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Background: Maternal smoking around birth (MSAB) and early-life breastfeeding (BAB) represent critical factors that may exert enduring effects on neuropsychiatric health. Although previous research has examined these exposures separately, the combined impact of both on disorders such as ADHD, ASD, BD, MDD, ANX, and SCZ remains unclear. This study aims to evaluate the causal relationships between MSAB and BAB and the risk of developing these neuropsychiatric disorders through Mendelian randomization (MR) analysis., Methods: A two-sample MR analysis was conducted to investigate the potential causal effects of MSAB and BAB on a range of neuropsychiatric disorders. Genetic variants associated with MSAB and BAB were obtained from genome-wide association studies (GWAS), while summary data for neuropsychiatric disorders were gathered from large GWAS consortia. The primary MR analysis was conducted using the inverse-variance weighted (IVW) method, with additional sensitivity analyses performed to confirm the robustness of the findings. A False Discovery Rate (FDR) correction was applied to control for the issue of multiple comparisons and reduce the risk of Type I errors., Results: The IVW analysis indicated that there were significant associations between MSAB and an increased risk of the following conditions: The IVW analysis indicated significant associations between MSAB and an increased risk of ADHD (odds ratio [OR] = 5.36, 95 % confidence interval [CI] = 2.58-7.63, p-value for false discovery rate [PFDR] = 0.004) and major depressive disorder (MDD) (OR = 1.92, 95 % CI = 1.29-2.88, PFDR = 0. Furthermore, significant associations were observed between MSAB and an increased risk of bipolar disorder (BD) (OR = 6.33, 95 % CI = 1.56-8.73, PFDR = 0.020), anxiety disorders (ANX) (OR = 1.03, 95 % CI = 1.00-1.05, PFDR = 0.039), and attention deficit hyperactivity disorder (ADHD) (OR = 5.36, 95 % CI = 2.58-7.63, PFDR = 0.004). No significant associations were identified between MSAB and Autism Spectrum Disorder (ASD) or Schizophrenia (SCZ). In contrast, the results indicated that BAB was associated with a protective effect against ADHD (OR = 0.17, 95 % CI = 0.04-0.63, PFDR = 0.025), MDD (OR = 0.26, 95 % CI = 0.12-0.58, PFDR = 0.006), and ANX (OR = 0.96, 95 % CI = 0.49-0.99, PFDR = 0.030). No significant effects of BAB were observed for ASD, BD, or SCZ., Conclusions: This study shows that maternal smoking around the time of birth increases the risk of attention-deficit/hyperactivity disorder (ADHD), major depressive disorder (MDD), bipolar disorder (BD), and anxiety disorders (ANX). In contrast, breastfeeding during infancy offers protective benefits against ADHD, MDD, and ANX. These findings underscore the vital importance of maternal health behaviours during the perinatal and infant feeding periods. They also highlight the need for targeted public health interventions aimed at reducing the risk of neuropsychiatric disorders., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: In the US, lung cancer burden is greater in counties that are either rural or in persistent poverty. This study examined lung cancer risk (e.g., smoking), incidence, and mortality across four county types defined by cross-classification of rurality and persistent poverty., Methods: We conducted a secondary analysis of county characteristics and lung cancer risk, incidence and mortality. We used data from USDA to classify counties according to rurality (using rural-urban continuum codes) and persistent poverty (i.e., 20% + of residents living below the poverty line for 30 + years). We used publicly-available data to calculate mean county-level prevalence of smoking among adults (in 2019), lung cancer incidence (2015-2019), and lung cancer mortality (2015-2019) across county types. Beta and binomial regression models assessed differences in smoking, lung cancer incidence, and lung cancer mortality by rurality and persistent poverty., Results: Among U.S. counties, 1,115 were urban, non-persistent poverty, 1,675 were rural, non-persistent poverty, 52 were urban, persistent poverty, and 301 were rural, persistent poverty. Smoking, lung cancer incidence, and lung cancer mortality were higher in rural counties and in persistent poverty counties than in their comparison counties. Counties that were both rural and persistent poverty had the highest rates of smoking, lung cancer incidence, and lung cancer mortality. Persistent poverty and rurality interacted in their relationship with smoking prevalence (p < 0.01), and lung cancer mortality (p < 0.10)., Conclusions: Smoking, lung cancer incidence, and lung cancer mortality are highest in counties that are both rural and persistent poverty, suggesting an urgent need to develop targeted lung cancer interventions in these communities., Competing Interests: Declarations. Ethics approval and consent to participate: This secondary data analysis was deemed exempt by the Institutional Review Board. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Research indicates major risk factors including smoking, alcohol consumption, obesity and physical inactivity contribute significantly to global disease burden and healthcare costs. However, these studies have challenges, such as increased bias and uncertainty arising from use of population attributable fractions (PAF) and the issue of reverse causality in cross-sectional data. This study aims to evaluate the long-term healthcare costs associated with these behaviors using a longitudinal cohort., Methods: This longitudinal cohort study used the Korean National Health Insurance Service-National Sample Cohort database (NHIS-NSC 2.0), covering 2002-2019. The cohort included individuals aged 40-69 years who underwent health examinations in 2002-2004 and had no pre-existing risk factor-related diseases. Cumulative healthcare costs during 2010-2019 were analyzed using a generalized linear model with log-link function and gamma distribution, adjusted for other health behaviors and sociodemographic factors., Results: Smoking, alcohol consumption, obesity, and physical inactivity significantly increased healthcare costs for both sexes. Male current smokers incurred 13.8% higher costs than never-smokers, while female smokers spent 18.6% more. Former smokers had lower costs than current smokers, with reductions of 9.9% for males and 13.2% for females. Almost daily alcohol consumption raised costs by 21.4% for males and 31.8% for females. Costs varied by BMI categories, with severe obesity increasing expenditures by 26.9% for males and 46.5% for females compared to normal weight. Overweight status showed contrasting effects between sexes, with a 3.4% decrease in healthcare costs for males but a 7.6% increase for females. Exercising 1-4 times weekly reduced costs by 7.6% for males and 7.4% for females compared to non-exercisers., Conclusions: The study underscores the economic impact of health risk behaviors and supports the need for targeted public health interventions. The findings highlight the importance of targeted interventions for high-risk groups for reducing healthcare costs., Competing Interests: Declarations. Ethics approval and consent to participate: This study involving human participants was reviewed and approved by the institutional review board (IRB) of Inha University Hospital (Approval No 2023-12-040). Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. The confidentiality of participant data was strictly maintained, and all analyses were conducted using deidentified datasets. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Comorbidity between depression and cardiometabolic diseases is an emerging health concern, with childhood maltreatment as a major risk factor. These conditions are also linked to unhealthy lifestyle behaviours such as physical inactivity, smoking, and alcohol intake. However, the precise degree to which lifestyle behaviours moderate the risk between childhood maltreatment and comorbid depression and cardiometabolic disease is entirely unknown., Methods: We analysed clinical and self-reported data from four longitudinal studies (N pooled  = 181,423; mean follow-up period of 5-18 years) to investigate the moderating effects of physical activity, smoking, and alcohol intake, on the association between retrospectively reported childhood maltreatment and i) depression, ii) cardiometabolic disease and iii) their comorbidity in older adults (mean age range of 47-66 years). Estimates of these moderation effects were derived using multinomial logistic regressions and then meta-analysed., Results: No meaningful moderation effects were detected for any of the lifestyle behaviours on the association between childhood maltreatment and each health outcome. Physical activity was linked to lower odds of depression (OR [95% CI] = 0.94 [0.92; 0.96]), while smoking was a risk factor for all three outcomes (OR [95% CI] = 1.16 [1.04; 1.31] or larger). Alcohol intake was associated with slightly lower odds of comorbidity (OR [95% CI] = 0.69 [0.66; 0.73]), although this association was not stable across all sensitivity analyses., Conclusions: Lifestyle behaviours did not moderate the risk association between childhood maltreatment and depression, cardiometabolic disease, and their comorbidity in older adults. However, we confirmed that childhood maltreatment was associated with these conditions. Further research should address the limitations of this study to elucidate the most optimal targets for intervention., Competing Interests: Declarations. Ethics approval and consent to participate: All participants provided informed consent and ethical approval for each study was obtained from local research ethics committees. Cohort Considerations ALSPAC, mothersALSPAC, partners Informed consent for the use of data collected via questionnaires and clinics was obtained from participants following the recommendations of the ALSPAC Ethics and Law Committee at the time. Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees. NESDA All participants provided written informed consent. Ethical approval was obtained from the Ethical Review Board of the VU University Medical Centre and subsequently by local review boards of each participating center. UK Biobank This research was conducted using the UK Biobank resource, application numbers 65769 & 374130. All participants gave full informed written consent. Generic ethical approval was obtained from the National Health Service, National Research Ethics Service (approval letter dated 17 June 2011, Ref 11/NW/0382). Consent for publication: Not applicable. Competing interests: FL has received speaker fees from Novo Nordisk B.V. The other authors declare that they have no competing interests., (© 2025. The Author(s).)

Objectives: This study aimed to investigate the association and population-attributable fraction (PAF) of maternal smoking and secondhand smoke (SHS) exposure during pregnancy with placental abruption., Design: Prospective cohort study., Setting: 15 regional centres in Japan., Participants: Pregnant women registered between January 2011 and March 2014 from the Japan Environment and Children's Study., Outcome Measures: Data were transcribed from medical records and two self-administered questionnaires. The outcome measure was the incidence of placental abruption. Maternal smoking exposure during pregnancy was categorised based on the number of cigarettes smoked (≤10 or ≥11 cigarettes per day). SHS exposure during pregnancy was evaluated by frequency and duration (almost never or never, 1-3 days/week and/or <1 hour/day and 4-7 days/week and ≥1 hour/day). A modified Poisson regression model, adjusted for known placental abruption risk factors, calculated the risk ratio (RR) and PAF for placental abruption with a 95% Cl., Results: Of the 81 974 eligible pregnant women, pregnant women smoking ≥11 cigarettes/day during pregnancy had a significantly higher risk of placental abruption. The adjusted RR (aRR) was 2.21 (95% CI 1.21 to 4.06), and the adjusted PAF (aPAF) was 1.90% (95% CI 0.09 to 3.71%). Pregnant women among never-smokers with SHS exposure of 4-7 days/week and ≥1 hour/day had a significantly higher risk (aRR: 2.34, 95% CI 1.29 to 4.28), and the aPAF was 1.89% (95% CI -0.05 to 3.83). Additionally, pregnant women among those who smoked during pregnancy with similar SHS exposure had a significantly higher risk (aRR: 2.21, 95% CI 1.30 to 3.76), with the aPAF of 2.29% (95% CI 0.11 to 4.48)., Conclusions: Maternal smoking and SHS exposure during pregnancy significantly contribute to the risk of placental abruption in Japan. Therefore, preventive interventions and measures to reduce exposure are required to prevent placental abruption., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background and Purpose: Knowledge regarding the risk factors for early death in patients with head and neck squamous cell carcinoma (HNSCC) is scarce. This study aims to evaluate the rate of early death (during or within 6 months of treatment) and its associated risk factors in HNSCC patients treated with curative intent., Materials and Methods: A retrospective, population-based analysis of all HNSCC patients (n = 762) treated with curative intent at the Helsinki University Hospital (Helsinki, Finland) during 2012-2015 was conducted. Using the chi-square test, associations between categorical variables were assessed. Univariate and multivariate analyses were performed to identify independent factors for early death., Results: The rate of early death was 10.1% with a median age of 70 years at diagnosis. Advanced stage, smoking > 40 pack-years, and heavy alcohol consumption were associated with increased odds of early death. Elevated thrombocyte levels > 380 (× 10⁹L) were observed more frequently in the early-death group when comparing the levels with the late-death group (p < 0.01). However, only age (odds ratio [OR] 1.05; 95% confidence interval [CI]:1.02-1.08), T4 class (OR 5.98; 95% CI: 2.60-13.74), N2 class (OR 2.98; 95% CI: 2.60-13.74), and N3 class (OR 12.24; 95% CI: 2.99-50.19) emerged as independent risk factors for early death., Interpretation: Early death risk is increased in older patients and those with advanced-stage HNSCC. Elevated thrombocyte count requires further studies to assess its utility as a potential clinical marker.

Background: Abdominal aortic aneurysm (AAA) is a severe aortic disease for which no pharmacological interventions have yet been developed. This investigation focused on identifying protein-based therapeutic targets and assessing how proteins mediate the interplay between modifiable risk factors and AAA development., Methods: Causal inferences between plasma proteins and AAA were drawn using 2-sample Mendelian randomization, followed by comprehensive sensitivity testing, colocalization, and replication efforts. Further analyses included database interrogation, single-cell RNA data analysis, enrichment analysis, protein-protein interaction networks, and immunohistochemistry to map the tissue-specific expression of these proteins, their expression within AAA tissues, and their biological roles. Mediation Mendelian randomization was employed to evaluate the mediating effects of AAA-related proteins on the associations between AAA and 3 risk factors: hypertension, smoking, and obesity., Results: A total of 43 proteins were identified as having causal links to AAA. Colocalization analysis pinpointed 13 proteins with strong evidence of colocalization with AAA. Of these, the causal involvement of 10 proteins was substantiated by external validation data. Consistent evidence for PCSK9 (proprotein convertase subtilisin/kexin type 9), IL6R (interleukin-6R), ECM1 (extracellular matrix protein 1), and ANGPTL4 (angiopoietin-related protein 4) was further validated through tissue immunohistochemistry and blood data. Moreover, Mendelian randomization analysis identified 10 proteins as mediators of the influence of hypertension, smoking, and obesity on AAA development., Conclusions: This analysis identifies 4 proteins (PCSK9, IL6R, ECM1, and ANGPTL4) as high-priority therapeutic targets for AAA and emphasizes the intermediary role of plasma proteins in linking hypertension, smoking, obesity, and AAA. Further investigations are needed to clarify the specific roles of these proteins in AAA pathology.

Background: The adverse cardiovascular effects of smoking are well established. We aimed to investigate the less well-understood effects of pregnancy smoke exposure on offspring cardiovascular health in early adolescence., Methods and Results: Data were drawn from the nationally representative Longitudinal Study of Australian Children's Child Health CheckPoint. Mothers reported mean daily cigarettes smoked in each trimester (≤10 versus >10/day), and smoking cessation during pregnancy. Blood pressure, pulse wave velocity, carotid intima-media thickness, and retinal microvascular parameters were measured in early adolescence (mean 11.5 years). Hypertension was defined as systolic blood pressure ≥120 or diastolic blood pressure ≥80 mm Hg. 187 (11.8%) of 1582 women (mean age 30.7±0.2 years), smoked during pregnancy, of whom 143 (76.5%) smoked throughout pregnancy, and 58 (31.0%) smoked >10 cigarettes/day. Compared with those born to nonsmoking mothers, the odds of hypertension in early adolescence were 1.44 (95% CI, 1.01-2.06) if mothers ever smoked, 1.99 (1.22-3.24) if mothers smoked >10 cigarettes/day, and 1.64 (1.11-2.42) if mothers smoked throughout pregnancy There was limited evidence of associations between smoking throughout pregnancy and other cardiovascular measures. Offspring of mothers who stopped smoking during pregnancy and nonsmokers had similar cardiovascular measures, apart from hypertension., Conclusions: Offspring of mothers who smoked in pregnancy have increased risks of hypertension in adolescence, with increased risk with greater exposure intensity and duration. Mothers who stopped smoking during pregnancy had offspring with similar cardiovascular health to those born to nonsmokers. Our findings underscore the importance of specific strategies to stop maternal smoking before conception and during pregnancy.

Objectives: Lifestyle factors play a significant role in the development of chronic diseases. While researchers have extensively studied individual lifestyle components, the combined impact of multiple lifestyle factors on rheumatoid arthritis (RA) remains unclear. This study aimed to explore the association between a Combined Healthy Lifestyle Score (CHLS) and the odds of developing RA among Iranian adults., Design: A nested case-control study., Setting: The study was conducted in Dena County (Sisakht region) near Yasuj city, Iran, as part of the PERSIAN Cohort Study., Participants: 130 RA cases and 260 matched controls, aged 35-70 years. Cases were identified based on biochemical tests and rheumatologist consultation., Outcome Measures: Primary outcome was the odds of RA. Secondary outcomes included anthropometric measurements (body mass index (BMI), waist circumference) and dietary quality indicators., Methods: The CHLS score was calculated based on four parameters: smoking status, physical activity level, BMI and dietary quality, as assessed by the Healthy Eating Index-2020. Scores ranged from 0 (representing the unhealthiest lifestyle) to 4 (representing the healthiest lifestyle). Multiple logistic regression analysis was used to evaluate the association between CHLS and the odds of developing RA., Results: Participants with higher CHLS exhibited significantly lower BMI and waist circumference compared with those with lower scores. Additionally, higher CHLS was associated with greater consumption of fruits and whole grains (p<0.05). Individuals with the highest CHLS had 90% lower odds of developing RA compared with those with the lowest scores (OR 0.105; 95% CI 0.024 to 0.461, p trend=0.001), after adjusting for potential confounders., Conclusions: Our findings suggest that adherence to a healthy lifestyle-characterised by non-smoking, regular physical activity, maintaining a normal BMI and following a healthy dietary pattern-is associated with reduced odds of developing RA among Iranian adults. The results of this study underscore the potential importance of combined lifestyle modifications in the prevention of RA. These insights emphasise the value of promoting comprehensive lifestyle changes as a strategy to mitigate RA risk., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Tobacco smoking remains the leading preventable cause of death, whereas chronic pain is the leading cause of disability. Chronic pain and tobacco smoking are closely interrelated. We investigated whether pain predicts daily cigarette smoking and if daily cigarette smoking predicts the development of pain., Methods: We analyzed eight years of longitudinal data from the Population Assessment of Tobacco and Health study. We examined whether baseline pain (scored ≥4 on a 0-10 scale) predicts transition to daily smoking among individuals who do not smoke, and whether baseline daily smoking predicts the development of pain among those with no/low pain (scored 0-3). The pain and smoking outcomes were only included in the survival analysis if they persisted consistently throughout all subsequent years after the initial onset. Our analysis incorporated survey population controlled for alternative tobacco product use, gender, age categories, and race/ethnicity., Results: Among the 32,320 participants, 49.5 % were women, the largest age cohort was 18-24 (28.2 %). Racial and ethnic distribution was 73.9 % White, 15.6 % Black, and 17.2 % Hispanic. Survival analysis revealed that baseline pain (scored ≥4) significantly increased the risk of transitioning to daily smoking (HR=2.40, 95 % CI=1.62-3.55, p < 0.001, n = 5731). Further, daily smoking at baseline was associated with an increased risk of developing persistent pain (scored ≥4) over the study period (HR=2.00, 95 % CI=1.86-2.16, p < 0.001, n = 12,099)., Conclusion: This study provides evidence for the existence of a bidirectional relationship between chronic pain and cigarette smoking. Treatment strategies should consider this relationship early, aiming to prevent development of persistent pain at its earliest stages., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Joao P. De Aquino reports financial support was provided by National Institute on Drug Abuse. Julio C. Nunes reports financial support was provided by National Institute on Drug Abuse. Mehmet Sofuoglu reports financial support was provided by Veterans Integrated Services Network 1 Mental Illness Research Education and Clinical Center. Joao P. De Aquino reports a relationship with Boehringer Ingelheim Corp USA that includes: consulting or advisory. Joao P. De Aquino reports a relationship with Jazz Pharmaceuticals that includes: non-financial support. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier B.V.)

Introduction: Psychosocial and behavioral risk factors often co-occur in patients with type 2 diabetes (T2D). The clustering of these risk factors and their role in predisposing patients to cardiovascular complications is not well understood. This study aims to identify patient subgroups with distinct psychological and behavioral risk patterns and evaluate the long-term risk of cardiovascular complications associated with these risk patterns., Methods: A total of 24,467 patients with T2D were identified from the UK Biobank (mean age 59 years, 86.7 %white), used Latent Class Analysis (LCA) to distinguish risk patterns among observed psychosocial (social isolation, loneliness, high neuroticism, anxiety, and depression) and behavioral (smoking, alcohol consumption, sleep duration, diet quality, and physical inactivity) risk factors. the Cox proportional hazards model was applied to assess the association of the identified risk patterns and risk of coronary heart disease (CHD), stroke, and a composite CVD (CHD or stroke) accounting for age, age at T2D diagnosis, race, gender, Townsend Deprivation Index, anti-diabetes medications, lipid-lowering medications, and anti-hypertensive medications., Results: Three distinct latent classes were identified: a low-risk group (n = 8,227, 33.62 %), a high psychosocial risk group (n = 15,965, 65.25 %), and a high behavioral risk group (n = 275, 1.12 %). Over a median follow-up of 12 years, the fully adjusted model showed that the high psychosocial risk group had a significantly increased risk of CHD (HR = 1.16; 95 % CI 1.08, 1.24) and composite CVD (HR = 1.13; 95 % CI 1.06, 1.20)., Conclusion: The psychosocial risk pattern is significantly associated with the risk of CHD and CVD among patients with T2D. These findings emphasize the importance of integrating psychosocial support into tailored care strategies to mitigate cardiovascular risks in T2D patients., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.)

Rationale: Chronic lung diseases are associated with increased risk of mortality due to coronary heart disease (CHD). Nonetheless, the population attributable fraction (PAF) of lung function impairment relative to other established cardiovascular risk factors is unclear. Objectives: To evaluate the PAF of low lung function for CHD mortality Methods: We harmonized and pooled lung function and clinical data across eight U.S. general population cohorts. Impaired lung function was defined as forced expiratory volume in 1 second (FEV 1 ) and/or forced vital capacity ≤ 95% predicted on baseline spirometry. The association between CHD mortality and risk factors was assessed using cause-specific proportional hazards and Fine-Gray proportional subdistribution hazard models, treating non-CHD mortality as a competing risk. Models were adjusted for lung function as well as age, sex, race/ethnicity, educational attainment, body mass index, smoking status, pack-years of smoking, diabetes mellitus, high-density lipoprotein, and high low-density lipoprotein (≥130 mg/dl). PAF was calculated as the relative change in the average absolute risk of 10-year CHD mortality by elimination of lung function lower than 95% predicted. Results: Among 35,143 participants, 1,844 of 13,174 (14.0%) deaths were due to CHD. Compared with percentage predicted FEV 1 (FEV 1 pp) > 95%, the subdistribution adjusted hazard ratio for low FEV 1 pp was 1.30 (95% confidence interval, 1.18-1.44). The PAF for FEV 1 pp ≤ 95% was 12%, ranking low FEV 1 third on the list of PAF for CHD mortality, after hypertension and diabetes. Low FEV 1 pp ranked second in the subgroup of active smokers (PAF 14%), after hypertension. Conclusions: Low lung function, even in the range considered clinically normal, ranks high on the list of attributable risk factors for CHD mortality and should be considered in cardiovascular risk stratification.

Introduction: This longitudinal study aimed to explore the impacts of adopting a healthy lifestyle on self-reported physical and mental health outcomes among Australian females who are living with stroke., Methods: The study utilized data retrieved from the Australian Longitudinal Study on Women's Health's 1946-51 cohort (from survey 5 conducted in 2007 to survey 9 conducted in 2019), focusing on 531 female stroke survivors. The dependent variables for this study were self-reported physical and mental health status, whereas the independent variables were lifestyle behaviors, including physical activity, smoking, alcohol consumption, and supplement use. Generalized Estimating Equation models were employed to assess the longitudinal associations between a dependent variable and the independent and confounding variables., Results: The average age of the participants was 58.1 (SD = 1.4) years in survey 5 and 70.5 years in survey 9. The longitudinal analyses revealed that stroke survivors who engaged in moderate/high levels of physical activity had significantly better physical and mental health status than their inactive or sedentary counterparts. Besides, current smokers had significantly poorer physical and mental health status than nonsmokers. In addition, risky/high-risk alcohol consumers had significantly poorer mental health status compared to no/low-risk alcohol consumers., Conclusions: Our findings suggest that post-stroke individuals can improve their physical and mental health by maintaining a healthy lifestyle. Specifically, targeted and appropriate programs and strategies are needed to promote physical activity and reduce smoking and alcohol consumption in female stroke survivors in order to optimize their overall health and quality of life.

Background: Modifiable lifestyle factors are implicated as risk factors for neurological and psychiatric disorders, but whether these associations are causal remains uncertain. We aimed to evaluate associations and ascertain causal relationships between modifiable lifestyle factors, neurological and psychiatric disorder risk, and brain structural magnetic resonance imaging (MRI) markers., Methods: We analyzed data from over 50,000 UK Biobank participants with self-reported lifestyle factors, including alcohol consumption, smoking, physical activity, diet, sleep, electronic device use, and sexual factors. Primary outcomes were stroke, all-cause dementia, Parkinson's disease (PD), Major depression disorder (MDD), Anxiety Disorders (ANX), and Bipolar Disorder (BIP), alongside MRI markers. Summary statistics were obtained from genome-wide association studies and Mendelian randomization (MR) analyses investigated bidirectional associations between lifestyle factors, neurological/psychiatric disorders, and MRI markers, with mediation assessed using multivariable Mendelian randomization (MVMR)., Results: Cross-sectional analyses identified lifestyle factors were associated with neurological and psychiatric disorders and brain morphology. MR confirmed causal relationships, including lifetime smoking index on Stroke, PD, MDD, ANX and BIP; play computer games on BIP; leisure screen time on Stroke and MDD; automobile speeding propensity on MDD; sexual factors on MDD and BIP; sleep characteristics on BIP and MDD. Brain structure mediated several lifestyle-disorder associations, such as daytime dozing and dementia, lifetime smoking and PD and age first had sexual intercourse and PD., Conclusion: Our results provide support for a causal effect of multiple lifestyle measures on the risk of neurological and psychiatric disorders, with brain structural morphology serving as a potential biological mediator in their associations., Competing Interests: Declaration of competing interest The authors declare no competing financial interests., (Copyright © 2024. Published by Elsevier B.V.)

Background: Clozapine is effective for treatment-resistant schizophrenia and bipolar disorder but is often discontinued due to adverse effects. This study compared early clozapine discontinuation rates and reasons in patients with mood and psychotic disorders., Methods: Data from all individuals with mood or psychotic disorders who initiated clozapine for the first time at the inpatient psychiatric unit of Mayo Clinic, Rochester, Minnesota, between 2014 and 2022 were retrospectively analyzed. Early clozapine discontinuation, defined as discontinuation within 90 days of initiation, was the primary outcome. Cox proportional hazards regression was used to assess factors associated with discontinuation., Results: Of 83 patients (mood group n = 37, psychosis group n = 46), those in the mood group were older ( P = 0.022) and more likely to be nonsmokers ( P = 0.034). The overall 90-day clozapine discontinuation rate was 45.7%. Early discontinuation was significantly higher in the mood group than in the psychosis group (hazard ratio = 2.41, 95% confidence interval = 1.26-4.64, P = 0.008). Other factors associated with early discontinuation were female sex ( P = 0.033), older age ( P = 0.026), and nonsmoking ( P = 0.001). In multivariable analysis, smoking status was the only factor significantly inversely associated with early clozapine discontinuation (hazard ratio = 0.47, 95% confidence interval = 0.22-0.99, P = 0.048), while diagnostic group, sex, and age did not show significant associations (all P > 0.05). Discontinuations were primarily due to adverse drug reactions in both groups., Conclusions: Nearly half of the patients discontinued clozapine early, with higher rates in the mood group. Studies should further explore potential pharmacodynamic and pharmacokinetic factors associated with discontinuation, including the influence of smoking. Careful monitoring and personalized management of side effects are crucial for optimizing clozapine therapy and improving treatment outcomes., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Aims: Vaping products are diverse with a wide variety of features, and popular products change rapidly. This study examined the features and types of vaping products that people who smoke and/or vape perceive contribute to the health harms of vaping., Design, Setting and Participants: This was a cross-sectional survey co-designed with adults who smoked/vaped and pre-registered. An on-line survey (November 2022) was used of a convenience sample of adults in the United Kingdom who smoked and/or vaped (n = 494)., Measurements: As primary outcomes, respondents were asked to select any of 15 vaping product features they perceived might have any effect on the health harms of vaping (for each: selected, not selected). Independent variables were smoking/vaping status (smoke and vape; vape, formerly smoked; vape, never regularly smoked; smoke, do not currently vape); relative vaping harm perceptions [less harmful than smoking (accurate), equally/more harmful than smoking or do not know/refused (other)]. Binary logistic regressions were used to compare outcomes by current vaping/smoking status and relative harm perceptions, adjusting for age and sex., Findings: Most people (54.7%) selected between one and three features. The most frequently selected were nicotine concentration (62.2%) and amount of e-liquid consumed (59.1%), followed by nicotine type (e.g. salt or freebase; 33.0%), source/purchase location (25.3%), flavours (24.7%), temperature to heat e-liquid (21.1%), heat produced by device (20.9%), e-liquid brand (20.9%), amount of emissions (18.6%), device type (e.g. disposable, pod, tank; 17.2%), material of tank (17.0%), power/wattage (13.0%), device brand (8.1%), device size (4.1%) and device weight (2.4%). Higher nicotine concentrations, more e-liquid and salt (versus freebase) nicotine were perceived to confer greater harms. Disposables were perceived as slightly more harmful than reusable devices. There were few differences by current vaping/smoking status and between those with accurate (versus other) harm perceptions of vaping relative to smoking (P > 0.05 for most contrasts, adjusting for age and sex)., Conclusions: Certain features and types of vaping products [higher nicotine concentrations, more e-liquid consumed and salt (versus freebase) nicotine] were perceived to confer greater health harms among a sample of UK adults who smoked and/or vaped. Findings are consistent with pervasive misperceptions that nicotine is a major cause of harm, although e-liquid volume is likely to contribute to harms., (© 2024 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Aims: To provide data on prevalence and trends in the use of different types of e-cigarettes (disposable, pod, tank) in Germany (a country with high smoking prevalence of approximately 30%) from 2016 to 2023, and to analyse the characteristics and smoking behaviours of users of these types., Design: A series of nationally representative cross-sectional face-to-face household surveys., Setting: General population of Germany, 2016-2023., Participants: A total of 92 327 people (aged ≥14 years) of which 1398 reported current use of e-cigarettes., Measurements: Type of e-cigarette usually used (single choice: disposable, pod, or tank), person characteristics, and smoking/vaping behaviour., Findings: E-cigarette use in the population of Germany has increased from 1.6% (95% confidence interval [CI] = 1.1,2.2) in 2016 to 2.2% (95% CI = 1.6,3.0) at the end of 2023. Disposable e-cigarette use has increased in this period from 0.1% (95% CI = 0.0,0.3) to 0.8% (95% CI = 0.4,1.8). Pod type use exhibited the most stable trend, with a steady rise to 0.6% (95% CI = 0.4,0.9) in 2023. Tank e-cigarette use peaked at 1.6% (95% CI = 1.3,1.9) in November 2017, declined to 0.7% (95% CI = 0.6,0.9) in December 2020, and has since remained constant at 0.8% (95% CI = 0.6,1.0). Disposable e-cigarette users were on average 3.5 and 4.1 years younger than tank and pod users, respectively. They were more likely than tank users to be female, non-daily users, and dual users of tobacco. In the subgroup of dual users, there were no significant differences with regard to urges to smoke, cigarettes smoked per day, motivation to stop, and attempts to stop smoking between users of disposables and other types., Conclusions: The use of e-cigarettes has increased in Germany from 2016 to 2023, especially that of disposable e-cigarettes, which are now the most commonly used type with a prevalence rate of 0.8%. However, the use of e-cigarettes is still much lower compared with tobacco smoking., (© 2024 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Introduction: Primary care delivery in the United States, including tobacco treatment, was negatively impacted by the COVID-19 public health emergency, leading to pandemic-related cessation disparities. Early in the public health emergency, rates of tobacco assessment during telehealth visits were substantially lower than during in-person visits. It is unknown if these changes persisted., Methods: Electronic health record data were extracted and analyzed in 2024 from adult patients with ≥1 primary care visit to a primary care community-based health clinic between 01/01/2019 and 05/31/2023 (N=1,792,934 patients from 541 clinics in 17 states). The monthly percentage of visits with smoking assessment (yes/no) were examined overall and by visit modality., Results: Prior to March 2020, <1% of visits were via telehealth. In the months following, >50% were via telehealth, leveling to 25% in the later study months. Prior to the public health emergency, >95% of all visits included smoking assessment; the highest monthly percentage after the public health emergency declaration was 77%. For in-person visits, assessments occurred at >95% of visits in each study month prior to March 2020, with subsequent percentages ranging from 46% (April 2020) to 95% (May 2023). In contrast, assessment during telehealth visits reached a maximum of 9% in late 2022., Conclusions: Smoking assessment remained consistently lower during the public health emergency compared with the months prior, primarily driven by lack of assessment during telehealth visits. Concerted efforts are needed to ensure that telehealth visits are leveraged to promote equitable smoking assessment and delivery of evidence-based tobacco treatment among a patient population with high rates of tobacco use., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To examine cardiovascular risk factors in 40-year-old participants in the health screening program targeted health dialogues (THDs)., Design: Cross-sectional study., Setting: 99 Swedish healthcare centers., Intervention: Metabolic risk factors and health behaviors were assessed. THDs were provided., Subjects: 1831 (62.3%) THD participants that consented to take part in the research project., Main Outcome Measures: (1) Prevalence of metabolic risk factors (blood pressure, LDL cholesterol, fasting plasma glucose, BMI, waist-hip ratio) and unhealthy behaviors (tobacco, alcohol, diet, physical activity) by sex, education, and place of birth. (2) Associations between different health behaviors and between the number of unhealthy behaviors and prevalence of metabolic risk factors. (3) THD participation by sociodemographics compared to age-matched controls., Results: Men had a higher prevalence of all metabolic risk factors, excessive alcohol use and tobacco use than women. Lower educated individuals had a higher prevalence of metabolic risk factors (except for LDL cholesterol) and tobacco use than highly educated. Participants born outside Sweden had a higher prevalence of obesity, high waist-hip ratio, and tobacco use. Participants with 3-4 unhealthy behaviors had significantly higher prevalence of each of the metabolic risk factors except BMI. Women, highly educated and Swedish-born participants were slightly over-represented in the THDs., Conclusion: Considering the associations between unhealthy behaviors and metabolic risk factors, the THD method, covering lifestyle as well as objective health measures, may be an appropriate method for early identification of individuals at risk for future non-communicable diseases in the whole population with a specific focus on certain groups., Clinicaltrials.gov: NCT04912739.

Background: Increased lung cancer risks for low socioeconomic status (SES) groups are only partially attributable to smoking habits. Little effort has been made to investigate the persistent risks related to low SES by quantification of potential biases., Methods: Based on 12 case-control studies, including 18 centers of the international SYNERGY project (16,550 cases, 20,147 controls), we estimated controlled direct effects (CDE) of SES on lung cancer via multiple logistic regression, adjusted for age, study center, and smoking habits and stratified by sex. We conducted mediation analysis by inverse odds ratio weighting to estimate natural direct effects and natural indirect effects via smoking habits. We considered misclassification of smoking status, selection bias, and unmeasured mediator-outcome confounding by genetic risk, both separately and by multiple quantitative bias analyses, using bootstrap to create 95% simulation intervals (SI)., Results: Mediation analysis of lung cancer risks for SES estimated mean proportions of 43% in men and 33% in women attributable to smoking. Bias analyses decreased the direct effects of SES on lung cancer, with selection bias showing the strongest reduction in lung cancer risk in the multiple bias analysis. Lung cancer risks remained increased for lower SES groups, with higher risks in men (fourth vs. first [highest] SES quartile: CDE, 1.50 [SI, 1.32, 1.69]) than women (CDE: 1.20 [SI: 1.01, 1.45]). Natural direct effects were similar to CDE, particularly in men., Conclusions: Bias adjustment lowered direct lung cancer risk estimates of lower SES groups. However, risks for low SES remained elevated, likely attributable to occupational hazards or other environmental exposures., Competing Interests: Disclosure: The authors do not declare any conflict of interest. J.H., B.K., T. Brüning, and T. Behrens, as staff of the Institute for Prevention and Occupational Medicine (IPA), are employed by the study’s main financing body, the German Social Accident Insurance. IPA is an independent research institute of the Ruhr-University Bochum. The authors are independent of the German Social Accident Insurance in study design, access to the collected data, responsibility for data analysis and interpretation, and the right to publish. The views expressed in this article are those of the authors and not necessarily those of the sponsor. Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policies, or views of the International Agency for Research on Cancer/World Health Organization., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: Recent recognition of the importance of abnormal spirometry without obstruction has generated interest in its epidemiology, risk factors, longitudinal outcomes, and clinical implications., Recent Findings: Preserved ratio impaired spirometry (PRISm), defined as an forced expiratory volume in 1 s (FEV 1 )/ forced vital capacity (FVC) ≥0.7 with an FEV 1 <80% predicted, has a high prevalence globally (2.4-16.7%) and is more common in individuals with metabolic comorbidities, smoking history, female sex, and higher BMI. PRISm is associated with increased respiratory symptoms and poor clinical outcomes such as increased all-cause mortality and cardiovascular events compared to normal spirometry. Longitudinal studies show substantial subsets of individuals with PRISm will transition to other spirometric categories, including progression to obstruction. Individuals with PRISm are heterogeneous; recent investigations have focused on subtyping PRISm based on spirometric features or pathobiologically-based phenotypes., Summary: PRISm is a common spirometric abnormality which is robustly associated with negative outcomes. However, current knowledge gaps with respect to heterogeneity, specific etiologies, and longitudinal progression preclude the development of universal evidence-based diagnostic and management strategies. At present, clinicians are advised to focus on risk factor modification (e.g., diabetes, obesity) and the identification of actionable traits (e.g. emphysema, interstitial lung abnormalities) among patients with PRISm., (Copyright © Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Objective: The current medical landscape lacks comprehensive data regarding the impact of preoperative smoking status on both short and long-term outcomes for patients undergoing carotid endarterectomy (CEA). This study seeks to elucidate the influence of smoking cessation on in-hospital and long-term outcomes in this patient population., Methods: Data were collected from the Vascular Quality Initiative for all asymptomatic patients who underwent CEA from 2016 to 2023. Outcomes were compared across three different smoking status groups: never smoke (NS), current smoker (CS), and quit >30 days ago. Our primary outcomes included in-hospital stroke, death, and myocardial infarction. Secondary outcomes included 1-year and 3-year death. We used inverse probability of treatment weighting to balance the following preoperative factors: age, gender, race, ethnicity, body mass index, diabetes, coronary artery disease, prior congestive heart failure, renal dysfunction, chronic obstructive pulmonary disease, hypertension, prior coronary artery bypass grafting/percutaneous coronary intervention, prior CEA/carotid artery stenting, degree of stenosis, urgency, anesthesia type, and medications., Results: The final analysis included 85,237 CEA cases with 22,343 NS (26.2%), 41,731 who quit >30 days ago (49.0%) , and 21,163 CS (24.8%). Notably, NS tended to be older and more likely to be female. In contrast, patients who quit >30 days ago were more likely to have comorbidities, including obesity, coronary artery disease, prior congestive heart failure, and CKD, as well as prior procedures. Patients who are CS were more likely to have chronic obstructive pulmonary disease and stenosis of >80%. After inverse probability of treatment weighting, we found no statistical difference for in-hospital stroke, death, myocardial infarction outcomes across the three groups. However, the long-term outcomes revealed quit >30 days ago and CS compared with NS had higher odds of 1-year death (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-1.5; P < .001; OR, 1.4; 95% CI, 1.2-1.6; P < .001) and 3-year death (OR, 1.5; 95% CI, 1.3-1.6; P < .001; OR, 1.5; 95% CI, 1.4-1.7; P < .001), respectively. There was no significant difference in midterm mortality outcomes between those who quit >30 days ago and CS., Conclusions: In this large national study, we found that smoking status did not emerge as a substantial determinant of adverse short-term outcomes for asymptomatic patients undergoing CEA. However, smoking did adversely affect midterm mortality in these patients. In light of these findings, our study suggests that delaying CEA for smokers may not be warranted. It is crucial to recognize that the complex relationship between smoking and surgical outcomes requires further exploration and validation through additional prospective studies., Competing Interests: Disclosures None., (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: Persistent smoking after cancer diagnosis causes adverse outcomes while smoking cessation can improve survival. Thus, integration of smoking assessment and cessation assistance into routine cancer care is critical. Aiming for incremental practice change that could be sustained and built upon through future quality improvement (QI) projects, the American College of Surgeons initiated Just ASK in 2022 to increase implementation of smoking assessment among its accredited Cancer Programs. This manuscript describes outcomes from Just ASK., Methods: Seven hundred sixty-two programs enrolled in this cohort study, followed Plan Do Study Act methodology, and used local QI teams to facilitate practice change. The primary outcome was the ask rate (ie, patients asked/patients seen). Programs completed three surveys across the 1-year study (89.8% retention), answering questions about their program plus organizational readiness, implementation barriers, implementation strategies, and clinical practices related to assessing smoking among patients newly diagnosed with cancer. Data analysis involved descriptive statistics and analysis of change over time (eg, McNemar chi-squares)., Results: Programs (53.1% community-based) tended to report moderate organizational readiness, multiple implementation barriers, and adoption of 4.63 ± 1.49 of eight possible implementation strategies (eg, training staff/providers). Programs reported frequency of assessing smoking status, documenting it in the electronic health record, advising patients who smoke to quit, and documenting advice and treatment increased over time (all P < .001). The ask rate increased from baseline to mid to final survey ( P < .01; 87.79% v 88.65% v 91.92%, respectively)., Conclusion: Just ASK is the latest, and by far the largest, endeavor to improve assessment of cancer patients' smoking status. Participants reported significant advances within a short time span and study results underscore the potential for national accreditation organizations to transform oncology practice.

Background: Understanding factors influencing electronic cigarette (e-cigarette) trial in adolescents is crucial for shaping policies and interventions to reduce consumption and potentially prevent addictive tendencies, particularly in countries with weak regulations like Guatemala., Objective: We aimed to longitudinally assess predictors of e-cigarette trial among Guatemalan adolescents surveyed in 2019, 2020, and 2021., Methods: Students (13 to 18 years old) from nine private schools completed self-administered questionnaires about e-cigarette use and associated risk factors. Data from those who had at least one follow-up survey after reporting that they had never tried e-cigarettes at either the 2019 or 2020 survey (N = 838) was analyzed. We used a mixed-effects logistic regression clustered by student and school to assess predictors of ever e-cigarette use., Results: Nearly one-quarter (21.0 %) of unique students tried e-cigarettes at follow-up. Risk factors for e-cigarette trial included cigarette or heated tobacco products use (adjusted odds ratio [AOR] = 2.95, 95 %CI = 1.24-7.04), frequent exposure to online e-cigarette marketing (AOR = 2.46, 95 %CI = 1.39-4.35), alcohol or marihuana use (AOR = 1.74, 95 %CI = 1.17-2.58), and parental approval of e-cigarette use (AOR = 1.65, 95 %CI = 1.14-2.40). The perception that serious illness from life-long e-cigarette use is likely or certain (AOR = 0.57, 95 %CI = 0.36-0.91, and AOR = 0.37, 95 %CI = 0.19-0.72, respectively) appeared as a protective factor for e-cigarette trial., Conclusion: Our findings align with international research, indicating shared risk factors across youth worldwide. The incorporation of these factors into policies and interventions targeting the reduction of e-cigarette trial is imperative for optimizing their efficacy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Perianal draining tunnels in hidradenitis suppurativa (HS) and perianal fistulizing inflammatory bowel disease (IBD) present diagnostic and management dilemmas., Methods: We conducted a retrospective chart review of patients with perianal disease evaluated at Mayo Clinic from January 1, 1998, through July 31, 2021. Patients' demographic and clinical data were extracted, and 28 clinical features were collected. After experimenting with several machine learning techniques, random forests were used to select the 15 most important clinical features to construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD., Results: A total of 263 patients were included (98 with HS, 100 with IBD, and 65 with both IBD and HS). Patients with HS had a higher mean body mass index, a higher smoking rate, and more commonly showed cutaneous manifestations of tunnels and comedones, while fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD. In addition to having lesions in the perianal area, patients with IBD often had lesions in the buttocks and perineum, while those with HS had additional lesions in the axillae and groin. Among the statistically significant features, the 15 most important were identified by random forest: fistula, tunnel, digestive symptom, knife-cut ulcer, perineum, body mass index, age, axilla, abscess, tags, smoking, groin, genital cutaneous edema, erythema, and bilateral/unilateral., Conclusions: The results of this study may help differentiate perianal lesions, especially perineal HS and fistulizing perineal IBD, and provide promise for a better therapeutic outcome., (© 2024 the International Society of Dermatology.)

Objective: To analyze the impact of individual and combined healthy behaviors on all-cause and premature mortality risk in Mexican adults., Methods: Data on physical activity, fruit and vegetable intake, sleep hours, alcohol intake, and smoking from 95,142 adults from the MCPS (Mexico City Prospective Study) were used. All-cause mortality was monitored for up to 22 years, until December 31, 2020. Cox proportional hazards regression was used to assess mortality risk., Results: Physical activity (HR, 0.88; 95% CI, 0.84 to 0.92), fruit and vegetable intake (HR, 0.94; 95% CI, 0.91 to 0.98), no excessive alcohol consumption (HR, 0.86; 95% CI, 0.81 to 0.92), and not smoking (HR, 0.93; 95% CI, 0.89 to 0.97) were individually associated with lower mortality. All-cause mortality risk decreased progressively by 8% (95% CI: 0.86 to 0.99) to 29% (95% CI, 0.63 to 0.81) for each additional healthy behavior attained. Similarly, premature mortality risk decreased by 13% (95% CI, 0.80 to 0.95) to 30% (95% CI, 0.59 to 0.83)., Conclusion: Over 22 years, adopting a healthier life was linked with lower all-cause and premature mortality risk, decreasing with the clustering of one additional healthy behavior. Law and policy changes as well as efforts to address the root causes of not adopting healthy behaviors in low- and middle-income countries, such as creating structural conditions for people to engage in physical activity or strong social marketing to raise awareness of the daily consumption of fruits and vegetables, are needed for improving health and delaying mortality., (Copyright © 2024 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the association between U.S. adult cancer information seekers' comprehension level and preventable cancer risk factors., Design: Cross-sectional analysis., Setting: Health Information National Trends Survey-6, 2022., Subjects: 2,453 cancer information seekers., Measures: Four cancer risk factors were dichotomized: cigarette smoking (have smoked ≥100 cigarettes and currently smoke every day/some days); experiencing sunburn (≥1 times/past 12 months); being overweight/obese (≥25 body mass index [kg/m 2 ]); and binge drinking (≥5 [male] or ≥4 [female] alcoholic drinks on one occasion/past 30 days). Individuals who reported that cancer information was hard to understand were considered having comprehension difficulties., Analysis: Binomial and multinomial logistic regression analyses were conducted to examine the association of cancer information comprehension level with individual and cumulative cancer risk factors, adjusting for sex, race/ethnicity, age, annual household income, education level, metropolitan status, depressed mood, and cancer diagnosis history., Results: Cancer information seekers with comprehension difficulties had higher odds of binge drinking (aOR: 1.66, 95% CI: 1.12, 2.46), being overweight/obese (aOR: 1.46, 95% CI: 1.09, 1.96), and experiencing sunburn (aOR: 1.61, 95% CI: 1.23, 2.11), as well as having ≥3 (aOR: 3.38, 95% CI: 1.87, 6.09) cancer risk factors concurrently than cancer information seekers without comprehension difficulties., Conclusion: Dissemination of easy-to-understand cancer information would help better prevent cancer risk factors for cancer information seekers with comprehension difficulties., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Tobacco prices and income determine the affordability of cigarettes. Affordability in turn affects smoking prevalence. Both prices and incomes can vary widely across a large country. The aim of this paper is to find out whether there is an association between affordability of cigarettes and smoking/cessation prevalence across Russian regions. We assess the proportions of people who smoke and those who smoked and quit., Methods: We use microdata from a repeated survey on the living conditions of the Russian population that is representative at the regional level (2014, 2016, 2018, 2020, 2022, 77 regions). We aggregate the microdata by region and combine them with official macro data. Using descriptive and multivariable analyses, we identify factors that correlate with the prevalence of smoking and quitting in the regions., Results: A one per cent increase in real prices was associated with a 0.1% decrease in the smoking prevalence rate and with a 0.2% increase in quitting prevalence rate. A 1% decrease in real income is associated with a 0.5% increase in the proportion of those who quit. The more cigarettes that can be purchased for a daily per capita income, the higher the smoking prevalence rate and the lower the proportion of quitting, with affordability elasticities of 0.1 and -0.27 respectively., Conclusions: Rising real prices, as well as reduced affordability of cigarettes not only reduce the proportion of people who smoke, but also increase the proportion of those who quit. In a country with a large geographical spread and high regional income inequality, tobacco taxes should be set at the regional level to eliminate significant differences in the affordability of cigarettes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Background: Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are inflammatory diseases. These two entities often co-exist, but little is known about the prevalence of this phenomenon in patients with PAD. The objectives of this prospective cross-sectional study were to determine the prevalence of COPD in patients with PAD and to assess the frequency of COPD underdiagnosis in this group of patients. Patients and methods: Consecutive patients admitted to angiology department were evaluated. Measurements of ankle-brachial and toe-brachial index as well as peripheral arteriography were performed in all participants to confirm PAD. In tobacco smokers with PAD spirometry was performed to identified patients with COPD. Clinical information was obtained from the patients on the basis of questionnaires. Results: Eighty-eight out of 300 consecutive patients were included and assessed. COPD was diagnosed in 33 (37.5%) hospitalized smokers with PAD. COPD has not previously been diagnosed in 28 (84.8%) patients who met the criteria of the disease. Conclusions: There was high prevalence of COPD among tobacco smokers hospitalized in the angiology department. Most of them had never had spirometry performed before. The underdiagnosis rate is relatively high; therefore, all patients with PAD who smoke tobacco should have a spirometry performed, as a screening for COPD.

Objective: To evaluate the interaction between smoking status and operative approach following esophagectomy on perioperative outcomes., Methods: Patients undergoing esophagectomy for esophageal cancer between January 1, 2009, and December 31, 2022, were identified from the STS-GTSD database and divided into 6 groups based on smoking status-never (NS), former (FS), or current (CS)-and surgical approach-minimally invasive (MIE) or open (OpenE). Primary outcomes were respiratory complications, operative mortality, major morbidity, and composite major morbidity and mortality., Results: The final study population comprised 27,373 patients (28.3% NS, 68.0% FS, and 13.7% CS) from 295 hospitals. Most cases were OpenE (58.1%), but the proportion of MIE increased from 19.2% in 2009 to 56.3% in 2022. Multivariable analysis showed that (1) risk-adjusted operative mortality was decreased only in never-smokers who underwent MIE (MIE-NS: adjusted odds ratio [aOR], 0.61; 95% confidence interval [CI], 0.45-0.82), and; (2) there were no significant differences in mortality among the groups compared to the reference OpenE-NS group. Respiratory complications, major morbidity, and composite mortality and morbidity outcomes showed similar smoking and surgical approach effects. All outcomes were worse in smokers irrespective of approach, and within the same smoking status group, AORs for respiratory complications and morbidity were slightly lower in MIE versus OpenE, but these differences were nonsignificant., Conclusions: Respiratory complications and other major morbidity outcomes following esophagectomy are substantially worsened by smoking history, particularly in current smokers. Among NS, MIE is associated with reduced operative mortality., Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Tobacco use is known to affect incidence and postoperative outcome for several neurosurgical disorders, but its relationship to trigeminal neuralgia (TN) is not known. We sought to identify unique population characteristics that correlate with tobacco use in a cohort of patients with TN who underwent microvascular decompression (MVD), including effect on long-term postoperative outcome., Methods: Data about 171 patients with classic TN treated with MVD were obtained from a prospectively maintained registry. Patients were classified as smokers or nonsmokers based on the use of tobacco within the 6 months before surgery. Analysis of clinical characteristics and postoperative outcome was performed., Results: Compared with nonsmokers with TN, MVD patients using tobacco were significantly younger (53 vs 62 years, P < .01) and less likely to report pain in a single distribution of the trigeminal nerve (36% vs 65%, P < .01). There was no difference between smokers and nonsmokers in the presence of some degree of continuous pain, severity of neurovascular compression, sex, race, obesity, pain duration before presentation, immediate postoperative outcome, length of stay, or postoperative complication profile. Among 128 patients followed for at least 6 months, smokers were significantly less likely to be pain-free off medications at the last follow-up (36% vs 57%, P < .05)., Conclusion: In patients undergoing MVD for TN, smoking is associated with younger age of TN onset, more widespread facial pain, and worse long-term postoperative outcome after MVD. These features suggest that TN in smokers may represent a more severe disease form compared with TN in nonsmokers with different responses to treatment., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Community-acquired pneumonia (CAP) continues to be a cause of significant morbidity and mortality worldwide. Much recent attention in this area of research has been focused on host factors associated with the infection. This article will discuss 4 diverse, yet often coexistent conditions, namely, smoking, excessive alcohol use, diabetes mellitus, and metabolic syndrome. While all these conditions can be considered to be largely associated with lifestyle factors, they represent important risk factors for CAP. All can lead to acquired host immune suppression that underlies their risk for the development of severe CAP., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent chronic respiratory illness. Pentraxin-3 (PTX3) is abnormally elevated in the plasma of patients with acute exacerbation of COPD. However, the role and significance of PTX3 in the clinical diagnosis of COPD remain unclear., Objectives: This study was to explore the functional role of plasma PTX3 in COPD and its relationship with lung function metrics and influence on the severity of the disease., Methods: We prospectively recruited 170 patients with stable-stage COPD admitted to our hospital between June 2020 and May 2023 and healthy study participants as study participants. Based on their smoking history, all participants were classified into those with a history of smoking and those without a smoking history., Results: Stable-stage smoking-related COPD patients exhibited lower values for FEV1(% predicted) and reduced FEV1/FVC ratios, with increased values for smoking index, red cell distribution width, fibrinogen, d-dimer, white blood cell counts, neutrophil to lymphocyte ratio (NLR), Medical Research Council (mMRC) scores, COPD assessment test (CAT) score, and plasma PTX3 level. There was a positive correlation of PTX3 levels with mMRC and CAT scores and a negative correlation with FEV1 % predicted and FEV1/FVC. Increased smoking index and plasma PTX3 and NLR were independent risk factors for exacerbation in stable smoking-related COPD patients. The area under the curve (AUC) for plasma PTX3 in predicting severe COPD was 0.831., Conclusions: A plasma PTX3 level > 246.2 ng/mL could be a valuable indicator for predicting exacerbations in patients with stable-stage smoking-associated COPD exacerbation., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024. Published by Elsevier Inc.)

Objective: This study investigated the impact of 2019 coronavirus disease (COVID-19) lockdowns on alcohol consumption and smoking behavior among young adults from Germany., Methods: An online survey was completed by N = 317 young adults living in Germany. Of these, 140 (44.2%) consumed alcohol and were included in the analysis. They reported on alcohol consumption, hangover frequency and severity, and smoking behavior across four time periods: (1) "BP" (the period before the COVID-19 pandemic), (2) "L1" (the first lockdown; March-May, 2020), (3), NL1 (the no lock-down period; summer 2020), and (4) L2 (the second lockdown, November 2020 to May 2021)., Results: During L1, a significant decrease was observed in weekly alcohol intake, the number of drinking days, and the number of days where more than eight alcoholic drinks were consumed. Whereas hangover frequency was significantly increased during L1, hangover severity was significantly reduced. During NL1, drinking behaviors returned to BP levels. During L2, the decrease in alcohol consumption was much smaller, and not significantly different from BP. However, compared to BP, during L2 hangover frequency was significantly increased and hangover severity was significantly reduced. With regards to smoking, no significant differences compared to BP were found., Conclusions: During the COVID-19 lockdown periods in Germany, a significant decrease in alcohol consumption was observed among this group of young adults. Whereas hangover frequency was significantly increased during the lockdown periods, hangover severity was significantly reduced., (© 2025 The Author(s). Human Psychopharmacology: Clinical and Experimental published by John Wiley & Sons Ltd.)

Background: Public health research and prevention policies often use the small area Index of Multiple Deprivation (IMD) at neighbourhood level to proxy individual socio-economic status because it is readily available. We investigated what household income adds to IMD in early childhood for predicting adverse health in adolescence., Methods: Using data from the Millennium Cohort Study, we analysed IMD and self-reported equivalised household income (ages 0-5) to predict outcomes at age 17: poor academic achievement, psychological distress, poor health, smoking, and obesity. Predictions were compared using IMD quintile groups alone, household income quintile groups alone, and both together., Results: Household income was a stronger and more consistent predictor of age 17 outcomes than IMD and revealed inequalities within neighbourhoods. Decreasing household income showed steep gradients in educational attainment and smoking across all IMD quintiles, and moderate gradients in obesity, psychological distress and poor health in most quintiles. IMD did not predict smoking or psychological distress within any income group, or educational attainment within the poorest income group., Conclusions: Household income is associated with inequality gradients within all quintiles of neighbourhood IMD. Early childhood public health strategies should consider household income in combination with neighbourhood deprivation., (© The Author(s) 2024. Published by Oxford University Press on behalf of Faculty of Public Health.)

Background: The COVID-19 pandemic has had repercussions in several areas. The indirect effects of the pandemic on healthy living behaviours are multiple and complex to assess. The aim is to assess the impact of the outbreak of COVID-19 pandemic in Italy on the most relevant modifiable behaviours risks for non-communicable diseases (NCDs)., Methods: PASSI 2008-2023 data referring to a sample of 18-69-year-olds residing in Italy was used to estimate the prevalences of smoking, alcohol, fruit and vegetable consumption, and physical inactivity lifestyle. For each of these risks was used an interrupted time series (ITS) study with Generalized Least Squares (GLS) model to assess trends before and after the pandemic's outbreak in Italy (March 2020). The "intervention" period is postulated as March 2020, and the "post-intervention" period extends from April 2020 to December 2023. In these models, the hypothetical situation without "intervention" and with the trend remains unchanged is commonly known as the 'counterfactual' scenario. Through ITS model both "counterfactual data" and "factual data" were obtained., Results: From 2008 to 2023, 532,115 people were interviewed. Results showed, during "post-intervention" period, significant differences between factual and counterfactual prevalences started in 2022 and strengthened during 2023 and for all of the four behavioural indicators analysed: smoking, high-risk alcohol consumption, fruit and vegetable consumption (both all three of them worsening) and physical inactivity (which appears to decrease). Current smokers exhibited similar prevalences in March 2020 (24.5% vs. 24.3%), followed by a plateau throughout the entire 'post-intervention' period. By December 2023, however, the counterfactual prevalence was significantly lower than the observed rate (24.5% factual vs. 22.7% counterfactual). The initial improvement observed in the prevalence of high-risk drinkers in March 2020 (13% factual vs. 17% counterfactual) was followed by a rapid worsening and in December 2023 the prevalence was significantly higher than expected (19.7% vs. 16.9%). The fruit and vegetable consumption worsened and the factual prevalence of five-a-day in December 2023 was significantly lower than counterfactual (6.6% vs. 9.0%). Physical inactivity following an initial worsening in March 2020 (albeit not statistically significant), appeared to decrease in December 2023, with the factual prevalence lower than counterfactual (26.9% vs. 32.4%)., Conclusions: Results found in this article showed at the end of studied period the achievement of a plateau for current smokers, a worsening in the high-risk alcohol consumption, in fruit and vegetable intakes and a reduction in physical inactivity. Understanding shifts in these lifestyle indicators is crucial for the proper design of interventions aimed at reducing the burden of NCDs., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Istituto Superiore di Sanità (the protocol number of the final opinion is CE-ISS 06/158—8 March 2007 for PASSI). Informed consent was obtained from all subjects involved in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The incidence of congenital malformations (CM) among non-Hispanic White American (NHWA) mothers was reviewed to identify and evaluate the geographic differences in the most frequent CM subtypes associated with smoking and other risk factors. Data on CM were obtained from 150,775 children (2000-2004) from the Centers for Disease Control and Prevention. Risk factors associated with CM development were the mother's age < 21 and > 35 years, body weight gain during pregnancy, anemia, diabetes mellitus, eclampsia (cases of preeclampsia were omitted), smoking, and alcohol use during pregnancy. Among smoking mothers, the most common CM was omphalocele, club foot, cleft lip, and polydactyly. The highest incidences (CM/10,000 births/year) of observed CM in children of smoking mothers were clubfoot, 25.51 cases (Utah), cleft lip, 22.47 (South Dakota), polydactyly, 21.23 (North Dakota), and omphalocele, 13.14 (Montana). The presence of maternal comorbidities, tobacco and alcohol consumption, and their association with other environmental factors can affect the incidence of CM in NHWA mothers. Further comparisons among the American states regarding the overall changes in CM over the last two decades should uncover crucial outcomes in terms of CM and smoking.

Background: Ultrafine particles are present in ever greater quantities in the workplace and only one epidemiological study to date has found an association with the occurrence of lung cancer., Objective: To investigate the effect of occupational exposure to ultrafine particles on the risk of lung cancer., Methods: The ARDCO is a surveillance program involving retiree workers who had been exposed to asbestos during their working life. Exposure to ultrafine particles over the complete lifetime occupational history was assessed using the French job exposure matrix MATPUF. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI)., Results: There was no association between exposure to ultrafine particles and lung cancer after adjustment for smoking and exposure to asbestos and crystalline silica., Conclusion: The findings do not indicate increased risks of lung cancer for UFP after adjustment for level of exposure to asbestos, crystalline silica, and smoking status., Clinical Trial Number: Not applicable., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the hospital ethics committee (CCPPRB Paris-Cochin n° 1946 2002), CCP Ile-de-France III, no 1946/11/02–02 (2010)). All participants received information on the study and provided their written informed consent. Participants gave informed consent to participate in the study before taking part. All study procedures were performed in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The tobacco epidemic is one of the biggest threats to public health globally. This study evaluates the prevalence of smoking among Iranian university students., Methods: A comprehensive search was conducted in international databases (Web of Science, Scopus, PubMed) and domestic databases (Magiran, SID, Irandoc). Cross-sectional studies in Farsi and English from 2012 to 2023 were included. The Newcastle-Ottawa scale was used to assess the quality of the articles. Heterogeneity was examined using Cochran's test and the I 2 index. Due to high heterogeneity, a random effects model was employed to estimate smoking prevalence, and a funnel plot was used to assess publication bias., Results: Out of 840 articles identified through the search, 149 records were removed as duplicates. Of the remaining 691 records screened for relevancy to the review question, 635 were excluded. Fifty-six reports were sought for full-text retrieval, and 54 full-text articles were successfully retrieved. However, 11 reports were excluded due to invalid data or insufficient information. Ultimately, 43 studies reporting the prevalence of smoking or the number of smokers in general, by gender, were included in the analysis. Specifically, 28 studies were included for males, 23 for females, and 43 for overall conditions. The overall prevalence of smoking was estimated to be 16% for both sexes combined, 26% for males, and 7% for females., Conclusions: The prevalence of smoking among male and female students is high. Due to the high heterogeneity of the studies, the results of this meta-analysis should be interpreted with caution., Trial Registration: The study is registered in Prospero with the code CRD42021240264., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Organizational Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.FNM.REC.1399.052). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Studies consistently demonstrate smoking is a socially contagious behavior, but less is known about the influence of social connections on vaping. This study examined associations between having close social connections who smoke or vape and relevant smoking and vaping outcomes., Aims and Methods: This was a representative cross-sectional survey of adults (≥16 years) in England. Participants (n = 1618) were asked how many people they discuss important matters with (ie, close social connections) and how many of them smoke/vape. We tested associations between (1) smoking and (2) vaping among close social connections and participants' own smoking and vaping status; harm perceptions of e-cigarettes (among current smokers); attempts and success in quitting smoking (among past-year smokers); and use of e-cigarettes as a smoking cessation aid (among past-year smokers who tried to quit)., Results: Adults with ≥1 close social connection who smoke were more likely than those with none to smoke themselves (32.8% vs. 9.4%; ORadj = 7.23[95% CI: 4.74 to 11.0]) and had an uncertain lower likelihood to quit (12.2% vs. 19.8%; ORadj = 0.46[0.17-1.23]). Those with ≥1 close social connection who vape were more likely than those with none to vape themselves (29.6% vs. 6.3%; ORadj = 5.16[3.15-8.43]) and to use e-cigarettes in their most recent attempt to quit (57.0% vs. 27.9%; ORadj = 18.0[1.80-181]), and had an uncertain higher likelihood to perceive e-cigarettes as less harmful than cigarettes (30.8% vs. 12.2%; ORadj = 2.37[0.82-6.90])., Conclusions: In England, we replicated well-established associations with smoking and found similar evidence for vaping. People were much more likely to vape and to use e-cigarettes to quit smoking if they had close social connections who vaped., Implications: The cross-sectional design means it is not clear whether smoking/vaping among close social connections influences people to smoke/vape themselves, or whether people who smoke/vape select to form close social connections with others who similarly smoke/vape. Further research is required to establish causality. If the associations we observed are causal, interventions that encourage smokers to switch to vaping may have positive spillover effects on social connections' perceptions of e-cigarettes and the use of these products to support smoking cessation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Objective: To examine airway inflammatory cell profiles in Indigenous Australian adults with asthma and chronic obstructive pulmonary disease (COPD)., Design/setting: A retrospective, cross-sectional study on data from a tertiary referral respiratory outpatient clinic., Participants: Indigenous (n=23) and non-Indigenous (n=71) adults were matched according to diagnosis, gender and age to the ratio of 1:3., Main Outcome Measures: Participants were defined by self-determined identification as Indigenous (Aboriginal) or non-Indigenous. A relevant history was taken, and lung function was measured by spirometry. In those with a diagnosis of asthma, symptom control was assessed by the Asthma Control Questionnaire, six items (ACQ6). In those with a diagnosis of COPD, symptoms were assessed by the COPD assessment test (CAT). Airway cell counts were obtained in all groups from bronchial lavage (BL) cell count., Results: Lung function and inhaled corticosteroid dose were similar between groups. Current smoking was three times more common in Indigenous people (35%) compared with non-Indigenous people (12%, p=0.009). In participants with asthma, ACQ6 scores were similar between Indigenous and non-Indigenous participants with asthma. In those with COPD, Indigenous participants had significantly higher total CAT scores as well as scores for cough and sputum with a score indicating a high impact on quality of life (CAT score ≥14, 85%-25%, p=0.017). There was no difference in BL cell differential counts., Conclusions: Indigenous people with COPD had higher smoking rates, worsened CAT scores and more symptoms of cough and sputum production. There were no differences between the groups in airway inflammation, but neutrophilic inflammation was associated with poorly-controlled asthma., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Age-related macular degeneration (AMD) is a leading cause of irreversible visual loss in the elderly population, affecting millions of the people worldwide. AMD has a substantial effect on quality of life in older individuals. Understanding and identifying risk factors are crucial for developing preventive strategies., Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive literature search across databases including PubMed, Scopus, and Web of Science up to January 28, 2024. Studies were selected using standardized inclusion and exclusion criteria, and the quality of the studies was assessed via the Newcastle Ottawa Scale. Meta-analysis was conducted using Review Manager software to pool the odds ratio (OR) of each included risk factors at the 95% confidence interval (CI)., Results: Eighteen of the 2640 identified studies met the inclusion criteria for the meta-analysis. Older age compared to younger age, male gender compared to female gender, smoking, hypertension, cardiovascular diseases, and diabetes were statistically significant predictors for AMD occurrence, with ORs of 1.11 (95% CI = 1.06-1.15, P < .00001), 1.63 (95% CI = 1.13-2.35, P = .009), 1.86 (95% CI = 1.33-2.6, P = .0003), 1.24 (95% CI = 1.09-1.4, P = .0007), 1.44 (95% CI = 1.11-1.87, P = .006), and 1.44 (95% CI = 1.3-1.6, P < .00001), respectively. Other factors, such as body mass index, cerebrovascular diseases, cholesterol, and triglycerides, were not significantly associated with AMD., Conclusion: This updated meta-analysis highlights the significance of modifiable risk factors for AMD, including smoking, hypertension, cardiovascular diseases, and diabetes. Early identification of AMD accompanied by strategic management of these modifiable risk factors may preserve patients' visual acuity without advancing to advanced stages., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The incidence of early-onset breast cancer (< 50 years) has been increasing over the past decades with the role of modifiable, lifestyle-related risk factors remaining mostly unidentified., Methods: To investigate the role of key lifestyle factors in the incidence trends of early-onset breast cancer (EOBC), we pooled data from six health studies in Finland in 1972-2015 and combined them with breast cancer data from the Finnish Cancer Registry. The cohort consisted of 56,253 women with 397 EOBCs. The effects of risk factors (hazard ratios) on EOBC and average annual percent change (AAPC) of incidence were estimated using Poisson regression models., Results: The highest annual increase in age-standardized incidence was observed among women aged 40-49 who were overweight (AAPC 4.0%, 95% CI 0.5-7.7%), currently smoking (AAPC 3.3%, 95% CI 0.1-6.6%) or moderately physically active (AAPC 2.9%, 95% CI 0.3-5.6%)., Conclusions: The increase in early-onset breast cancer incidence was highest among women aged 40-49 who were overweight, currently smoking, or moderately physically active, while no change by risk factors was found in women under 40 years of age. Our findings suggest a different type of cancer process in young adults and highlight the importance of lifestyle risk factors in the incidence of EOBC., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Ethical Committee of the Finnish Institute of Health and Welfare (Permit no THL/1588/5.05.00/2019). All methods were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki). Informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: The aim of this study was to determine the incidence and predictive factors of lung cancer in rheumatoid arthritis (RA)., Methods: We conducted a retrospective follow-up study of patients who were diagnosed with RA at our institution between April 2001 and December 2022. Pulmonary complications were evaluated using high-resolution computed tomography (HRCT) at RA diagnosis. Patients were followed until the diagnosis of lung cancer, diagnosis of other malignancies, death, loss to follow-up, or the end of the study., Results: Among 771 RA patients, 3.5% were diagnosed with combined pulmonary fibrosis and emphysema (CPFE), 4.9% with interstitial lung disease (ILD) alone, and 6.0% with emphysema alone. During follow-up (mean of 9.3 years), the crude incidence rates of lung cancer per 1000 patient-years were 2.9 in all patients, 47.8 in CPFE patients, 10.5 in ILD patients, 11.9 in emphysema patients, and 0.8 in patients without these complications. Only male patients showed a higher incidence of lung cancer compared with the general population. In multivariable Fine-Gray regression analysis, the presence of HRCT-proven CPFE, ILD, and emphysema, and smoking history were identified as predictive factors for lung cancer in RA patients., Conclusions: Close monitoring of lung cancer is needed for RA patients with smoking history and pulmonary complications, especially CPFE., (© Japan College of Rheumatology 2024. Published by Oxford University Press.)

Background: This study examined the associations between health literacy and smoking behaviors among residents in Ningbo City, Zhejiang Province, China, investigating both the impact of health literacy on smoking prevalence and intensity, and its potential role in smoking cessation interventions., Methods: This cross-sectional study analyzed data from 2,948 male participants in the 2023 Health Literacy and Tobacco Use Surveillance Survey. We applied logistic regression models and restricted cubic spline analyses to assess the association between health literacy and smoking behaviors, adjusting for demographic characteristics, socioeconomic factors, and self-reported health status., Results: Our findings indicate that higher levels of health literacy are associated with significantly lower rates of smoking ( OR  = 0.643, 95% CI  = 0.528, 0.783) and daily cigarette consumption ( β  = -1.938, 95% CI  = -3.649, -0.228). Non-smokers with higher health literacy were more likely to discourage others from smoking ( OR  = 1.464, 95% CI  = 1.096, 1.955), underscoring health literacy's crucial role in smoking prevention and control. A nonlinear relationship between health literacy and smoking behavior was identified., Conclusion: Health literacy significantly influences smoking behavior, with higher literacy levels associated with reduced smoking prevalence and intensity. These findings support incorporating health literacy enhancement into comprehensive smoking cessation strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Tao, Xu, Zhu, Jin, Chen, Ding, Zhao and Dong.)

Smoking is a significant risk factor for both acute and chronic cardiovascular diseases. These diseases contribute to approximately twenty percent of all-cause mortality. Research indicates that quitting smoking can substantially reduce or even reverse the harmful effects associated with smoking on cardiovascular health. Notably, these benefits can be observed in a relatively short period compared to the duration of smoking history. This article aims to provide data to understand the effects of smoking on the cardiovascular system locally as well as its effects as a pandemic globally and hence provide comprehensive strategies in the management of cardiovascular patients for smoking cessation., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2025 The Author(s).)

Background: Women with migraine, especially with aura (MA), have a higher risk of white matter hyperintensities (WMH) and ischemic stroke. We aimed to assess differences in stroke etiology between women with and without migraine and the impact of migraine on WMH volume in women with stroke., Methods: We included women aged 40-60 years with a history of ischemic stroke, migraine or both. Stroke etiology was categorized using the TOAST criteria. WMH volume was measured using 3D-FLAIR images. Presence or absence of cerebellar WMH was scored. We used regression analysis to assess differences between groups, with adjustments for age, BMI, hypertension and smoking status., Results: We included 55 women with stroke, 55 with stroke and migraine, and 38 with MA. Women with stroke more often had a history of smoking than those with stroke and migraine (74% vs. 46%, p = 0.004). Stroke of undetermined origin was more common in women with both conditions than with stroke alone (49% vs. 27%, p = 0.019). Periventricular WMH volumes were higher in women with stroke with migraine than in those with MA alone (0.55mL vs. 0.42mL, B = 0.21, 95%CI = 0.01-0.41, p = 0.040). There were no differences in deep WMH volume and cerebellar WMH between groups. Importantly, the addition of migraine did not affect WMH volume in women who had experienced stroke., Conclusion: Women with both stroke and migraine more often had undetermined etiology of stroke compared to women with stroke alone, and in women with stroke alone smoking was a more prevalent risk factor. Migraine did not contribute to increased WMH volume in women with stroke., Competing Interests: Declarations. Ethics approval and consent to participate: The Medical Ethics Committee Leiden - Den Haag - Delft (METC-LDD) approved the CREW-MIST (P15.384) and WHISPER (P18.130) study protocols and all participants provided written informed consent prior to study participation. Competing interests: NW, KL and HO report no disclosures. MW was supported by personal grants from the Netherlands Organization for Scientific Research (VIDI Grant no. 91717337 and Aspasia grant). TH received support from the Dutch Heart Foundation and the Netherlands Organisation for Scientific Research (NWO), as part of their joint strategic research programme: “Earlier recognition of cardiovascular diseases”. AW and GT and IB report grant support by the European Community (101070917), Stichting Dioraphte (20010407), and the Clayco foundation. In addition, IB reports independent research support from the Dutch Heart Foundation (2020T065), and GT reports additional grants or consultancy support from Abbvie, Novartis, Lilly, Lundbeck, Organon, Pfizer, Teva, and independent support from the Dutch Research Council, Heart Foundation, Dutch Brain Foundation. AMB received honoraria and research/travel grants from Allergan/AbbVie, Amgen/Novartis, Eli Lilly, Pfizer, Satsuma, Teva, and Tonix, and independent support from the Dutch Research Council and ZonMw., (© 2025. The Author(s).)

Background: Colorectal cancer (CRC) is a prevalent and lethal malignancy. This study examines differences in clinical and prognostic characteristics of CRC between patients under 50 years and those aged 50 and above, treated at a reference hospital in Southern Brazil., Methods: A retrospective cohort study was conducted, analyzing data from the Cancer Hospital Registry in Porto Alegre, RS. Patients diagnosed with colon or rectal adenocarcinoma between January 2013 and December 2017 were included. Variables analyzed included family history, alcoholism, smoking status, clinical staging, tumor laterality, clinical presentation, CEA levels at diagnosis, adjuvant chemotherapy, and neutrophil-to-lymphocyte ratio., Results: The study cohort included 1,121 patients, with 85% aged 50 years or older, and 15% younger than 50 years. Significant differences were observed in smoking status and clinical presentation, with younger patients presenting with a higher prevalence of obstruction/subocclusion at diagnosis, which may reflect differences in clinical presentation due to delayed diagnosis., Conclusions: Age and lifestyle factors, particularly smoking, significantly influenced the clinical presentation and management of colorectal cancer. These findings underscore the importance of targeted prevention strategies and personalized treatment approaches for younger CRC patients., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the Research Ethics Committee of Santa Casa de Misericórdia de Porto Alegre (Approval No. 4.488.237, January 4, 2021). Given the retrospective design and use of anonymized data, the requirement for informed consent was waived by the ethics committee. Consent for publication: Not applicable. No identifying images or personal or clinical details of participants are presented that compromise anonymity. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Although smoking is considered the primary cause of chronic obstructive pulmonary disease (COPD), there is a growing realization that there may be important secondary risk factors. Tuberculosis may lead to lung impairment; however, whether residual lung damage results in clinically significant, long-term outcomes, independent of smoking, has not been well studied. We aimed to investigate the association between tuberculosis and the subsequent development of COPD using a large, population-based cohort study., Methods: We conducted a longitudinal cohort study within the Chinese Electronic Health Records Research in Yinzhou study between 2009 and 2021. We followed participants free of COPD at the beginning of the study, and investigated whether previous or current tuberculosis was an important risk factor. Tuberculosis was recorded based on the Chinese National Disease Reporting system which includes all diagnosed cases at the city, provincial and national levels. We assessed the relationship between tuberculosis and COPD using multivariable survival models, adjusting for demographic and lifestyle characteristics, education level, comorbidities and use of medications., Results: Among 477 046 participants, 198 882 were eligible for inclusion in our analysis. In a multivariable model, pulmonary tuberculosis and all tuberculosis were associated with a 2.57-fold [95% confidence interval (CI), 2.31-2.87)] and 1.67-fold (95% CI, 1.48-1.90) increased COPD risk, respectively. Stronger associations of pulmonary tuberculosis and all tuberculosis with COPD were seen in participants who were elderly, or with lower body mass index or education level (Pinteraction<0.001). People with tuberculosis were at an increased risk of COPD if they were current smokers [adjusted hazard ratio (aHR), 1.40; 95% CI, 1.02-1.93] or non-smokers (aHR, 1.72; 95% CI, 1.50-1.98)., Conclusions: Persons who developed tuberculosis were at much greater risk of developing COPD, even accounting for smoking and other potential confounders., (© The Author(s) 2025; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Family history of lung cancer (FHLC) has been widely studied but most prospective cohort studies have primarily been conducted in non-Asian countries. We assessed the association between FHLC with risk of lung cancer (LC) incidence and mortality in a population of East Asian individuals. A total of 478,354 participants from 11 population-based cohorts in the Asia Cohort Consortium were included. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). A total of 7,785 LC incident cases were identified. FHLC (any LC subtype) was associated with an increased risk of LC incidence (HR = 1.45, 95% CI = 1.30-1.63). The positive association was observed in men and women (HR = 1.44, 95% CI = 1.26-1.66 in men; HR = 1.47, 95% CI = 1.22-1.79 in women), and in both never-smokers and ever-smokers (HR = 1.43, 95% CI = 1.18-1.73 in never-smokers; HR = 1.46, 95% CI =1.27-1.67 in ever-smokers). FHLC was associated with an increased risk of lung adenocarcinoma (HR = 1.63, 95% CI: 1.36-1. 94), squamous cell carcinoma (HR = 1.88, 95% CI: 1.46-2.44), and other non-small cell LC (HR = 1.94, 95% CI: 1.02-3.68). However, we found no evidence of significant effect modification by sex, smoking status, and ethnic groups. In conclusion, FHLC was associated with increased risk of LC incidence and mortality, and the associations remained consistent regardless of sex, smoking status and ethnic groups among the East Asian population., (© 2024 The Author(s). International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)