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Background: Vaping prevalence has increased rapidly in England since 2021. This study estimated trends between 2013 and 2024 in vaping among ex-smokers, overall and among those who did not use e-cigarettes to support their quit attempt. Methods: Data were collected via nationally-representative, monthly cross-sectional surveys in England, October 2013 to May 2024. We analysed data from 54,251 adults (≥ 18y) who reported having tried to stop smoking in the past year or having stopped smoking more than a year ago. Logistic regression estimated associations between time and e-cigarette use. Results: Across the period, there were increases in the use of e-cigarettes to support attempts to stop smoking (from 26.9% [24.0–30.0%] in October 2013 to 41.4% [37.7–45.2%] in May 2024), in current vaping among ≥ 1y ex-smokers (1.9% [1.5–2.5%] to 20.4% [18.7–22.2%]), and in late uptake of vaping after smoking cessation (i.e., current vaping among people who quit smoking before e-cigarettes started to become popular in 2011; 0.4% [0.2–0.8%] to 3.7% [2.8–4.9%]). These increases were non-linear, with much of the difference occurring since mid-2021, and were greatest at younger ages (e.g., current vaping among ≥ 1y ex-smokers reached 58.9% among 18-year-olds vs. 10.7% among 65-year-olds). Conclusions: Vaping prevalence increased substantially among adult ex-smokers in England over the past decade, particularly at younger ages. While this is likely to have been largely driven by increased use of e-cigarettes in quit attempts and continued use thereafter, there was also evidence of increased uptake of vaping among those who had been abstinent from smoking for many years. [ABSTRACT FROM AUTHOR]

Background There is a strong correlation between cigarette smoking and the development of many cancer types. It is therefore paradoxical that multiple reports have suggested a reduced incidence of melanoma in smokers. This study aimed to analyze all existing studies of melanoma incidence in smokers relative to nonsmokers. Methods Searches of MEDLINE and Embase were conducted for studies reporting data on melanoma in smokers and never-smokers. No study design limitations or language restrictions were applied. The outcome examined was the association between smoking status and melanoma. Analyses focused on risk of melanoma in smokers and never-smokers generated from multivariable analyses, and these analyses were pooled using a fixed-effects model. Risk of bias was assessed using the Newcastle-Ottawa tool. Results Forty-nine studies that included 59 429 patients with melanoma were identified. Pooled analyses showed statistically significant reduced risks of melanoma in male smokers (risk ratio [RR] = 0.60, 95% confidence interval [CI] = 0.56 to 0.65, P  < .001) and female smokers (RR = 0.79, 95% CI = 0.73 to 0.86, P  < .001). Male former smokers had a 16% reduction in melanoma risk compared with male never-smokers (RR = 0.84, 95% CI = 0.77 to 0.93, P  < .001), but no risk reduction was observed in female former smokers (RR = 1.0, 95% CI = 0.92 to 1.08). Conclusions Current smokers have a statistically significant reduced risk of developing melanoma compared with never-smokers, with a reduction in melanoma risk of 40% in men and 21% in women. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate which of two short questionnaires, the Asthma Control Test (ACT) or the COPD Assessment Test (CAT), correlates better with severity variables and whether they share similar determinants in patients with asthma–COPD overlap. Method: This observational, cross-sectional, multicentric study included smokers and former smokers of more than 10 pack-years, with non-fully reversible airflow obstruction and either a concomitant diagnosis of asthma or signs of type 2 inflammation, from 15 centres in Spain. Results: A total of 157 patients were included, 109 (69.4%) were men, the mean age was 63.3 (SD: 9) years and the mean FEV1 (%) was 59.7% (SD: 20.5%). The mean CAT score was 14.5 (SD: 8.7), and the mean ACT score was 17.9 (SD: 5.2). Both scores showed good correlations (r = 0.717; p < 0.001). In the multivariate analysis, the Hospital Anxiety and Depression Scale and mMRC dyspnoea scores were independently and significantly associated with both the CAT and ACT scores; however, age was only significantly associated with the CAT, and the EQ-5D scores and the number of exacerbations in the previous year were only significantly associated with the ACT scores. The ACT had a slightly better predictive value for exacerbations than the CAT (AUC = 0.70 (95% CI: 0.62 to 0.79 vs. 0.65 (95% CI: 0.56 to 0.74))). Conclusions: There is a good correlation between ACT and CAT scores in patients with ACO. However, severe patients scored worse on the CAT than the ACT. Anxiety, depression and dyspnoea were significantly associated with both the CAT and ACT scores. The ACT was a slightly better predictor of exacerbations than the CAT in this population. [ABSTRACT FROM AUTHOR]

This is the first study aimed to detect morphological abnormalities in vivo in the skin capillaries of amyotrophic lateral sclerosis patients (ALS). Videocapillaroscopy assessed subungueal capillaries in 28 ALS patients (cases) and 35 controls (p = 0.42). The mean age was 61.46 and 61.23 years, respectively (p > 0.99). No statistically significant differences were observed between the groups regarding dominant hand, arterial hypertension, dyslipidemia, diabetes mellitus, active smoker, and former smoker variables. 78.57% of cases had spinal onset and 21.43% bulbar. The median disease duration (time between the onset of symptoms and the date of videocapillarscopy) was 29.71 months. Dilated capillaries were detected in 17.8% of cases and 11.43% of controls (p = 0.49). The median of capillary diameter in cases was 10.15 µm and 8.72 µm in controls (p = 0.011). 35.71% of cases and 2.86% of controls had severe capillary tortuosities (p < 0.001). Ramified capillaries were observed in 46.43% of cases and 11.43% of controls (p < 0.002). Micro-hemorrhages were only observed in 10.71% of cases. No significant correlations were observed between disease duration and dilated capillaries, tortuosity, ramified capillaries, and micro-hemorrhages. The present in vivo study shows abnormalities in the skin capillaries of ALS patients that do not depend on disease duration. [ABSTRACT FROM AUTHOR]

Background: Dual bronchodilator therapy, consisting of a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), has proven effective for patients with chronic obstructive pulmonary disease (COPD). However, it remains uncertain whether there are efficacy differences between current and former smokers with COPD. This study aims to explore the effectiveness of LABA/LAMA therapies in both these groups. Methods: The TOReTO trial assessed lung function, symptoms, health status, the occurrence of exacerbations, clinically significant exacerbations, and the use of LABA/LAMA therapies. These therapies include Tio/Olo, umeclidinium/vilanterol (Umec/Vi), and umeclidinium/vilanterol (Umec/Vi) are used in patients with COPD. The study examined the differences in outcomes between current and former smokers. To balance the baseline characteristics, propensity score matching (PSM) was employed. Results: Data from 967 patients were collected. After PSM, the time to the first acute exacerbation in current smokers was analyzed separately for the three treatment groups and was significantly different between them (p = 0.0457). Among, there are differences in the occurrence of acute exacerbation between treatment and smoking status in Umec/Vi (p = 0.0114). There is no significant difference in the treatment of former smokers among the three different groups of LABA/LAMA fixed-dose combinations (p = 0.3079). COPD-related symptoms remained stable throughout the treatment period. There were no significant differences in symptom scores, including CAT and mMRC, among the three groups at the end of the study. Conclusions: The three fixed-dose combinations of LABA/LAMA showed no difference in reducing exacerbations in former smokers but did show differences in current smokers. This trend has clinical significance, and future research will be conducted to control influencing variables to validate this point. However, due to the non-randomized study design, these findings should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Background: Earlier studies suggested a potential association between tobacco smoking and nickel sensitization, but little is known about other contact allergens. Objectives: To investigate the association of smoking status and contact sensitizations as well as subtypes of dermatitis, and to analyse the sensitization profiles of tobacco smokers. Patients and Methods: Within the Information Network of Departments of Dermatology (IVDK), we performed a cross‐sectional multicentre pilot study comprising 1091 patch‐tested patients from 9 departments, comparing 541 patients with a history of cigarette smoking (281 current and 260 former smokers) with 550 never‐smokers. Results: We could not confirm the previously reported association between nickel sensitization and tobacco smoking. Moreover, sensitizations to other allergens, including colophony, fragrance mix I, Myroxylon pereirae and formaldehyde, were not increased in cigarette smokers compared with never smokers. Hand dermatitis (50.6% vs. 33.6%) and occupational cause (36.2% vs. 22.5%) were significantly more frequent among cigarette smokers compared with never‐smokers as shown by non‐overlapping 95% confidence intervals. Conclusions: Although our study does not allow a firm conclusion on whether smoking status contributes to certain contact sensitizations, it confirms an association of smoking with hand dermatitis and occupational cause. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo systematically assess the association between cigarette smoking and development of Primary Open Angle Glaucoma (POAG) in the general adult population. Heterogeneity will be explored appropriately.Outcomes of glaucoma, OAG and POAG were explored in adults who were current, former, and never cigarette smokers. An additional category of ‘smokers with “any” smoking status’ was used where former smokers were not clearly distinguished from current and never smokers and in smokers whose form of smoking was not defined. All studies were observational and there was no limit to time period. Databases used were MEDLINE, Embase, Global Health and Web of Science. Study quality was assessed using the JBI critical appraisal tool. The DerSimonian-Laird random-effects model and weighting method was applied for meta-analysis with subgroup and sensitivity analyses along with meta-regression.Four cohort, six cross-sectional and nine case–control studies were included. Only one cohort study attained a low risk of bias (RoB), two cohort studies were of medium RoB and the rest of the studies were of high RoB. There was no evidence for an association between smoking statuses: current smoking: OR 0.96, 95%CI (0.76,1.21), former smoking: OR 0.96, 95%CI (0.83,1.11), smoking (any): OR 1.48, 95%CI (0.96, 2.29) and glaucoma. Sensitivity analyses did not have a material impact on findings. Heterogeneity was not explained by smoking status, study quality, smoking exposure, and glaucoma outcome criteria.This review suggests no evidence for an association between cigarette smoking and the development of POAG. There was no evidence that current, former, and general smoking increased the risk of glaucoma. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence To identify risk factors associated with increased postoperative opioid consumption and inferior pain outcomes following knee and shoulder arthroscopy.Using the data set from the NonOpioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) trial, eight prognostic factors were chosen a priori to evaluate their effect on opioid consumption and patient‐reported pain following arthroscopic knee and shoulder surgery. The primary outcome was the number of oral morphine equivalents (OMEs) consumed at 2 and 6 weeks postoperatively. The secondary outcome was patient‐reported postoperative pain using the Visual Analogue Scale (VAS) at 2 and 6 weeks postoperatively. A multivariable linear regression was used to analyse these outcomes with eight prognostic factors as independent variables.Tobacco usage was significantly associated with higher opioid usage at 2 (p < 0.001) and 6 weeks (p = 0.02) postoperatively. Former tobacco users had a higher 2‐week (p = 0.002) and cumulative OME (p = 0.002) consumption compared to current and nonsmokers. Patients with a higher number of comorbidities (p = 0.006) and those who were employed (p = 0.006) reported higher pain scores at 6 weeks. Patients in the ‘not employed/other’ category had significantly lower pain scores at 6 weeks postoperatively (p = 0.046).Former smoking status was significantly associated with increased post‐operative opioid consumption following knee and shoulder arthroscopy at 2 and 6 weeks postoperatively. Increased pain was found to be significantly associated with employment status and an increasing number of comorbidities at 6 weeks postoperatively. These findings can aid clinicians in identifying and mitigating increased opioid utilization as well as worse pain outcomes in high‐risk patient populations.Level III, cohort study. [ABSTRACT FROM AUTHOR]

Introduction: While indoor smoking restrictions are common, outdoor restrictions are still rare. We explored opinions and support for regulating smoking in different indoor and outdoor environments among adults who smoke and those who recently quit smoking, in Spain. Methods: The 2021 ITC EUREST-PLUS Spain Survey is a cross-sectional study conducted among a nationally representative sample of 1006 adults aged ≥18 years who smoked cigarettes (n=867) or had recently quit smoking (n=139). Using Poisson regression with robust variance, we estimated adjusted prevalence and prevalence ratios of favorable opinions on regulating smoking in different indoor and outdoor environments and support for regulation in unregulated outdoor environments, by sociodemographic and smoking-related characteristics. Results: There were highly favorable opinions for regulating smoking in places with minors (>95% in primary and secondary playgrounds, and cars with preschool children and minors) and outdoor transportation (60–80%). There were less favorable opinions for regulating smoking in outdoor terraces of bars/pubs and restaurants (15–20%). Support for further total outdoor regulations on smoking was moderate for markets/shopping centers, public building entrances and swimming pools (40–60%), and low for restaurants/bars/pubs (29.2%). Having quit smoking, having no significant others who smoke and/or believing that cigarette smoke is harmful to others, were factors positively associated with favorable opinions and support for regulating smoking. Conclusions: The settings in Spain with the most favorable opinions for regulation among adults who smoke and have recently quit smoking are places with minors, private cars with others and outdoor areas of public transportation, while the settings with the least favorable opinions were outdoor terraces of bars, pubs, and restaurants. Support for further total outdoor smoking bans is generally moderate, but low for restaurants, bars, and pubs. Overall, these findings suggest the feasibility of extending smoke-free policies to other public and private settings to protect others from tobacco smoke exposure. [ABSTRACT FROM AUTHOR]

Introduction: Muscle strength is known to play an important role in the health of older adults. The health burden of cigarette smoking among older adults remains significant. We investigated the association between smoking cessation and dynapenia among older lifetime smokers in Korea. Methods: This study is a secondary dataset analysis of cross-sectional data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016– 2019. We included 1450 participants aged 65–79 years, excluding those who had never smoked. Dynapenia was defined as grip strength <28 kg for men and <18 kg for women based on the Asian Working Group for Sarcopenia 2019 criteria. Multivariable logistic regression analysis evaluated the association between smoking cessation and dynapenia. Results: Compared with current smokers, the adjusted odds ratio (AOR) of dynapenia in former smokers was 0.66 (95% CI: 0.44–0.99). The AORs for smoking cessation periods of ≤10 years, 10–20 years, 20–30 years, and >30 years were 0.67 (95% CI: 0.39–1.16), 0.61 (95% CI: 0.36–1.03), 0.65 (95% CI: 0.37–1.14), and 0.52 (95% CI: 0.25–1.06), respectively. The AOR for dynapenia significantly decreased with the years since smoking cessation (p for trend=0.043). Conclusions: Our findings suggest that smoking cessation can reduce the likelihood of dynapenia among older lifetime smokers, with a decreasing likelihood trend associated with longer cessation periods. [ABSTRACT FROM AUTHOR]

Visceral adiposity index (VAI) is a reliable indicator of visceral adiposity. However, no stu-dies have evaluated the association between VAI and DKD in US adults with diabetes. Theref-ore, this study aimed to explore the relationship between them and whether VAI is a good pr-edictor of DKD in US adults with diabetes. Our cross-sectional study included 2508 participan-ts with diabetes who were eligible for the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. Univariate and multivariate logistic regression were used to an-alyze the association between VAI level and DKD. Three models were used to control for pot-ential confounding factors, and subgroup analysis was performed for further verification. A tot-al of 2508 diabetic patients were enrolled, of whom 945 (37.68%) were diagnosed with DKD. Overall, the VAI was 3.36 ± 0.18 in the DKD group and 2.76 ± 0.11 in the control group. VAI was positively correlated with DKD (OR = 1.050, 95% CI 1.049, 1.050) after fully adjusting for co-nfounding factors. Compared with participants in the lowest tertile of VAI, participants in the highest tertile of VAI had a significantly increased risk of DKD by 35.9% (OR = 1.359, 95% CI 1.355, 1.362). Through subgroup analysis, we found that VAI was positively correlated with the occurrence of DKD in all age subgroups, male(OR = 1.043, 95% CI 1.010, 1.080), participants wit-hout cardiovascular disease(OR = 1.038, 95% CI 1.011, 1.069), hypertension (OR = 1.054, 95% CI 1.021, 1.090), unmarried participants (OR = 1.153, 95% CI 1.036, 1.294), PIR < 1.30(OR = 1.049, 95% CI 1.010, 1.094), PIR ≧ 3 (OR = 1.085, 95% CI 1.021, 1.160), BMI ≧ 30 kg/m2 (OR = 1.050, 95% CI 1.016, 1.091), former smokers (OR = 1.060, 95% CI 1.011, 1.117), never exercised (OR = 1.033, 95% CI 1.004, 1.067), non-Hispanic white population (OR = 1.055, 95% CI 1.010, 1.106) and non-Hipanic black population (OR = 1.129, 95% CI 1.033, 1.258). Our results suggest that elevated VAI levels are closely associated with the development of DKD in diabetic patients. VAI may be a simpl-e and cost-effective index to predict the occurrence of DKD. This needs to be verified in furt-her prospective investigations. [ABSTRACT FROM AUTHOR]

Objective: Türkiye is the leading country that has been applying the MPOWER criteria of the World Health Organization for years. However, the prevalence of smoking among nurses appears to be high, according to the literature. Therefore, we aimed to determine the prevalence, addiction levels, and dynamics of tobacco smoking among nurses in Türkiye. Method: In this descriptive cross-sectional study, a questionnaire (prepared in cooperation with the "World Health Organization") and the Fagerström Test for Nicotine Dependence were administered to 529 nurses working at a tertiary-care university hospital in 2020. Logistic regression was performed to determine factors predicting smoking. Results: The prevalence of smoking among nurses was 32.7% (n = 173). The mean Fagerström test score indicated a "low dependence" level (score: 3 ± 2.6). Both results were higher for males. A relationship was found between trying smoking cigarette and hookah. Of the "current smokers" group, 102 (60.4%) stated that they wanted to quit smoking. Only 21 (27.6%) of the nurses who have tried to quit smoking thus far have received professional help. Conclusion: The prevalence of smoking among nurses working at a tertiary-care university hospital was relatively low compared to that among nurses in Türkiye. While females are normally expected to smoke less, the high prevalence of smoking among nurses (most of them female) raises the question of the professional basis of this situation. However, the low rate of receiving professional help reveals the lack of promotion and accessibility of smoking cessation outpatient clinics in the faculty environment. Finally, the perception that hookah is an alternative tobacco product leads to cigarette smoking. The good news was that nurses had a low dependency rate. [ABSTRACT FROM AUTHOR]

Introduction: Smoking among medical, dental, and pharmacy students is an issue in every university worldwide, which will impact future smoking cessation services as they are future healthcare providers. This study investigates the smoking prevalence, exposure to secondhand smoke, and factors associated with smoking among medical, dental, and pharmacy students at a public university in Malaysia. Methods: The self-administered online survey utilized in this cross-sectional study was derived from the Global Health Professions Students Survey (GHPSS), which involved medical, dental, and pharmacy students. A total of 328 participants completed a questionnaire from June to August 2022, with a response rate of 91.1%. Results: The overall smoking prevalence was 4.6% among the medical, dental, and pharmacy students who participated in this study; 46.7% of current smokers were exposed to secondhand smoke at home compared to 17.6% of non-smokers (p=0.011); and 66.7% of smokers were exposed to secondhand smoke in public compared to 40.3% of non-smokers (p=0.043). In all, 99.1% of respondents supported the smoking ban and 46.7% of current smokers supported the smoking ban in discos/bars/pubs, compared to 82.0% of non-smokers (p=0.002). Of the participants, 96.6% received lessons on the danger of tobacco, and 65.5% received smoking cessation training. Among factors associated with current smoking was gender; male students had a 19-fold higher likelihood of smoking than female students (adjusted odds ratio, AOR=19.25; 95% CI: 4.25–87.19, p<0.001). In addition, home exposure to secondhand smoke was four times more common for current smokers (OR=4.11; 95% CI: 1.43–11.79, p=0.009). Conclusions: Although smoking prevalence was low among the students in this study, there was a higher percentage of them exposed to secondhand smoke at home and in public. [ABSTRACT FROM AUTHOR]

This study examines the propensity of responding "don't know" (DK) to a set of financial literacy questions provided by the National Financial Capability Study (NFCS), a nationally representative U.S. data set. When given the opportunity to respond correctly, incorrectly, or DK, the inclusion of a DK response item uniquely encompasses facets of financial literacy, which are often overlooked. While researchers utilizing the NFCS have historically treated these responses as incorrect in financial literacy assessments or excluded/dropped DK responses in empirical analyses, this study's findings suggest that the interpretation of DK responses may be better viewed as an amalgamation of survey participants' uncertainty, response confidence, ambiguity regarding the question, or unwillingness to respond, rather than an outright lack of financial literacy. The empirical results suggest that females and those without financially independent children tend to respond DK more frequently to the financial literacy questions examined and that those who are older, married, highly educated, retired, have higher incomes, and current and former military personnel tend to select DK less frequently. Compared to Whites, Blacks are more likely and Asian/Pacific Islanders are less likely to answer DK. [ABSTRACT FROM AUTHOR]

Objectives: To identify the characteristics of individuals transitioning from metabolically healthy obesity (MHO) to unhealthy obesity and the factors influencing the change. Design: This is a nationwide cohort study using data from the National Health Insurance Service in South Korea. Sample: Individuals with obesity but metabolically healthy in 2009 and 2010 and those still obese 4 years later were selected. Measurements: Sociodemographic, physical, metabolic, and health behavior variables were collected, and logistic regression was used to find an association with the transition. Results: We analyzed 1,564,467 individuals, observing significant differences in all variables and the transition from MHO to unhealthy obesity. Among males, the transition was associated with smoking and drinking positively and physical activity negatively. Among females, drinking demonstrated a negative correlation. Regardless of age, regular exercise was negatively associated with the transition for all individuals. Except for older adults, all age groups showed a positive correlation with smoking and drinking. Conclusions: Considering the significant factors in the transition, it is essential to develop and implement interventions varied by gender and age to delay and prevent the change in metabolic status. The necessity of developing interventions enables individuals to engage in regular exercise, regardless of age and gender. [ABSTRACT FROM AUTHOR]

Associations of fractional exhaled nitric oxide (FeNO) with airway wall remodeling and mucus plugs remain to be explored in smokers and nonsmokers with asthma. Ultra-high-resolution computed tomography (U-HRCT), which allows accurate structural quantification of airways >1 mm in diameter, was used in this study to examine whether higher FeNO was associated with thicker walls of the 3rd to 6th generation airways and mucus plugging in patients with asthma. The retrospective analyses included consecutive former smokers and nonsmokers with asthma who underwent U-HRCT in a hospital. The ratio of wall area to summed lumen and wall area was calculated as the wall area percent (WA%). Mucus plugging was visually scored. Ninety-seven patients with asthma (including 59 former smokers) were classified into low (<20 ppb), middle (20–35 ppb), and high (>35 ppb) FeNO groups (n = 24, 26, and 47). In analysis including all patients and subanalysis including nonsmokers or former smokers, WA% in the 6th generation airways was consistently higher in the high FeNO group than in the low FeNO group, whereas WA% in the 3rd to 5th generation airways was not. In multivariable models, WA% in the 6th generation airways and the rate of mucus plugging were higher in the high FeNO group than in the low FeNO group after adjusting for age, sex, body mass index, smoking status, lung volume, and allergic rhinitis presence. Higher FeNO may reflect the inflammation and remodeling of relatively peripheral airways in asthma in both former smokers and nonsmokers. [ABSTRACT FROM AUTHOR]

We document a positive relationship between culturally inherited beliefs about gender equity and female smoking, using data on first and second‐generation immigrants living in the United States. We find that a one standard deviation increase in our measure of gender equity is associated with an increase in the probability that a female immigrant smokes of approximately 1.4 and 1.8 percentage points or 23% and 20% for first and second‐generation immigrants respectively. As male smoking behavior is largely unaffected by gender equality, we find that gender equity tends to reduce the size of the gender gap in smoking. [ABSTRACT FROM AUTHOR]

One of the top priorities of most countries around the world is sustainable development, to achieve which financial inclusion is identified as one of the key elements. Thus, unlike previous studies, the current study aims to channel the impact of financial inclusion on energy efficiency by constructing a parametric-based index that covers availability, accessibility, and usage of the former. The index provides an overall picture of financial services in all the three covered aspects. The analysis based on novel econometric time-series approaches, the method of moment quantile regression and the robust least square approach, shows that financial inclusion increases energy efficiency. The impact is overall positive for each quantile, i.e. 25th–90th. The impact of green innovation, human capital, and political risk is also supportive for energy efficiency. However, the impact of political risk improvement exhibits negative in the initial stages and turns positive later. In terms of policy implications, broadening financial inclusion base with the promotion of green innovation and human capital is important to achieve higher energy efficiency. In the meantime, improvement in the political risk profile should also be considered for a stable financial system to pave the way for increasing energy efficiency. [ABSTRACT FROM AUTHOR]

Following two requests from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the revision of the tolerable upper intake level (UL) for preformed vitamin A and β‐carotene. Systematic reviews of the literature were conducted for priority adverse health effects of excess vitamin A intake, namely teratogenicity, hepatotoxicity and endpoints related to bone health. Available data did not allow to address whether β‐carotene could potentiate preformed vitamin A toxicity. Teratogenicity was selected as the critical effect on which to base the UL for preformed vitamin A. The Panel proposes to retain the UL for preformed vitamin A of 3000 μg RE/day for adults. This UL applies to men and women, including women of child‐bearing age, pregnant and lactating women and post‐menopausal women. This value was scaled down to other population groups using allometric scaling (body weight0.75), leading to ULs between 600 μg RE/day (infants 4–11 months) and 2600 μg RE/day (adolescents 15–17 years). Based on available intake data, European populations are unlikely to exceed the UL for preformed vitamin A if consumption of liver, offal and products thereof is limited to once per month or less. Women who are planning to become pregnant or who are pregnant are advised not to consume liver products. Lung cancer risk was selected as the critical effect of excess supplemental β‐carotene. The available data were not sufficient and suitable to characterise a dose–response relationship and identify a reference point; therefore, no UL could be established. There is no indication that β‐carotene intake from the background diet is associated with adverse health effects. Smokers should avoid consuming food supplements containing β‐carotene. The use of supplemental β‐carotene by the general population should be limited to the purpose of meeting vitamin A requirements. [ABSTRACT FROM AUTHOR]

Ex-smokers without spirometry or CT evidence of chronic obstructive pulmonary disease (COPD) but with mildly abnormal diffusing capacity of the lungs for carbon monoxide (DL CO) are at higher risk of developing COPD. It remains difficult to make clinical management decisions for such ex-smokers without other objective assessments consistent with COPD. Hence, our objective was to develop a machine-learning and CT texture-analysis pipeline to dichotomize ex-smokers with normal and abnormal DL CO (DL CO ≥ 75% pred and DL CO <75% pred). In this retrospective study, 71 ex-smokers (50–85 yrs) without COPD underwent spirometry, plethysmography, thoracic CT, and 3He MRI to generate ventilation defect percent (VDP) and apparent diffusion coefficients (ADC). PyRadiomics was utilized to extract 496 CT texture-features; Boruta and principal component analysis were used for feature selection and various models were investigated for classification. Machine-learning classifiers were evaluated using area under the receiver operator characteristic curve (AUC), sensitivity, specificity, and F1-measure. Of 71 ex-smokers without COPD, 29 with mildly abnormal DL CO had significantly different MRI ADC (p <.001), residual-volume to total-lung-capacity ratio (p =.003), St. George's Respiratory Questionnaire (p =.029), and six-minute-walk distance (6MWD) (p <.001), but similar relative area of the lung < −950 Hounsfield-units (RA 950) (p =.9) compared to 42 ex-smokers with normal DL CO. Logistic-regression machine-learning mixed-model trained on selected texture-features achieved the best classification accuracy of 87%. All clinical and imaging measurements were outperformed by high-high-pass filter high-gray-level-run-emphasis texture-feature (AUC = 0.81), which correlated with DL CO (ρ = −0.29, p =.02), MRI ADC (ρ = 0.23, p =.048), and 6MWD (ρ = −0.25, p =.02). In ex-smokers with no CT evidence of emphysema, machine-learning models exclusively trained on CT texture-features accurately classified ex-smokers with abnormal diffusing capacity, outperforming conventional quantitative CT measurements. [ABSTRACT FROM AUTHOR]

Background: To examine the prevalence of smoking among medical faculty students in Turkey, and to explore the associations between smoking, depression, and other factors. Methods: This cross-sectional study was carried out among medical students in Konya, Turkey, from November 2018 to February 2019. The first section included eight questions pertaining to sociodemographic details. The second comprised nine questions addressing smoking and other harmful habits. The third section involved the Fagerstrom Test for Nicotine Dependence while the fourth was the Beck Depression Inventory (BDI). Results: The study was completed with a total of 1117 participants (90.2% of all students). In regard to smoking, 813 (72.78%) were non-smokers, 98 (8.77%) were ex-smokers, and 222 (19.87%) were active smokers. Notably, 16.29% of students (n = 182) had a high BDI score (≥17). Male sex, good economic status, depression diagnosis at any time in life, and alcohol use were independently associated with active smoking. Being a senior student and regular exercise were independently associated with a low (<17) BDI score, whereas depression diagnosis at any time in life and drug use were independently associated with high (≥17) BDI. Conclusions: Almost 20% of medical school students were active smokers, with about a 2.5-fold higher prevalence among males compared to females. There is a significant association between smoking frequency and symptoms of depression. Policies targeting modifiable risk factors can reduce smoking and depression among future physicians, which can have a strong impact on population-wide smoking. [ABSTRACT FROM AUTHOR]

OBJECTIVES Patients with severe coronary artery disease who undergo coronary artery bypass grafting consistently demonstrate that continued smoking after surgery increases late mortality rates. Smoking may exert its harmful effects through the ongoing chronic process of atherosclerotic progression both in the grafts and the native system. However, it is not clear whether cardiac mortality is primary and solely responsible for the inferior late survival of current smokers. METHODS In this retrospective analysis, we included all consecutive patients undergoing primary isolated coronary artery bypass surgery from 1 January 2000 to 30 September 2015 in an Academic Hospital in Northern Portugal. The predictive or independent variable was the patients' smoking history status, a categorical variable with 3 levels: non-smoker (the comparator), ex-smoker for >1 year (exposure 1) and current smoker (exposure 2). The primary end point was long-term all-cause mortality. Secondary outcomes were long-term cause-specific mortality (cardiovascular and noncardiovascular). We fitted overall and Fine and Gray subdistribution hazard models. RESULTS We identified 5242 eligible patients. Follow-up was 99.7% complete (with 17 patients lost to follow-up). The median follow-up time was 12.79 years (interquartile range, 9.51–16.60). Throughout the study, there were 2049 deaths (39.1%): 877 from cardiovascular causes (16.7%), 727 from noncardiovascular causes (13.9%) and 445 from unknown causes (8.5%). Ex-smokers had an identical long-term survival than non-smokers [hazard ratio (HR) 0.99; 95% confidence interval (CI) 0.88, 1.12; P  = 0.899]. Conversely, current smokers had a 24% increase in late mortality risk (HR 1.24; 95% CI 1.07, 1.44; P  = 0.004) as compared to non-smokers. While the current smoker status increased the relative incidence of noncardiac death by 61% (HR 1.61; 95% CI 1.27, 2.05, P  < 0.001), it did confer a 25% reduction in the relative incidence of cardiac death (HR 0.75; 95% CI 0.59, 0.97; P  = 0.025). CONCLUSIONS Whereas ex-smokers have an identical long-term survival to non-smokers, current smokers exhibit an increase in late all-cause mortality risk at the expense of an increased relative incidence of noncardiac death. By subtracting the inciting risk factor, smoking cessation reduces the relative incidence of cardiac death. [ABSTRACT FROM AUTHOR]

Bordetella hinzii (B. hinzii), a Gram-negative bacillus commonly associated with respiratory infections in animals, has garnered attention for its sporadic cases in humans, particularly in immunocompromised individuals. Despite its opportunistic nature, there remains limited understanding regarding its pathogenicity, diagnostic challenges, and optimal treatment strategies, especially in the context of immunosuppression. Herein, we present the first documented case of acute bronchitis caused by B. hinzii in an immunocompromised patient following double-lung transplantation. The patient, a former smoker with sarcoidosis stage IV, underwent transplant surgery and subsequently developed a febrile episode, leading to the identification of B. hinzii in broncho-alveolar lavage samples. Antimicrobial susceptibility testing revealed resistance to multiple antibiotics, necessitating tailored treatment adjustments. Our case underscores the importance of heightened awareness among clinicians regarding B. hinzii infections and the imperative for further research to elucidate its epidemiology and optimal management strategies, particularly in immunocompromised populations. [ABSTRACT FROM AUTHOR]

Purpose: To review the effects of firsthand tobacco smoking on central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) of firsthand tobacco smokers. Methods: We performed a search on EMBASE and PubMed for studies up to 15th July 2022. Two independent reviewers selected studies with baseline data of CRAE and CRVE of current smokers, nonsmokers, and former smokers. Initial search identified 893 studies, of which 10 were included in the meta-analysis. Two independent reviewers extracted data from the included studies. The quality of studies was assessed by the Newcastle–Ottawa Scale. Results: In this meta-analysis, 7431 nonsmokers, 2448 current smokers and 5786 former smokers, as well as 7404 nonsmokers, 2430 current smokers and 5763 former smokers were included in CRAE and CRVE analysis respectively. Nonsmokers had narrower CRVE (Weighted mean difference [WMD], -12.15; 95% CI, -17.33 – -6.96) and CRAE (WMD, -4.77; 95% CI, -7.96 – -1.57) than current smokers, and narrower CRVE (WMD, -3.08; 95% CI, -6.06 – -0.11) than former smokers. Current smokers had wider CRVE (WMD, 10.42; 95% CI, 7.80 – 13.04) and CRAE (WMD, 7.05; 95% CI, 6.65 – 7.46) than former smokers. Subgroup analysis and sensitivity analysis were performed. Conclusion: Firsthand tobacco smoking resulted in wider CRAE and CRVE in current and former smokers, particularly in CRVE, and such changes may not be reversible after smoking cessation. Therefore, retinal vessel caliber may reflect the effects of firsthand tobacco smoking and be used to estimate the risk of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Introduction: Studies evaluating smoking and periodontal status show controversial results regarding the impact on oral health‐related quality of life (OHRQol). The aim was to evaluate the association between OHRQol and periodontal status in patients according to their smoking habit. Methods: Cross‐sectional study with a total of 100 patients (31.44 ± 8.50 years, 55% females) answered the short version of Oral Health Impact Profile (OHIP‐14) and underwent a periodontal examination. Associations between periodontal status and total mean OHIP‐14 scores related with smoking habit were analysed with Kruskal–Wallis test. Results: Mean percentage of sites with Bleeding on Probing (BOP), Clinical Attachment Loss (CAL) and Number of Teeth were significantly different between current smokers (n = 53) and never (n = 40) or former smokers (n = 7; p < 0.05). There was no significant difference for Periodontal Probing Depth (PPD) in relation to smoking status. A total mean OHIP‐14 score of 13.07 was observed for the entire sample. The corresponding total mean OHIP‐14 scores, for current smokers, never smokers and former smokers, were 15, 10 and 13 (p = 0.280), respectively. The domains social disability and handicap of the OHIP‐14 were worse in current smokers (p = 0.028 and p = 0.026, respectively). Conclusion: Current smoking was associated with a negative influence on OHRQoL in the domain of social disability and handicap. In addition, smokers have worse periodontal status, related to less BOP, greater CAL and fewer teeth than never and former smokers. [ABSTRACT FROM AUTHOR]

Background: Cigarette sales in Indonesia continue to increase, as does the number of people who consume cigarettes, children who smoke, and also deaths caused by smoking. This study aimed to analyze the factors that influence the decision to stop smoking in the Special Region of Yogyakarta using the information motivation behavior skills theory. Subjects and Method: This research is an analytical observational study with a cross-sectional study approach conducted in the Special Region of Yogyakarta in June-July 2023. There were 212 adults consisting of 153 active smokers and 59 former smokers. The dependent variable is the decision to stop smoking. The independent variable is Information Motivation Behavior Skill (IMB). Data was collected using a questionnaire distributed online and analyzed using a path analysis test. Results: Good information (b= 1.25; 95% CI= 0.32 to 2.17; p< 0.008) and high motivation (b= 2.23; 95% CI= 1.54 to 2.9; p< 0.001) were associated with smoking cessation skills, smoking cessation skills good (b= 1.72; 95% CI= 1.01 to 2.43; p< 0.000) is associated with the decision to stop smoking. Conclusion: Good information, high motivation, and smoking cessation skills are statistically related directly and indirectly to the decision to stop smoking. [ABSTRACT FROM AUTHOR]

Introduction: Commercial tobacco use was systematically embedded as a valuable commodity through colonisation that continues to be exploited for profit by the Tobacco Industry. There have been significant declines in current smoking prevalence among Aboriginal and Torres Strait Islander peoples 18 years and over, from 55% in 1994 to 43% in 2018–2019. This paper seeks to better understand smoke‐free behaviours, and to systematically quantify associations between a range of SDOH and non‐smoking/never‐smoking among Aboriginal and Torres Strait Islander adults (≥18) living in regional Australia. Objective: To explore the social determinants of health (SDOH) related to non‐ and never‐smoking among Aboriginal and Torres Strait Islander peoples in regional Australia. Design: Cross‐sectional analysis of the NATSIHS, weighted to the Aboriginal and Torres Strait Islander adult population living in regional Australia, was conducted. Participants were characterised as people who were current smokers, never‐smokers and non‐smokers (ex‐ and never‐smokers). The social determinants of health exposures related to socioeconomic position, well‐being and access to healthcare. Setting: Regional Australia is distinct from urban and remote areas, based on the ASGS Remoteness Structure (ABS) 2018–2019. Participants: Aboriginal and Torres Strait Islander adults (≥18 years) who were selected, consented and asked questions about smoking in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS 2018/19). Results: High income was associated with non‐smoking (Prevalence Ratio [PR] = 2.07; 95% CI: 1.66–2.57) and never‐smoking (PR = 2.02; 1.46–2.79), as was completing year 10 (non‐smoking PR = 1.34; 1.12–1.61 and never‐smoking PR = 1.56; 1.20–2.03). Better food security was associated with a higher prevalence of never‐smoking (PR = 2.42; 1.48–3.98). Lower psychological distress scores were associated with non‐smoking (PR = 1.30; 1.10–1.53) and never‐smoking (PR = 1.56; 1.21–2.01). Never‐smoking was more frequent in participants reporting no experiences of unfair treatment (PR = 1.59; 1.22–2.06). Having a usual healthcare provider was associated with non‐smoking (PR = 1.38; 1.02–1.86). Positive exposure to the SDOH were associated with non‐ and never‐smoking among Aboriginal and Torres Strait Islander adults in regional Australia. Structural and systemic changes to address the SDOH, including discrimination and racism, are expected to accelerate non‐smoking behaviours and improve health outcomes for Aboriginal and Torres Strait Islander peoples. [ABSTRACT FROM AUTHOR]

Around the world, there are persistent and growing health inequalities both between and within countries. The U.K. Government's flagship policy for addressing inequalities is called 'Levelling Up'. One of its missions is to narrow the gap in healthy life expectancy (HLE) between the healthiest and unhealthiest areas in England and to improve overall HLE by 5 years by 2035. We show that smoking is one of the major causes of health inequalities. We find a 17-year difference in HLE between local authorities, and that the number of years spent in ill health tended to be greatest in areas with the highest mortality from smoking-related disease. Our aim is to see if the 5-year target could be achieved, assuming there were drastic controls on the sale and consumption of tobacco. We show that never smokers enjoy six more years of good health at age 20 than current or ex-smokers. A complete ban on smoking would lead to a 2.5-year improvement in HLE, and also lengthen the working lives of both men and women. We conclude that while a complete tobacco ban is significant, other public health measures are needed for the full achievement of the target. The paper briefly considers wider issues and suggestions for further research and its international significance. [ABSTRACT FROM AUTHOR]

Little is known about the effect of statin use in lung cancer development in idiopathic pulmonary fibrosis (IPF). We analyzed the database of the National Health Insurance Service to further investigate the clinical impacts of statin on lung cancer development and overall survival (OS) in IPF patients. The analysis included 9,182 individuals diagnosed with IPF, of which 3,372 (36.7%) were statin users. Compared to statin non-users, the time from diagnosis of IPF to lung cancer development and OS were longer in statin users in IPF patients. In Cox proportional hazard regression models, higher statin compliance, statin use, and being female had an inverse association with lung cancer risk, while older age at diagnosis of IPF and smoking history were associated with higher risk of lung cancer in IPF patients. For OS, statin use, female sex, higher physical activity frequency, and diabetes were associated with longer survival. In contrast, older age at diagnosis of IPF and smoking history were associated with shorter OS in IPF patients. These data from a large population indicate that statin had an independent protective association with lung cancer development and mortality in IPF patients. [ABSTRACT FROM AUTHOR]

Background: There has been little information on the actual diagnosis of pulmonary lesions in patients with a history of urinary tract transitional cell carcinoma (TCC) and short- and long- outcomes of pulmonary resection for these patients. Methods: In the present study, the data of 37 consecutive patients with a history of TCC who underwent pulmonary resection for solitary pulmonary lesions were reviewed, and the clinical factors and short- and long-term outcomes were analyzed. Results: The study population included 35 male patients, and 2 female patients. The mean age was 72.5 years. Twenty patients (80%) were smokers and showed a high incidence of chronic obstructive pulmonary disease. Pulmonary lesions and primary TCC were detected simultaneously in 5 patients and metachronously in 32 patients. The median interval between treatment for primary TCC and the detection of pulmonary lesion was 43 months. The mean tumor diameter was 23 mm. The types of resection included lobectomy (n = 19), segmentectomy (n = 8), and partial resection (n = 10). Twelve of 37 patients (32%) developed postoperative complications. The pathological diagnoses included primary lung cancer (n = 28), pulmonary metastasis from TCC (n = 7), and others (n = 2). The 5-year overall survival rate for all patients was 72%. The 5-year overall survival rate of patients with primary lung cancer was 74%, while that of patients with pulmonary metastasis from TCC was 57%. Conclusions: Surgery can be proactively considered for treating pulmonary lesions in patients with a previous history of TCC, as it provides favorable long-term outcomes. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to devise and validate a clinical scoring system for risk prediction of bladder cancer to guide urgent cystoscopy evaluation among people with diabetes. Methods: People with diabetes who received cystoscopy from a large database in the Chinese population (2009–2018). We recruited a derivation cohort based on random sampling from 70% of all individuals. We used the adjusted odds ratios (aORs) for independent risk factors to devise a risk score, ranging from 0 to 5: 0–2 'average risk' (AR) and 3–5 'high risk' (HR). Results: A total of 5905 people with diabetes, among whom 123 people with BCa were included. The prevalence rate in the derivation (n = 4174) and validation cohorts (n = 1731) was 2.2% and 1.8% respectively. Using the scoring system constructed, 79.6% and 20.4% in the derivation cohort were classified as AR and HR respectively. The prevalence rate in the AR and HR groups was 1.57% and 4.58% respectively. The risk score consisted of age (18–70: 0; >70: 2), male sex (1), ever/ex‐smoker (1) and duration of diabetes (≥10 years: 1). Individuals in the HR group had 3.26‐fold (95% CI = 1.65–6.44, p = 0.025) increased prevalence of bladder than the AR group. The concordance (c‐) statistics was 0.72, implying a good discriminatory capability of the risk score to stratify high‐risk individuals who should consider earlier cystoscopy. Conclusions: The risk prediction algorithm may inform urgency of cystoscopy appointments, thus allowing a more efficient use of resources and contributing to early detection of BCa among people planned to be referred. [ABSTRACT FROM AUTHOR]

Tobacco use and dependence alongside environmental tobacco exposure collectively form a leading cause of morbidity and mortality for the global population. Several clinical and public health interventions have sought to address this growing epidemic on both micro and macro levels. One national campaign, Tips From Former Smokers was prominent across the tobacco cessation landscape. Implemented by the U.S. Centers for Disease Control and Prevention, this campaign garnered coverage and engagement across the national population and also on virtual spaces via social media platforms in our digital era. This study is the first of its kind to critically examine sources and formats as well as assess the nature of content covered across the widely viewed videos pertaining to this campaign on YouTube. Prior studies have analyzed this campaign's content on Facebook and Twitter. This study was cross-sectional, descriptive, and observational in design and involved conducting a content analysis of the most popular videos covered on the campaign across YouTube. Videos pertaining to health and aesthetic effects stemming from the sequelae of smoking, environmental tobacco exposure, and comorbidities with smoking attracted the most views. The majority of the widely viewed videos on the campaign were in the form of testimonials. There was scant coverage on tips and strategies for cessation across the videos. We present several clinical, campaign and systemic implications from these findings. We also propose recommendations for further considerations in future campaign development and implementation that build off the limitations and draw on the strengths of the Tips From Former Smokers campaign in addressing tobacco use and dependence as well as environmental tobacco exposure as targets for future cessation interventions. In addition, we further delineate recommendations that account for health equity, diversity, and inclusivity considerations in coverage of content that could heighten engagement, relatability, connectivity, and acceptability of content by viewers worldwide. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) . [ABSTRACT FROM AUTHOR]

Objectives: To assess cigarette smoking's effects on efficacy of the preferential Janus kinase (JAK) 1 inhibitor filgotinib and drug persistence in patients with rheumatoid arthritis (RA). Methods: Efficacy in non-smokers, former smokers, and current smokers from phase 3 filgotinib trials was analyzed, including patients with inadequate response (IR) to methotrexate (MTX) or biologic disease-modifying antirheumatic drugs (bDMARDs) or who were MTX-naïve. Proportions achieving Disease Activity Score in 28 joints with C-reactive protein (DAS28[CRP]) ≤ 3.2 were compared using logistic regression. Retrospective claims-based switching data were reviewed. Results: Week 12 (W12) DAS28(CRP) ≤ 3.2 was achieved by 50, 61, and 62% of MTX-IR non-smokers, former smokers, and current smokers taking filgotinib 200 mg (FIL200) + MTX vs. 23, 16, and 32% taking placebo + MTX (p < 0.001, < 0.001, and 0.001) and 50, 34, and 33% taking adalimumab + MTX (p = 0.97, 0.013, and 0.006 vs. FIL200 + MTX). W12 DAS28(CRP) ≤ 3.2 was achieved by 46, 48, and 32% of bDMARD-IR non-smokers, former smokers, and current smokers taking FIL200 + conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) vs. 16, 23, and 5% taking placebo + csDMARD (p < 0.001, 0.077, and 0.051); 57, 58, and 59% of respective MTX-naïve smoking groups achieved W12 DAS28(CRP) ≤ 3.2 with FIL200 + MTX vs. 28, 37, and 18% with MTX (p < 0.001, 0.026, and < 0.001). Claims data showed former/current smokers were likelier than non-smokers to switch from adalimumab to other biologics or JAK inhibitors. Conclusions: Greater proportions of MTX-IR current/former smokers responded to FIL200 + MTX vs. adalimumab + MTX. In non-smoking MTX-IR, bDMARD-IR, and MTX-naïve patients with RA, FIL200 + MTX demonstrated increased response vs. controls. Current/former smokers were likelier to discontinue adalimumab vs. non-smokers in real-world clinical settings. Trial Registration: NCT02889796, NCT02873936, NCT02886728. [ABSTRACT FROM AUTHOR]

Background Research on smoking as a risk factor for death due to COVID-19 remains inconclusive, with different studies demonstrating either an increased or decreased risk of COVID-19 death among smokers. To investigate this controversy, this study uses data from the Netherlands to assess the relationship between smoking and death due to COVID-19. Methods In this population-based quasi-cohort study, we linked pseudonymized individual data on smoking status from the 2016 and 2020 'Health Monitor Adults and Elderly' in the Netherlands (n  =   914 494) to data from the cause-of-death registry (n  =   2962). Death due to COVID-19 in 2020 or 2021 was taken as the main outcome. Poisson regression modelling was used to calculate relative risks (RRs) and 95% CIs of death due to COVID-19 for current and former smokers compared with never smokers while adjusting for relevant confounders (age, sex, educational level, body mass index and perceived health). Results Former smokers had a higher risk of death due to COVID-19 compared with never smokers across unadjusted (RR, 2.22; 95% CI, 2.04–2.42), age–sex-adjusted (RR, 1.38; 95% CI, 1.22–1.55) and fully adjusted (RR, 1.30; 95% CI, 1.16–1.45) models. Current smokers had a slightly higher risk of death due to COVID-19 compared with never smokers after adjusting for age and sex (RR, 1.21; 95% CI, 1.00–1.48) and after full adjustment (RR, 1.08; 95% CI, 0.90–1.29), although the results were statistically non-significant. Conclusions People with a history of smoking appear to have a higher risk of death due to COVID-19. Further research is needed to investigate which underlying mechanisms may explain this. [ABSTRACT FROM AUTHOR]

Youth use of electronic cigarettes ("e-cigarettes") is an ongoing concern. Vaping is usually assumed to be of nicotine, but survey responses may also include vaping of non-nicotine substances (particularly cannabis), which can impose different risks. The current study quantifies the proportions of nicotine-specific and cannabis-specific vaping among adolescents. Data from the Monitoring the Future (MTF) 2021 survey were analyzed with respect to the substance vaped: nicotine, cannabis, or flavoring only. Past-30-day (P30D) nicotine-specific vaping (exclusively, or also having vaped other substances) and cannabis-specific vaping were calculated. Results were also broken down by grade level, cigarette smoking history (current, former, or never), and frequency of e-cigarette use (<20 vs. 20+ days in P30D). Among 4706 P30D e-cigarette users, 84.2% vaped nicotine; the remaining 15.8% reported not vaping any nicotine in P30D. Cannabis vaping was reported by 48.4% of P30D vapers. Vaping both nicotine and cannabis in P30D was more common in current and former smokers than in never-smokers, and in frequent vapers (of any substance). Conversely, never-smokers were more commonly vaping cannabis but not nicotine, compared to current and former smokers. Supplementary NYTS 2022 analyses were consistent with these findings. A notable proportion of self-reported P30D vapers reported not vaping nicotine; nearly half vaped cannabis. Capturing the variety of substances used in vaping devices is imperative for accurate public health surveillance of both nicotine and cannabis vaping among US adolescents, considering their different respective harms and regulatory frameworks. [ABSTRACT FROM AUTHOR]

Smoking is a well-recognized risk factor for the development of head and neck cancer. The aim of this study was to explore the reasons why patients referred with suspected head and neck cancer to an ENT unit had chosen to quit smoking. A secondary aim was to investigate smoking cessation methods those patients used. 129 consecutive ex-smoking patients were seen in an urgent ENT diagnostic clinic. All patients were asked to complete a smoking behavior questionnaire. Reasons given to quit smoking, methods and support structures utilized were recorded. The most popular method for quitting smoking was willpower alone with no external support. The most common reasons for quitting smoking were present and future health concerns. Knowing the common smoking cessation methods patients have used and the motivational reasons behind their decisions to quit will help clinicians responsible for supporting these patients. By identifying the needs and personal situations of each patient, more specific smoking cessation advice can be provided that may improve the chances of a successful cessation attempt. [ABSTRACT FROM AUTHOR]

Background: Mucus plugs have been described in the airways of asthmatic subjects, particularly those with associated with type 2 inflammation and sputum eosinophilia. In the current study we addressed the question of whether smoking, neutrophilic inflammation and airway dimensions affected the prevalence of mucus plugs. Methods: In a cohort of moderate to severe asthmatics (n = 50), including a group of ex-smokers and current smokers, the prevalence of mucus plugs was quantified using a semi-quantitative score based on thoracic computerized tomography. The relationships between mucus score, sputum inflammatory profile and airway architecture were tested according to patient's smoking status. Results: Among the asthmatics (37% former or active smokers), 74% had at least one mucus plug. The median score was 3 and was unrelated to smoking status. A significant but weak correlation was found between mucus score, FEV1 and FEV1/FVC. Mucus score was significantly correlated with sputum eosinophils. Among former and active smokers, mucus score was correlated with sputum neutrophils. Mucus score was positively associated with FeNO in non-smoking subjects. The lumen dimensions of the main and lobar bronchi were significantly inversely correlated with mucus score. Conclusion: Airway mucus plugs could define an asthma phenotype with altered airway architecture and can occur in asthmatic subjects with either neutrophilic or eosinophilic sputum according to their smoking status. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate differences between non-smokers, ex-smokers and current smokers in hospital length of stay (LOS), readmission (seven and 28 days) and cost of readmission for patients admitted for elective surgery. Methods: A retrospective cohort study of administrative inpatient data from 24, 818 patients admitted to seven metropolitan hospitals in Western Australia between 1 July 2016 and 30 June 2019 for multiday elective surgery was conducted. Data included smoking status, LOS, procedure type, age, sex and Indigenous status. LOS for smoking status was compared using multivariable negative binomial regression. Odds of readmission were compared for non-smokers and both ex-smokers and current smokers using separate multivariable logistic regression models. Results: Mean LOS for non-smokers (4.7 days, SD=5.7) was significantly lower than both ex-smokers (6.2 days SD 7.9) and current smokers (6.1 days, SD=8.2). Compared to non-smokers, current smokers and ex-smokers had significantly higher odds of readmission within seven (OR=1.29; 95% CI: 1.13, 1.47, and OR=1.37; 95% CI: 1.19, 1.59, respectively) and 28 days (OR=1.35; 95% CI: 1.23, 1.49, and OR=1.53; 95% CI: 1.39, 1.69, respectively) of discharge. The cost of readmission for seven and 28-day readmission was significantly higher for current smokers compared to non-smokers (RR=1.52; 95% CI: 1.1.6, 2.0; RR=1.39; 95% CI: 1.18, 1.65, respectively). Conclusion: Among patients admitted for elective surgery, hospital LOS, readmission risk and readmission costs were all higher for smokers compared with non-smokers. The findings indicate that provision of smoking cessation treatment for adults undergoing elective surgery is likely to produce multiple benefits. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between smoking initiation in adolescence and subsequent different smoking trajectories of people who smoke, and to examine the combined effect of adverse childhood experiences (ACEs) and smoking initiation in adolescence on smoking trajectories of people who smoke. Design and Sample: Data are from 8757 individuals in Great Britain from the birth cohort National Child Development Study and who reported being smokers or former smokers by age 23. Measurements: Smoking initiation in adolescence was measured at 16 y and smoking trajectories were derived from smoking variables from ages 23 to 55. We modelled the relationship between smoking initiation in adolescence with or without ACEs and smoking trajectories. Results: Individuals who initiated smoking in adolescence were more likely to quit later than quitting in twenties (RRR quitting in thirties = 3.43 [2.40; 4.89] p <.001; RRR quitting in forties = 5.25 [3.38; 8.14] p <.001; RRR quitting in fifties = 4.48 [2.95; 6.79] p <.001), to relapse (RRR Relapse = 3.66 [2.82; 4.76] p <.001) and to be persistent smokers (RRR persistent = 5.25 [3.81; 7.25] p <.001) compared to those who had initiated smoking in young adulthood. These effects were particularly pronounced in case of ACEs. Conclusion: Smoking prevention programs aimed at reducing smoking initiation should be promoted to adolescents to limit the burden of smoking, especially for people who have suffered adversity during childhood. [ABSTRACT FROM AUTHOR]

Most frequently, people with renal insufficiency and smokers will both have carotid artery disease. When compared to non-smokers, smokers have a higher incidence of carotid artery stenosis. Moreover, smoking has been connected to the development of high-risk atheroma as well as an increase in carotid intima media thickness in an elderly population. Extracranial internal carotid artery stenosis higher than 50% is linked to around 8–15% of ischemic strokes [2]. Objective: To compare the color Doppler findings for assessment of carotid artery disease in smokers and non-smokers. Methodology: A cross-sectional study was performed on 120 patients, with clinically suspected carotid artery disease at the university ultrasound clinic, Green town Lahore by Doppler ultrasonography (Toshiba XARIO XG), with linear probe of 5-7.5 MHz frequency used. The data was analyzed with the help of SPSS version 25.0. Variables like age and Intima-media thickness were reported and the mean ± standard deviation of pulsatility index, resistive index, peak systolic velocity, and end diastolic velocity were calculated. An independent t-test was applied with a significant p-value, which was less than 0.05. Results: Data was collected from 120 patients. The mean ± SD of age of 120 patients were 43.10 ± 14.44 years. IMT of right carotid artery and PSV of right and left carotid artery, were observed to be statistically significant in smokers and non- smokers. Conclusion: This study concluded that smoking is considered as one of the most important risk factor that shows a significant association with carotid IMT thickening. [ABSTRACT FROM AUTHOR]

Introduction: This study examined the association between smoking and heart disease in workers with a medical history of hypertension. Methods: Data were obtained from the 2018 Indonesian Basic Health Research database. Information was collected from 80,602 respondents who met the inclusion criteria: workers between the ages of 15 and 64 years who were exposed to cigarettes and had a medical history of hypertension. Multivariate logistic regression analysis assessed the association between smoking behavior and heart disease in workers with hypertension. Results: A strong association was observed between passive smoking and heart disease. The odds of developing heart disease were significantly higher in passive smokers who were former cigarette smokers than passive smokers who never smoked a cigarette (adjusted odds ratio [aOR] = 2.11, 95% confidence interval [CI]: 1.85-2.41). However, the odds were lower in current smokers than in passive smokers without a history of cigarette smoking (aOR = 0.71, 95% CI: 0.63-0.79). In addition, the present study found that the odds of developing heart disease increased in respondents from urban areas (aOR = 1.27, 95% CI: 1.14-1.40), aged 46-64 years (aOR = 2.12, 95% CI: 1.90-2.36), and from high-level economic status (aOR = 1.41, 95% CI: 1.27-1.58). Conclusion: Implementing health advocacy initiatives, expanding smoking-free zones, and enhancing workplace anti-smoking policies are important for preventing and reducing the harmful effects of cigarette smoking among workers, particularly those with conditions that make them more susceptible, such as hypertension. [ABSTRACT FROM AUTHOR]

Objectives: Gingival pigmentation, the most common etiological factor of which is smoking, is a clinical condition that causes aesthetic complaints. Due to the dose-dependent effect of smoking, gingival pigmentation may present regression following cessation. This cross-sectional study aimed to evaluate gingival pigmentation in former tobacco consumers and compare with current ones. Material and Methods: A total of 110 people, 70 of whom were current smokers (Group CS) and 40 of whom were former smokers (Group FS), were included in the study. Participants filled out the data collection forms containing questions on demographic features and information related to tobacco consumption. In addition, all individuals were examined with Hedin's melanin index (HMI) to evaluate gingival pigmentation. Statistical significance was set at the P < 0.05 level. Results: The population consisted of 57.3% male, and the mean age of all participants was 39.43 (SD 12.3) years. The mean duration of tobacco consumption did not differ between groups, whereas the mean HMI score of Group FS was significantly lower (P = 0.001). The correlation analyses showed that while the HMI score of Group CS was in relation to both daily consumption amount and duration of consumption (for both, P < 0.01), the HMI score of Group FS showed a negative association with only time elapsed after cessation (P = 0.000). Conclusions: Considering the limitations of this study, the outcomes revealed a dose- and a time-dependent relation of gingival pigmentation in smokers. However, gingival pigmentation in former tobacco consumers was negatively correlated only with time elapsed after cessation. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) total-airway-count (TAC) and airway wall-thickness differ across chronic obstructive pulmonary disease (COPD) severities, but longitudinal insights are lacking. The aim of this study was to evaluate longitudinal CT airway measurements over three-years in ex-smokers. In this prospective convenience sample study, ex-smokers with (n = 50; 13 female; age = 70 ± 9 years; pack-years = 43 ± 26) and without (n = 40; 17 female; age = 69 ± 10 years; pack-years = 31 ± 17) COPD completed CT, 3He magnetic resonance imaging (MRI), and pulmonary function tests at baseline and three-year follow-up. CT TAC, airway wall-area (WA), lumen-area (LA), and wall-area percent (WA%) were generated. Emphysema was quantified as the relative-area-of-the-lung with attenuation < –950 Hounsfield-units (RA950). MRI ventilation-defect-percent (VDP) was also quantified. Differences over time were evaluated using paired-samples t tests. Multivariable prediction models using the backwards approach were generated. After three-years, forced-expiratory-volume in 1-second (FEV1) was not different in ex-smokers with (p = 0.4) and without (p = 0.5) COPD, whereas RA950 was (p

Pulmonary imaging measurements using magnetic resonance imaging (MRI) and computed tomography (CT) have the potential to deepen our understanding of chronic obstructive pulmonary disease (COPD) by measuring airway and parenchymal pathologic information that cannot be provided by spirometry. Currently, MRI and CT measurements are not included in mortality risk predictions, diagnosis, or COPD staging. We evaluated baseline pulmonary function, MRI and CT measurements alongside imaging texture-features to predict 10-year all-cause mortality in ex-smokers with (n = 93; 31 females; 70 ± 9years) and without (n = 69; 29 females, 69 ± 9years) COPD. CT airway and vessel measurements, helium-3 (3He) MRI ventilation defect percent (VDP) and apparent diffusion coefficients (ADC) were quantified. MRI and CT texture-features were extracted using PyRadiomics (version2.2.0). Associations between 10-year all-cause mortality and all clinical and imaging measurements were evaluated using multivariable regression model odds-ratios. Machine-learning predictive models for 10-year all-cause mortality were evaluated using area-under-receiver-operator-characteristic-curve (AUC), sensitivity and specificity analyses. DLCO (%pred) (HR = 0.955, 95%CI: 0.934-0.976, p

Objectives: Gingival pigmentation, the most common etiological factor of which is smoking, is a clinical condition that causes aesthetic complaints. Due to the dose-dependent effect of smoking, gingival pigmentation may present regression following cessation. This cross-sectional study aimed to evaluate gingival pigmentation in former tobacco consumers and compare with current ones. Material and Methods: A total of 110 people, 70 of whom were current smokers (Group CS) and 40 of whom were former smokers (Group FS), were included in the study. Participants filled out the data collection forms containing questions on demographic features and information related to tobacco consumption. In addition, all individuals were examined with Hedin’s melanin index (HMI) to evaluate gingival pigmentation. Statistical significance was set at the P < 0.05 level. Results: The population consisted of 57.3% male, and the mean age of all participants was 39.43 (SD 12.3) years. The mean duration of tobacco consumption did not differ between groups, whereas the mean HMI score of Group FS was significantly lower (P = 0.001). The correlation analyses showed that while the HMI score of Group CS was in relation to both daily consumption amount and duration of consumption (for both, P < 0.01), the HMI score of Group FS showed a negative association with only time elapsed after cessation (P = 0.000). Conclusions: Considering the limitations of this study, the outcomes revealed a dose- and a time-dependent relation of gingival pigmentation in smokers. However, gingival pigmentation in former tobacco consumers was negatively correlated only with time elapsed after cessation.

INTRODUCTION The aim of this study is to identify profiles of never smokers, ex-smokers, occasional smokers, and daily smokers, through their individual, lifestyle, and health characteristics. This analysis allows provides profiles of individuals with a greater or less propensity to use tobacco, which contributes to the design of effective prevention policies. METHODS Econometric models are used with data from the Spanish National Health Survey. Specifically, a multinomial logit model is estimated to evaluate the probabilities of tobacco use. Additionally, discrete changes, odds ratios, and predicted probabilities for prone individuals, are calculated. RESULTS Differences are found between the profiles of each alternative of tobacco use. The individual attributes with the most striking effect are being aged 26-45 years, which reduces the probability of being a non-smoker by 21 percentage points compared to the younger group, and regular exposure to secondhand smoke, which is 30% more likely to be a regular smoker. The characteristics that define an individual with higher probability of smoking daily are: belonging to a certain region of Spain, male, aged 26-45 years, born in Spain, unemployed, with primary studies, separated, no physical activity, consumes alcohol, and is exposed to smoke regularly, not chronically ill, and have very poor health. CONCLUSIONS Identification of the profiles most likely to choose each of the tobacco consumption alternatives can contribute to the design of more effective prevention strategies. The results confirm that the accumulation of bad habits results in a high risk of smoking. The quantification of the differences in the effects of each trait is an interesting contribution that is useful to orient the policies to specific segments of the population more prone to consume tobacco. [ABSTRACT FROM AUTHOR]

INTRODUCTION Electronic cigarette (e-cigarette) use is gaining popularity among adults. Monitoring e-cigarette-induced respiratory symptoms is crucial for both clinical and regulatory purposes. We systematically reviewed the current literature to understand the prevalence of respiratory symptoms among exclusive e-cigarette users, dual users, and former smokers. METHODS Databases searched included PubMed, CINAHL, Cochrane Library, Embase, and Scopus. We included all English-language, empirical quantitative articles that explored the prevalence of e-cigarette-related respiratory symptoms. Random-effects models were utilized in conducting the meta-analyses. The quality of identified studies was evaluated using the NIH Study Quality Assessment Tools. This study is registered with PROSPERO(#CRD42020165973). RESULTS The literature search identified 1240 references. After removing duplicates and screening for eligibility, 168 studies were included in the final review. The majority of included studies reported a wide range of adverse respiratory symptoms. The respiratory symptoms were prevalent among the exclusive e-cigarette users, dual users, and those who switched from combustible cigarettes to e-cigarettes. Further, out of the RCT studies, 5 were rated as good quality, while 3 were rated as fair. Among the observational studies, 24 were rated as good quality, and 9 were rated as fair. The two experimental studies were both rated as fair quality. CONCLUSIONS Continued monitoring of respiratory symptoms among e-cigarette users is warranted. Due to the heterogeneity and inconsistencies among studies, which limit result interpretation and highlight the need for studies assessing causal inference, further research using robust study designs is essential. This will provide clinicians with comprehensive knowledge about the potential respiratory risks of e-cigarette use. [ABSTRACT FROM AUTHOR]

Background The use of e-cigarettes has been rising in the UK, particularly by young people. This study investigated behaviours, attitudes and beliefs about e-cigarettes amongst 15–30-year-olds in the UK. Methods An online survey was administered to a sample of 1009 15–30-year-olds in the UK. Results About one in five participants currently used e-cigarettes at least monthly, with 1 in 10 using them daily. Amongst those using e-cigarettes at least monthly, 90% had used e-cigarettes containing nicotine. E-cigarettes were mainly obtained from vape shops and used at home. Having friends who used e-cigarettes and using them to help quit/reduce smoking were the most common reasons for vaping. About half of participants had been exposed to e-cigarette advertising, especially online, and warning labels on e-cigarettes. Most participants agreed that e-cigarettes are addictive (75%), help people quitting smoking (64%) and are bad for health (63%). Previous or current tobacco smokers were 9 and 22 times more likely to use e-cigarettes than never smokers, respectively. Perceiving e-cigarettes as harmful was associated with a 40% lower likelihood of use. Conclusion Raising awareness on the uncertain long-term consequences of vaping and regulation of marketing and sales are crucial to protect young people in the UK. [ABSTRACT FROM AUTHOR]

According to Joseph Heath, privatizations should be judged on a case-by-case basis with appeal to the Pareto criterion. This approach, or so I argue, amounts to a depoliticization of privatization. While Heath's approach is effective and at times illuminating, I show that a consistent application of his methodology is self-defeating in that it eventually requires a politicization of privatization. With appeal to transaction cost theory, I show there are social costs associated with affirming the competitive pressures of the market. Subsequently, I argue that while private actors may, according to Heath, pursue efficiency with appeal to an adversarial morality, state-owned enterprises (SOEs) are much more constrained in how they may achieve such gains. Due to the pressures of liberal neutrality, SOEs may chase efficiency only without setting actors back. Conversely, the private sector's potential for success is predicated on its ability to compete for Kaldor-Hicks efficiency, which specifically allows for win-lose interactions. While SOEs are often no more able than the private sector to achieve Pareto optima, this discrepancy makes it so that SOEs produce gains that are ex-ante lower but more equal, whereas the private sector produces gains that are ex-ante higher but more unequal. Thus, the social cost of affirming the competitive pressures of the market is ex-ante inequality. If this premise is accepted, there is no way to avoid the conclusion that a consistent case-by-case approach requires a structural, political view on how privatizations affect the state's ex-post Pareto-enhancing abilities. [ABSTRACT FROM AUTHOR]

Background: Alcohol and smoking brief interventions (BIs) in general practice have been shown to be effective in lowering alcohol and smoking-related harm. Aim: To assess prevalence of self-reported BI receipt among increasing or higher-risk drinkers and past-year smokers in England, Scotland, and Wales, and associations between intervention receipt and socioeconomic position. Design & setting: Cross-sectional study using data from a monthly population-based survey in England, Scotland, and Wales. Method: The study comprised 47 799 participants (15 573 increasing or higher-risk drinkers [alcohol use disorders identification test consumption score ≥5] and 7791 past-year smokers) surveyed via telephone in 2020-2022 (during the COVID-19 pandemic). All data were self-reported. Prevalence of self-reported BI receipt was assessed descriptively; associations between receipt and socioeconomic position were analysed using logistic regression. Results: Among adults in England, Scotland, and Wales, 32.2% (95% confidence interval [CI] = 31.8 to 32.7) reported increasing or higher-risk drinking and 17.7% (95% CI = 17.3 to 18.1) past-year smoking. Among increasing or higher-risk drinkers, 58.0% (95% CI = 57.1 to 58.9) consulted with a GP in the past year, and of these, 4.1% (95% CI = 3.6 to 4.6) reported receiving BIs. Among past-year smokers, 55.8% (95% CI = 54.5 to 57.1) attended general practice in the past year; of these, 41.0% (95% CI = 39.4 to 42.7) stated receiving BIs. There was a tendency for patients from socioeconomically disadvantaged backgrounds to receive more alcohol (adjusted odds ratio [aOR] 1.38, 95% CI = 1.10 to 1.73) or smoking BIs (aOR 1.11, 95% CI = 0.98 to 1.26), but for the latter the results were statistically non-significant. Results did not differ notably by nation within Great Britain. Conclusion: BIs in general practice are more common for smoking than for alcohol. A greater proportion of BIs for alcohol were found to be delivered to people who were from socioeconomically disadvantaged backgrounds and who were increasing or higher-risk drinkers. [ABSTRACT FROM AUTHOR]