risk of Bias Tool and New Castle-Ottawa scale. The protocol has been registered in PROSPERO. Results From 3,081 initially identified articles, 328 papers were removed because duplicate. The screening process is ongoing. Conclusions DI are a promising tool for engaging young populations through platforms they are familiar with and receptive to. By leveraging the high penetration of digital technology in the daily lives of children, these interventions have the potential to deliver smoking prevention messages in a compelling and interactive manner. Understanding the effectiveness of DI in smoking prevention can significantly contribute to public health by providing viable alternatives to traditional methods and potentially reducing future smoking-related health burdens. Key messages • Evaluating digital strategies for smoking prevention among children could offer vital alternatives to traditional methods, potentially reducing long-term health risks. • Digital interventions (DI) offer promising new ways to engage young audiences on smoking prevention using familiar platforms, potentially reshaping public health approaches.

A survey of smoking habits and perspectives in patients with hidradenitis suppurativa.

Patients attending the hidradenitis suppurativa (HS) clinic at our centre were surveyed about their smoking habits and their perspectives on the relationship between smoking and HS. We identified 27 patients with a smoking history, and age of onset of smoking preceded age of onset of HS in 81.5%, with an average time interval of 5 years. There were mixed patient perceptions on the role of smoking in HS, highlighting the need for more research in this area, and the importance of engaging and educating patients on the results of epidemiological studies in HS.

Exploring the link between sedentary behavior and cognitive decline: a comprehensive study combining Mendelian randomization and animal model experiments.

The causal link between detrimental behaviors and cognitive performance remains unclear. This research seeks to investigate the causal impact of adjustable lifestyle factors on cognitive deterioration, including frequency of alcohol intake, onset of smoking, and sedentary activities like prolonged television viewing. This research combines large-scale genetic data obtained from univariable and multivariable Mendelian randomization analyses with experimental findings obtained from animal models. Our findings reveal that the odds ratio (OR) for cognitive function deterioration was 0.445 (inverse variance weighted [IVW] 95% CI: 0.370 to 0.536, p < 0.001) for each standard deviation increase in television watching time. After adjustment for body mass index (BMI), number of days walked /moderate activity over 10+ min and education in Multivariable Mendelian Randomization (MVMR), only the genetic predisposition to increased television watching time remained significantly associated with worse cognitive function (OR 0.659, 95% CI: 0.452 to 0.960, p = 0.030). The other two habits had no significant effects. Sensitivity analyses have confirmed that genetic pleiotropy did not influence the results. To further explore the relationship between sedentary behavior and cognitive function, as well as the underlying mechanisms, we conducted a restricted cage housing experiment and a physical exercise training experiment in mice. The results showed that physical exercise significantly improved spatial memory, as assessed by the Morris water maze, and increased exploratory interest, as evaluated by the open field test (OFT) and the elevated plus-maze test, compared to the sedentary control group. These cognitive advantages may be mediated through mechanisms involving free radical scavenging and enhanced synaptic plasticity. Our research provides genetic evidence indicating that extended television viewing is linked to an elevated risk of cognitive decline. Additionally, experimental data from mouse models suggest that physical exercise can counteract cognitive decline and anxiety-like behaviors induced by sedentary behavior. This protective effect is likely mediated by reactive oxygen species (ROS)-dependent mechanisms that enhance synaptic plasticity within the hippocampus.

Smoking and cluster headache presentation and responsiveness to treatment

BackgroundThough an association between cluster headache (CH) and smoking has been postulated, data from the Middle East region is scarce.Aim of workTo study the relationship between smoking and CH clinical characteristics and responsiveness to therapy in Egypt.MethodologyThis was a prospective cohort hospital-based study conducted on patients with episodic and chronic CH in a tertiary headache clinic in Egypt during the period between 2019 and 2023. Patients were consecutively recruited at the time of their presentation and were followed up for two weeks after initiation of prophylactic treatment and steroids (as transitional therapy).ResultsOf 172 patients with CH recruited, 144 (83.7%) were smokers. Twenty-eight patients (16.3%) had chronic CH. The mean age was 42.08 ± 10.93 (20–66) years, and 131 (76.2%) were males. Smokers had a significantly higher median number of cluster bouts in the past five years (3.0 (IQR2.0–4.0) versus 2.0 (IQR 1.0–2.0)) and worse HIT-6 scores [51.0 (44.0–59.75) versus 41.0 (38.0–41.75)] than non-smokers (p < 0.001). The number of cluster bouts in the past five years was positively correlated with the smoking index (r = 0.249 (p = 0.006) and the smoking duration (in years) (r = 0.392 (p < 0.001)). HIT-6 scores were significantly correlated with the age at smoking onset (r=-0.190, = 0.023), smoking index (r = 0.519, p < 0.001), smoking duration (r = 0.611, p < 0.001), and number of cigarettes consumed per day (r = 0.392, p < 0.001).ConclusionSmoking is significantly correlated with the daily frequency of CH attacks, the frequency of CH bouts in the past five years, and the HIT-6 scores among our cohort.

Examining the onset and cessation patterns of active smoking among college students: an interpretative analysis

Smoking is a prevalent global issue, with a significant risk factor for various non-communicable diseases necessitating prolonged, costly, and potentially devastating medical treatments. In addition, infectious diseases such as tuberculosis, COVID-19, and pneumonia in toddlers are often associated with active and passive smoking habits. The correlation is evident across diverse demographics, encompassing individuals of varying ages, professions, and genders. Therefore, this research aimed to explore and describe behavior of active smokers among campus members at various universities, focusing on the initiation, cessation, and influencing factors associated with smoking.A qualitative research design was used with a hermeneutic phenomenological approach, where information was provided by five active smoker informants.These individuals started smoking as teenagers, and the fluctuating patterns were influenced by health concerns or a perceived lack of significance attributed to smoking. However, the periods of abstinence were only temporary due to the pervasive influence of social and environmental factors. The initiation of smoking commonly started from the influence of close acquaintances, such as family members. Meanwhile, the process of quitting encountered numerous obstacles, primarily from potent social factors outweighing personal intentions.The implementation of smoking cessation strategies posed challenges due to the profound impacts of addiction, requiring unwavering determination, comprehensive plans, and diligent efforts.

Combustible cigarette smokers versus dual combustible and electronic users: Evaluation of differences in anxiety, depression, and transdiagnostic constructs among Latinx adults

Research on dual combustible and electronic nicotine use among Latinx persons is needed to better understand patterns of use because this group is an established tobacco disparities population. Negative emotional symptoms and related processes (e.g., reactive transdiagnostic vulnerabilities) have been among the most prominent factors linked to the onset, maintenance, and relapse of smoking. As such, the current study sought to compare levels of mental health symptoms among combustible users compared to dual combustible and electronic users among Latinx persons who smoke. The current sample consisted of 297 adult Latinx daily cigarette smokers (Mage = 35.90 years; SD = 8.87; age range 18–61; 36.4% female), of which 92 reported current dual use of an e-cigarette (Mage = 33.34 years; SD = 7.75; age range 19–60; 28.3% female). Differences in anxiety, depression, anxiety sensitivity, emotion dysregulation, and distress tolerance were examined, and we hypothesized that dual users would showcase higher mental health problems. Results indicated that adult Latinx dual users evidenced greater levels of anxiety, depression, emotional dysregulation, anxiety sensitivity, and lower levels of distress tolerance compared to combustible users. The current study sheds light on the clinical importance of affective differences among dual versus combustible Latinx smokers.

Comparative analysis of the prevalence of smoking and consumption of nicotine-containing products and their risk factors among students of medical and technical universities of Saint Petersburg based on data from the PROTECT study

BACKGROUND: Taking into account the importance of quitting smoking of any nicotine-containing products by young people in various social groups, a comparative analysis of the prevalence of smoking tobacco and nicotine-containing products among students of medical and technical universities in St. Petersburg was carried out. AIM: To compare the prevalence and structure of consumption of tobacco and nicotine-containing products, as well as the smoking behavior of students at medical and technical universities. MATERIALS AND METHODS: A cross-sectional cross-sectional study of a random sample of student groups included 1,105 respondents. RESULTS: The prevalence of tobacco smoking among students at a technical university was 2 times higher than at a medical university (p 0.01). Cigarette smoking was also more often noted at the onset of smoking among engineering students and in their families (p 0.05). 17.2% of North-Western State Medical University named after I.I. Mechnikov students and 14.2% of Saint Petersburg Electrotechnical University “LETI” named after V.I. Ulyanov (Lenin) students consume nicotine-containing products. Men from the medical university smoke cigarettes significantly more often than women, or use nicotine-containing products, as well as a combination of both. No similar gender differences were found at the technical university. Female doctors used ES more often than women from a technical university at the beginning of smoking (p 0.05). Men at a medical university started using nicotine-containing products more often than women, considering them the least dangerous to health (p 0.05). The example of friends was the most common reason for starting smoking among respondents from both universities (43.9 and 30.8%, respectively). Common risk factors for smoking any product among students of North-Western State Medical University and LETI were boyfriend/girlfriend smoking, smoking among one’s immediate environment. Studying in senior years was a protective factor for girls at a medical university in comparison with students at a technical university (odds ratio 0.48). CONCLUSIONS: The data obtained on the lower prevalence of tobacco smoking among medical university students compared to technical students may indirectly indicate the latter’s insufficient knowledge about the harmful effects of tobacco smoking on the body. The high prevalence of nicotine-containing products consumption in universities of various fields of study and the lack of significant differences in the share of their consumers can also be interpreted as an underestimation of the health risks of new smoking products. This requires adjustments to educational programs in order to increase students’ awareness of the potential health hazards not only of smoking cigarettes, but also of using any nicotine-containing products.

Association between e-cigarette and conventional cigarette use among Spanish adolescents.

In recent years, studies have highlighted the upward trend in electronic cigarette use among adolescents, as well as the potential of e-cigarette use to lead to subsequent conventional cigarette use. The study's aims were two-fold: 1) to examine the progression from e-cigarette use to conventional cigarette use; and 2) to analyze the differences in the severity of smoking pattern among dual users (i.e., e-cigarette and conventional cigarette use), cigarette-only smokers, and e-cigarette-only users in a Spanish adolescent population. Data were obtained from the ESTUDES, a representative survey of addictive behaviors of Spanish adolescents aged 14-18, which was comprised of 38,010 adolescents (Mage = 15.69; SD = 1.19; 51.35% females). Results indicate that lifetime e-cigarette use increased the prevalence of subsequent conventional cigarette use by 1.86 times (95% CI 1.74, 1.99), and the prevalence of conventional cigarette use in the last month by 2.38 times (95% CI 2.19, 2.58), independently of whether the e-cigarette contains nicotine or not. Dual users showed a higher percentage of daily smokers, and a greater number of cigarettes per day, a higher use of e-cigarettes with nicotine, and an earlier age of smoking onset. Regarding risk perception, e-cigarette-only users perceived both conventional tobacco and e-cigarettes as less harmful (all p-values < .001). These findings document the strength of association between e-cigarette and conventional cigarettes, and underscore the importance of developing legal restrictions and prevention strategies aimed at reducing e-cigarette use, which in turn would reduce tobacco use.

Impact of demographic factors, comorbidities, and co‐medication on progression and survival in a large Chinese ALS cohort

AbstractObjectiveTo clarify the impact of specific risk/protective factors on the disease progression and survival in a large population of Chinese sporadic ALS (sALS) patients.MethodsWe investigated a cohort of 937 sALS patients prospectively. Uni‐ and multivariate regression analysis were performed to analyze the influence of demographic factors, comorbidities and medication on the progression and survival of ALS.ResultsOur results showed younger age of onset (p &lt; 0.05), long diagnostic delay (p &lt; 0.001) and intake of riluzole (p &lt; 0.001) were significantly related to low progression rate and long survival time. History of smoking (p &lt; 0.05) and bulbar onset (p &lt; 0.001) were risk factors for rapid progression and poor prognosis. Baseline ALSFRS‐R score (p &lt; 0.001) and total MRC score (p &lt; 0.05) were positively related to mean survival time of included patients. Neither comorbidities nor intake of antihypertensive drugs, antidiabetics, and statins as dependent variables showed considerable influence on ALS progression or survival.ConclusionOur study revealed early onset and long diagnostic delay were indicators of slow progression and long survival. Smoking and bulbar onset were risk factors for shorter survival times and abstaining from smoking was beneficial to patients with ALS in improving median survival time. Long‐term intake of riluzole should be recommended for affordable patients.

Opioid use disorders attributed to heroin and tramadol: sociodemographic and clinical similarities and differences

ABSTRACT Background and objective Tramadol misuse is a public health problem in Egypt. The objective of this study was to compare differences between patients with tramadol misuse and patients with heroin use regarding sociodemographic and clinical correlates. Methods This cross-sectional study included 58 consecutive male patients with heroin use and 37 male patients with tramadol misuse. Patients were assessed by a structural interview of SCID-I of DSM-IV-TR criteria for substance use disorders and comorbid psychiatric disorders. Patients were screened for drugs using a urine test. Results Patients with tramadol misuse were more likely to be older, to have higher education level, to be married and have a skilled profession than patients with heroin use. Patients with heroin use were more likely to have a higher smoking rate, younger age of onset of smoking, higher family history of substance use disorders, higher incarceration rate than patients with tramadol misuse. Conclusions Patients with tramadol misuse have more similarities than differences compared to patients with heroin use. Although tramadol has a dual mechanism of action and is seen as a molecule with low misuse potential it should be treated as an opioid use disorder.

Tobacco smoking and early onset cataracts

Background and Hypothesis:Cataracts are among the leading causes of blindness in the world. Smoking tobacco has been linked to cataract formation in old age. However, its linkage in causing an earlier onset is much more questionable. Assessing this linkage can help identify risk factors and help understand the causes and pathogenesis in development of cataracts over time. This can help direct modifiable risk factors in patients to prevent early deterioration in health, finance, physical capabilities, and overall comfort. It is hypothesized that history and intensity of smoking tobacco correlates with earlier onset cataracts.&#x0D; Experimental Design or Project Methods:Patient data of patients aged 40-65 were gathered from the last two years of cataract surgeries from Deen-Gross Eye Centers EMR (n=718). Age at date of surgery was used as observed value for determining earlier onset, and pre-operation charts were used to collect patient data on smoking status (light, someday, every day, heavy, former, never), age, gender, hypertension, diabetes, number of eyes operated on, family history (cataracts/glaucoma), and glaucoma. Statistical analysis was performed among the gathered data.&#x0D; Results:Statistical analysis revealed no significant difference in the ages of cataract surgeries between smokers and non-smokers. Controlling for non-hypertensive and non-diabetic patients revealed a similar result. There was no significant difference in smoking status between ages 40-55 and ages 56-65 who underwent surgery. There was no significant difference in age of surgery among each of the individual types of smokers.&#x0D; Conclusion:No significant associations were found. This calls for further research to better understand the linkage between tobacco smoking and cataracts, as well as the pathogenesis of earlier onset cataracts. No modifications in directing patient care can be made yet.

Childhood Cigarette Smoking and Risk of COPD in Older United States Adults: A Nationally Representative Replication Study.

A recent study found that the prevalence of COPD is significantly higher among adults who began smoking cigarettes before (vs after) 15 years of age, independent of current smoking, cigarette pack-years, and smoking duration. The current analysis went a step further to also account for second-hand smoke exposure, using data from U.S. adults aged 40+ years during Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study. Adults who had ever smoked cigarettes were asked at what age they began smoking fairly regularly. Multivariable Poisson regression assessed risk of self-reported COPD diagnosis due to childhood smoking (<15 years), adjusting for current smoking, cigarette pack-years or smoking duration, second-hand smoke exposure, and sociodemographic covariates. Overall, 13.4% reported that they had COPD. COPD prevalence was 7.5% for adults who never smoked compared to 29.0% and 21.1% for smoking onset at age <15 and 15+ years, respectively. Adults who initiated smoking at <15 (vs 15+) years had higher prevalence of current smoking (45.9% vs 33.3%), longer smoking duration (mean 34.2 vs 27.3 years), greater cigarette pack-years (mean 48.8 vs 30.8), and greater second-hand smoke exposure (p's<0.05). In multivariable analysis, the relative risk for COPD for smoking onset <15 (vs 15+) years of age was 1.27 (95% confidence interval [CI]=1.06, 1.51). The increased risk of COPD due to childhood smoking was independent of cigarette pack-years, smoking duration, second-hand smoke exposure, and current smoking. Findings give further evidence of increased COPD risk related to childhood smoking.

Relationship between mood disorders and substance involvement and the shared genetic liabilities: A population-based study in Taiwan

BackgroundThis study explored the phenotypic association of mood disorders, including major depressive disorder (MDD) and bipolar disorder (BPD), with a range of substance involvement, including lifetime experience and age at initiation of tobacco, alcohol, and betel nut use. Additionally, we elucidated polygenic risk score (PRS) association. MethodsIn total, 132,615 community participants were recruited from the Taiwan Biobank. Genome-wide genotyping data were available for 106,806 unrelated individuals, and the PRS for MDD and BPD was calculated. The significance of mood disorders and PRSs associated with substance involvement were evaluated using a linear/logistic regression model with adjustment for potential confounders. Sex differences were assessed. ResultsMDD and BPD were associated with regular alcohol consumption, drinking cessation, tobacco smoking, smoking cessation, betel nut chewing, and earlier onset of drinking. BPD was associated with an earlier onset of smoking. MDD PRS was associated with regular alcohol use (odds ratio [OR] per standard deviation increase in PRS = 1.03, p = 0.018), alcohol cessation (OR = 1.05, p = 0.03), regular tobacco use (OR = 1.08, p < 0.0001), and betel nut chewing (OR = 1.06, p < 0.0001), whereas BPD PRS was not associated with substance use. Phenotypic association strengths between MDD/BPD and regular drinking/smoking and the polygenic association between MDD PRS and regular smoking were larger in females than in males. LimitationsRetrospective self-reported MDD/BPD diagnoses and substance involvement. ConclusionsMood disorders were associated with a range of substance involvement. Shared genetic architecture contributed to the co-occurrence of MDD and substance involvement. These findings may help design prevention and cessation strategies for substance use.

Onset and Cessation of Smoking: Temporal Dynamics and Racial Difference in Educational Smoking Disparities among Women

Onset and Cessation of Smoking: Temporal Dynamics and Racial Difference in Educational Smoking Disparities among Women

Teacher's Perspectives About Tobacco Consumption and Its Prevention Among Students From Western Maharashtra, India: A Qualitative Study.

Background Teachers are role models for students and influential members of society. They are capable of influencing social norms related to tobacco control among students. This background study was planned to understand teachers' opinions and views about factors influencing tobacco use and prevention strategies being used. Methodology We conducted qualitative research on teacher's opinions about tobacco use among students. We chose focus group discussion as our data collection method, as we wanted to observe their personal views on social norms. We involved 70 high school teachers in our study from the Akola district. The data collected from the teachers were organized into various themes interrelated to the objectives. Results The majority of teachers mentioned that the reason for tobacco consumption among children was peer pressure, from observations of older individuals in society, and from TV serials. Some teachers suggested that proper counseling and telling them about the harmful effects of tobacco are useful for prevention. Tobacco's harmful effects and its prevention strategies were not included in the standard curricula of students, which is one of the key barriers. Conclusions There is a need to implement school-based tobacco prevention education programs to reduce the early onset of smoking among students. School authorities must implement the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act, 2003 effectively with the help of the police to prohibit tobacco use among teachers and students.

How Do Adolescent Smoking Prevention Interventions Work in Different Contextual Settings? A Qualitative Comparative Study Between the UK and Colombia

BackgroundAdolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings.MethodA comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11–15 years). The Theoretical Domains Framework guided a content analysis of the data.ResultsWe found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape.ConclusionThese findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping.

Adverse childhood experiences and early initiation of substance use: A survival analysis.

Early adversity, such as adverse childhood experiences (ACEs), is a risk factor for the development of substance use disorder (SUD). ACEs are associated with earlier initiation of substance use. This study examined the relationship between ACEs and age of initiation of substance use using survival analysis. It is hypothesized that individuals with higher ACEs will have an earlier age of initiation. Participants were recruited from the University of Kentucky's Laboratory for Human Behavioral Pharmacology. Participants were 18 years or older, English speaking, and actively engaged in substance use. Participants were not in substance abuse treatment nor were they seeking treatment. ACE scores were calculated, and age of substance use initiation was recorded. A Cox proportional hazard model was used to examine the effect of ACE score on age of substance use initiation. A total of 107 participants completed the study. An average number of 2.3 ACEs (SD = 2.2) were endorsed with 24% of participants reporting 4 or more ACEs. Higher ACE scores were associated with cigarette smoking and non-medical prescription opioid use onset ( hazard ratio (HR) = 1.14, 95% CI=1.02-1.28, p = 0.02, and HR=1.19, 95% CI = 1.04-1.37, p = 0.01, respectively. A significant association was found between higher ACE scores and earlier initiation of cigarette and non-medical prescription opioid use, consistent with prior research. Primary prevention of ACEs, screening for ACEs during childhood, and interventions for ACEs if detected, may help to reduce the risk of substance use/SUD in adulthood.

Association between premature onset of chondrodermatitis nodularis helicis and tobacco smoking (in adults

Association between premature onset of chondrodermatitis nodularis helicis and tobacco smoking (in adults <61 years): results of a multicentric, case-control retrospective study.

Survey of the Relationship between Age of Smoking Onset and Risk-Taking Behaviors among University Students: A Web-Based Study

Background. Smoking at a younger age puts people at greater risk for health damage. This study aimed to investigate the relationship between the age of smoking onset and high-risk behaviors such as smoking, alcohol consumption, substance abuse, and high-risk sexual behavior among university students in Tabriz, Iran. Methods. This web-based, cross-sectional study was conducted in Tabriz, Iran, in 2019. A total of 3,649 students were included in the study according to the proportion of students in each university. The required information was collected through an online questionnaire. Logistic regression analysis was used to assess the relationship between the age of smoking onset and high-risk behaviors. Results. The mean (standard deviation) age of the participants in the study was 22.85 (3.66) years old, and 55.7% were boys. The findings of the study indicate that students who initiated smoking at the age of 16 or younger exhibited higher likelihoods of alcohol consumption over the previous 30 days (OR= 1.77, CI 95%: 1.20 - 2.62) and participation in unsafe sexual practices (OR= 1.54, CI 95%: 1.06 - 2.26) compared to their non-smoking counterparts. Conclusion. Early smoking onset is associated with high-risk behaviors. The age of onset of smoking should be considered as one of the factors associated with high-risk behaviors, and smoking prevention programs should be started from adolescence.

Childhood Cigarette Smoking and Risk of Chronic Obstructive Pulmonary Disease in Older U.S. Adults.

Rationale: It is not certain the extent to which childhood smoking adds chronic obstructive pulmonary disease (COPD) risk independent of lifetime cigarette exposure. Objectives: We examined the association between age started smoking cigarettes regularly, current smoking status, smoking history, and risk of COPD. Methods: Cross-sectional survey of U.S. adults ⩾40 years old in the 2020 National Health Interview Survey. Respondents who were ever cigarette smokers were asked when they began smoking regularly. Multivariable analysis assessed self-report of COPD diagnosis as a function of age started smoking (<15 yr vs. ⩾15 yr) adjusting for current smoking, cigarette pack-years, and covariates. Measurements and Main Results: Overall, 7.1% reported that they had COPD, 2.6% for never-smokers compared with 23.1% and 11.6% for smoking onset <15 and ⩾15 years, respectively. Persons who began smoking regularly at <15 years of age had higher pack-years of smoking (median, 29 vs. 15, respectively), and higher smoking intensity (median, 20 cigarettes/d for <15 yr vs. 10 cigarettes/d for ⩾15 yr for current smokers). In the multivariable analysis, the relative risk for COPD among childhood smokers was 1.41 (95% confidence interval, 1.22-1.63) compared with later-onset smokers. Substituting smoking duration for pack-years confounded the association between current smoking and COPD but did not change the childhood smoking estimate. In a stratified analysis, higher risk for childhood smoking was found at all current smoking intensity levels. Conclusions: Among adults aged ⩾40 years, one-fifth of childhood smokers have COPD. Lifetime cigarette smoking explained some but not all of the higher risk. If replicated, this suggests a lung development window of enhanced vulnerability to cigarette smoking.