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Purpose: The purpose of this paper is to find out the anti-smoking counselling frequency and its correlates in a sample of Chinese physicians. Design/methodology/approach: In this paper, 268 physicians in Baoding, a city near Beijing, filled out a questionnaire asking about their own smoking status, their anti-smoking behaviors as well as their opinions on how to reduce cigarette smoking in China. Findings: The paper finds that 54 percent of the male and 8.4 percent of the female physicians were current cigarette smokers. When asked whether they had counselled their patients about cigarette smoking in the past year, 43.7 percent answered "always"; 38.1 percent "often"; 13.1 percent "sometimes"; 2.6 percent "occasionally", and 2.6 percent said: "not much". However, only 9.0 percent said that they were "very successful". Physicians' anti-smoking counselling practices were highly correlated with their own smoking status; whether they perceived their past anti-smoking activities as successful; whether they thought that they should set examples by not smoking; whether they felt that they had the responsibility to help patients and whether they perceived themselves as influential in persuading patients to quit smoking. Practical implications: The paper shows that messages aimed at increasing Chinese physicians' anti-smoking counselling should appeal to their responsibility, exemplary role, and unique influence on patients' health-related behaviors. Originality/value: The paper adds to the few studies on Chinese physicians' cigarette smoking behavior and their anti-smoking activities. In a country where cigarette smoking is a way of life among males, and few people are aware of the health consequences of cigarette smoking, physicians' efforts can be a spearhead to a cessation campaign. (Contains 3 tables.)

In 2011, China implemented tougher driving-under-the-influence laws, which criminalized driving under the influence of alcohol for the first time and increased penalties. This paper provides the first comprehensive analysis of the effects of stricter drinking policies on men's smoking behavior by using data from the 2010 and 2012 waves of the China Family Panel Studies. The results show that stricter drinking policies reduced smoking initiation and the number of cigarettes smoked per day among men by reducing the frequency and quantity of alcohol consumption. Heterogeneity analyses show that the impact of the policy is more pronounced not only for men aged 41-55, but also for men who have higher educational qualifications, who are employed, or who are not members of the Communist Party., 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.)

Aim: Smoking is harmful to human health. However, the relationship between smoking and blood pressure (BP) has not been consistent. This study aimed to analyse nurses' smoking behaviours and their relationship with BP. Methods: This cross‐sectional study recruited 128 009 nurses in 11 cities in China. They were surveyed with questionnaires including BP measurements. The main contents of the questionnaire included smoking status and other factors that might be associated with hypertension. Multiple linear regression analyses and binary logistic regression analyses were used to analyse the data. Results: The results showed there was a significant difference in the smoking rate among nurses with different characteristics (P < 0.05). For both male and female nurses, smoking was associated with increased diastolic BP and mean arterial pressure, but only with increased systolic BP of male nurses. The prevalence of hypertension among male and female nurses was not related to smoking. Conclusion: Despite a relatively low overall smoking rate, rates among some groups are high. Different cities, hospitals, and departments can combine local data and conditions to formulate targeted tobacco control measures to improve nurses' physical and mental health. Summary statement: What is already known about this topic?: The number of tobacco‐related diseases has been steadily increasing worldwide over the past few decades.A decrease in the smoking rate of medical staff can lead to a decrease in the smoking rate of the general population.The association between smoking and blood pressure remains controversial, and further clarification is required. What this paper adds?: There was a significant difference between the smoking rates of nurses with different characteristics.The smoking rates were relatively high for nurses in emergency departments and operating rooms and those with >10 night shifts per month within the last 6 months.Among nurses, smoking is related to increase in diastolic blood pressure and mean arterial pressure in both men and women but only to increased systolic blood pressure in men; however, there was no association with hypertension risk. The implications of this paper: This study can support nursing managers to take targeted interventions to target smoking populations to reduce their smoking rates.For nurses who smoke due to high pressure, it is suggested that the working hours and cycles should be adjusted appropriately, the proportion of nurses should be increased, and the work intensity should be reduced to alleviate the work pressure.Nurses with high blood pressure should especially be dissuaded from smoking. [ABSTRACT FROM AUTHOR]

Purpose: The reduction of tobacco use among medical students is a potentially powerful strategy to reduce tobacco use among future health professionals, who in turn, can have significant impact on tobacco use among patients as well as the general population in China. The goal of this study is to update information on the prevalence of cigarette smoking among Chinese medical students and to assess modifiable factors for smoking reduction. Design/methodology/approach: Presented in the paper are descriptive, associative and path model analyses of survey data collected among 758 medical students in year one through year three from Hainan Medical College, Hainan, China. Findings: Among the total 758 participants, 66.9 percent of males and 26 percent of females smoked and 26.5 percent of males and 1.6 percent of females had smoked in the past 30 days. The median monthly expenditure on cigarettes was 30 Chinese Yuan (approximately US$4.25). The likelihood of smoking increased with male gender, more advanced year group, poor academic performance, perceived peer smoking, and depressive symptoms, after controlling for covariates. Originality/value: Findings reported in this study provide further insight into the smoking prevalence among medical students in China as well as adding to knowledge about several potentially modifiable factors that are related to smoking. Data collected in this study are likely to prove valuable in prioritizing tobacco control among Chinese medical students, as they are future medical doctors, and their smoking behaviors will have strong influence on their patients as well as the general public. (Contains 4 tables and 1 figure.)

Aim: This study investigated the effectiveness of an instant message‐based lifestyle and stress management intervention delivered by nurses on cardiovascular disease risk reduction. Methods: In this nonrandomized concurrent controlled trial conducted from March 2013 to September 2013, 164 eligible employees in two companies were assigned to the intervention (n = 83) and control (n = 81) groups based on their worksites. Only participants were blinded to group assignment. All participants received two education sessions during 1 month, and the intervention group also received an instant message‐based lifestyle and stress management intervention for 5 months. The primary outcome was the Framingham Risk Score, and the data were collected at the first month and the sixth month. Results: The final analysis included 80 participants in the intervention group and 76 in the control group. After the intervention, significant intervention effects were found for the mean value and the changes of the Framingham Risk Score and the proportion of participants who improved their diet and exercise (P < 0.05). There were trends for improvement in the proportion of smoking and levels of stress, but statistically significant levels (P > 0.05) were not met. Conclusion: An instant message‐based lifestyle and stress management intervention can reduce cardiovascular disease risk in high‐risk individuals. Summary statement: What is already known about this topic? Cardiovascular disease is the leading cause of death globally and causes a heavy economic burden, while lifestyle changes and stress management are modifiable and cost‐effective ways to reduce the risk of cardiovascular disease in high‐risk individuals.The widespread use of mobile phones facilitates the implementation of health education to improve lifestyle and is well adapted for use in the developing world.Instant messaging tools are widely used for daily and work communication because of convenience and free access. These tools have also been used to improve health knowledge and self‐management. What this paper adds? More than half of participants had unhealthy diets and insufficient exercise, which contributed to abnormal body mass index and cholesterol levels.Lifestyle‐related health education that provided tailored strategies for improving lifestyle and stress reduction, as well as timely feedback and peer support, can reduce cardiovascular disease risk in high‐risk individual.Instant messaging tools provide a cost‐effective and feasible platform for health education on prevention of cardiovascular disease. The implications of this paper: Improving unhealthy diet and levels of exercise, which can decrease the prevalence of obesity and dyslipidemia, are two main aspects for prevention of cardiovascular disease that require continued focus.Using instant messaging tools as a platform to deliver health education, nurses can more easily manage high CVD risk individuals and provide guidance on healthy lifestyle. These tools should be used more widely, especially in developing countries with limited resources and heavy economic burdens. [ABSTRACT FROM AUTHOR]

• First estimation of nitrosamine intake via tobacco by smokers in 30 provinces, China. • First estimation of cancer risk (CR) of nitrosamines in tobacco to smokers in China. • CRs of NNK and NDMA are comparable in tobacco smoke (1.99 × 10−4 vs. 1.66 × 10 -4). • CR by nitrosamine intake: tobacco (3.80 × 10−4) > food (1.74 × 10−4) > water (1.38 × 10−5). • Tobacco smoking brings 202% extra cancer risk of nitrosamines to Chinese smokers. Nitrosamines are a class of carcinogens which have been detected widely in food, water, some pharmaceuticals as well as tobacco. The objectives of this paper include reviewing the basic information on tobacco consumption and nitrosamine contents, and assessing the health risks of tobacco nitrosamines exposure to Chinese smokers. We searched the publications in English from "Web of Science" and those in Chinese from the "China National Knowledge Infrastructure" in 2022 and collected 151 literatures with valid information. The content of main nitrosamines in tobacco, including 4-(methylnitrosoamino)-1-(3-pyridyl)-1-butanone (NNK), N -nitrosonornicotine (NNN), N -nitrosoanatabine (NAT), N -nitrosoanabasine (NAB), total tobacco-specific nitrosamines (TSNA), and N -nitrosodimethylamine (NDMA) were summarized. The information of daily tobacco consumption of smokers in 30 provinces of China was also collected. Then, the intakes of NNN, NNK, NAT, NAB, TSNAs, and NDMA via tobacco smoke were estimated as 1534 ng/day, 591 ng/day, 685 ng/day, 81 ng/day, 2543 ng/day, and 484 ng/day by adult smokers in 30 provinces, respectively. The cancer risk (CR) values for NNN and NNK inhalation intake were further calculated as 1.44 × 10−5 and 1.95 × 10−4. The CR value for NDMA intake via tobacco smoke (inhalation: 1.66 × 10−4) indicates that NDMA is similarly dangerous in tobacco smoke when compared with the TSNAs. In China, the CR values caused by average nitrosamines intake via various exposures and their order can be estimated as the following: smoke (3.75 × 10−4) > food (1.74 × 10−4) > drinking water (1.38 × 10−5). Smokers in China averagely suffer 200% of extra cancer risk caused by nitrosamines in tobacco when compared with non-smokers. [Display omitted] [ABSTRACT FROM AUTHOR]

INTRODUCTION This study examined the prevalence of tobacco exposure and drinking and ascertained the relationships between tobacco exposure, alcohol drinking, concurrent smoking and drinking, and hypertension in rural southwestern China. METHODS Data were collected from a cross-sectional health interview and examination survey, which included 7572 adults aged ≥35 years, in rural China. Participant demographic characteristics, smoking habits, exposure to secondhand smoke (SHS), and alcohol drinking habits were obtained using a standard questionnaire. Blood pressure (BP), height, weight, and waist circumference were measured for each participant. RESULTS The overall prevalence of smoking, SHS exposure, drinking, concurrent smoking and drinking, concurrent exposure to SHS and drinking, and hypertension was 37.7%, 27.4%, 16.2%, 12.6%, 1.6%, and 41.3%, respectively. Males had a significantly higher prevalence of smoking (74.1% vs 2.2%, p<0.01), drinking (31.1% vs 1.7%, p<0.01), and concurrent smoking and drinking than females (25.3% vs 0.3%, p<0.01). However, females had a higher prevalence of SHS exposure than males (30.2% vs 20.6%, p<0.01). Ethnic minorities had a higher prevalence of SHS exposure, drinking, and concurrent smoking and drinking, than Han participants (p<0.01). Participants with a higher education level had a higher prevalence of smoking, drinking, and concurrent smoking and drinking than their counterparts (p<0.01). In contrast, participants with a lower education level had a higher prevalence of SHS exposure than their counterparts (p<0.01). Multivariate logistic regression analysis found that smokers (AOR=1.31; 95% CI: 1.13-1.51), individuals exposed to SHS (AOR=1.24; 95% CI: 1.11-1.43), drinkers (AOR=1.31; 95%: CI: 1.15-1.50), and concurrent smokers and drinkers (AOR=1.45; 95% CI: 1.25-1.67) all had a higher probability of having hypertension (p<0.01). Additionally, concurrent smoking and drinking had the strongest association with the prevalence of hypertension (AOR=1.45; 95% CI: 1.25-1.67; p<0.01). CONCLUSIONS Socioeconomic factors play an important role in influencing the prevalence of smoking, exposure to SHS, and drinking in rural southwest China. Interventions to prevent and reduce hypertension should, in particular, focus on smokers, individuals exposed to SHS, drinkers, and, in particular, concurrent smokers and drinkers. [ABSTRACT FROM AUTHOR]

INTRODUCTION Food delivery drivers represent a rapidly growing occupational group in China in recent years. Their unique work patterns such as a complex work environment and high time-pressure may subject them to more severe tobacco use issues compared to other professions. This study aims to investigate the prevalence of tobacco use within this group and examine the underlying reasons behind it. METHODS A cross-sectional, multistage sampling design was conducted to select 1879 food delivery riders from Guangzhou and Shenzhen. A self-administered questionnaire was used to collect the data from August to December 2022. Chi-squared analysis and binary logistic regression analysis, adjusted for factors including gender, education level, type of employment, alcohol use, job-related uncertainty stress, and emotional exhaustion, were used to explore the key factors associated with smoking among this occupational group. RESULTS Altogether, 65.5% of individuals in this sample were smokers, with 69.5% among males and 26.2% among females. Factors found to be significantly associated with smoking behavior were male sex (AOR=5.48; 95% CI: 3.74-8.02), education level of junior high school or lower (AOR=1.60; 95% CI: 1.21-2.11), education level of senior high school (AOR=1.52; 95% CI: 1.18-1.95), full-time job (AOR=1.39; 95% CI: 1.18-1.80), alcohol use (AOR=3.91; 95% CI: 3.14-4.87), moderate level of job-related uncertainty stress (AOR=0.58; 95% CI: 0.42-0.81), high level of emotional exhaustion (AOR=1.57; 95% CI: 1.17-2.10) and moderate level of emotional exhaustion (AOR=1.52; 95% CI: 1.00-2.30). CONCLUSIONS Demographic factors like gender, education level, job type, and substance use should be considered in designing smoking cessation campaigns for this group. Improving work conditions, reducing emotional exhaustion, and managing stress may also reduce smoking and enhance the well-being of these riders. [ABSTRACT FROM AUTHOR]

INTRODUCTION China enacted an excise tax on e-cigarettes in November 2022, which offers a distinctive opportunity to examine the industry's reactions to this fiscal adjustment. This study delves into the industry's pricing strategies following the introduction of the excise tax, facilitating a thorough assessment of the subsequent impact on market dynamics and the government's revenue streams. METHODS We developed a TaXSiM model specifically tailored for e-cigarettes in China by integrating the country's e-cigarette tax framework. Our approach involved leveraging market data obtained from a representative product, the RELX Phantom Series, to ensure the model's effectiveness and relevance. RESULTS The excise implementation of 2022 significantly heightened the tax burden on e-cigarettes, marking an increase of approximately 150 RMB per device and 19 RMB per cartridge. Despite these financial pressures, electronic cigarette firms exemplified by RELX, strategically endeavored to sustain competitiveness. Their approach involved initially implementing a 'Razor blade model' and eventually a 'comprehensive under-shifting' strategy, which mitigated the health impact of the tax hike, resulting in a relatively minor decline in sales while amplifying the impact on tax revenue. However, this strategic pricing maneuver came at a cost, as it led to a substantial decrease in profits, and therefore expedited a reshuffling of the industry by compelling smaller brands to leave the market rapidly. CONCLUSIONS To effectively curb the use of e-cigarettes through tax policies, it is advisable to relocate the imposition of excise taxes on electronic cigarettes to the retail stage. This shift aims to narrow the scope for industry-level pricing strategies. Furthermore, this approach should be coupled with the introduction of an additional specific tax, strategically crafted to accentuate the health-related benefits associated with the excise taxation on electronic cigarettes. [ABSTRACT FROM AUTHOR]

Background: Despite the historically low smoking prevalence among Chinese women, there is a trend of future increase. Purpose: We systematically reviewed the correlates of smoking among Chinese girls and women. Method: We conducted a systematic review of literature on correlates of smoking among Chinese women using Medline and China Academic Journals databases. Following the PRISMA statement, two investigators independently searched for literature, identified and reviewed papers, assessed the quality of the papers, and extracted information. The characteristics of studies and correlates of smoking were synthesized separately for youth and adults. Results: A total of 15 articles (11 on adults, 4 on youth) met the inclusion criteria. Based on these studies, peer smoking was the most consistent correlate of smoking among Chinese girls. Among Chinese women, partner smoking, job-related stress, and exposure to cigarettes made for women were consistent correlates of smoking. Knowledge of harms and negative attitudes towards smoking were found to be negatively associated with smoking. Conclusion: Overall, the evidence base for smoking among Chinese women is limited. Although smoking among Chinese women is still at an early stage, it is becoming more prevalent among specific population subgroups, such as rural-to-urban migrant workers. Although further research is needed, findings from the current study provide a roadmap for research and policy on prevention of smoking among Chinese girls and women. [ABSTRACT FROM AUTHOR]

Background: Smoking is a serious public health problem that affects human health conditions. Although there is evidence that microorganisms are associated with smoking-related lung diseases, the relationship between the rich lung microbiome of upper respiratory tract groups and smoking has not been studied., Objective: In this study, we investigated the effects of smoking on environmental microbes and lung microbiome in the Chinese population and provided clues for the role of smoking in the development of respiratory disease., Methods: Bronchoalveolar lavage fluid samples were collected from 55 individuals with a history of smoking. Microbial gene sequencing was carried out through NGS technology. We analyzed and compared the diversity, community structure, and species abundance of bronchoalveolar lavage microbiome between smokers and nonsmokers, to speculate the effects of smoking on the lung microbiome., Results: Smoking hardly affected the α diversity of microbial groups of bronchoalveolar lavage, but it had a huge influence on the microbiome composition. The relative abundance of Rothia, Actinomycetes, Haemophilus, Porphyrins, Neisseria, Acinetobacter, and Streptococcus genera had a remarkable increase in the smoking group. On the other hand, the relative abundance of Plusella and Veronella decreased significantly., Conclusion: Smoking may change the environmental microbes and then alter the structure of the lung microbiome, which may lead to smoking-related diseases., 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 © 2022. Published by Elsevier B.V.)

INTRODUCTION Smoking is an independent and modifiable risk factor for the onset and development of psoriasis; however, evidence on the association between tobacco smoking and psoriasis treatment efficacy is limited. This study aimed to explore the influence of smoking on treatment efficacy in a cohort of patients with psoriasis in Shanghai, China. METHODS Patients with psoriasis were recruited from the Shanghai Skin Disease Hospital between 2021 and 2022. The treatment for patients with psoriasis includes acitretin, methotrexate, narrow-band ultraviolet/benvitimod, and biologics. Data were collected using a structured questionnaire, physical examination, and disease severity estimation at baseline, week four, and week eight. The achievement of a ≥75% reduction in psoriasis area and severity index (PASI75) score from baseline to week 8 was set as the primary outcome for treatment efficacy estimation. Data were analyzed using SAS 9.4. RESULTS A total of 560 patients with psoriasis were enrolled in this study, who were predominantly males (72.9%). The average age of patients was 48.4 years, and 38.8% of them were current smokers, 5.0% of them were former smokers. The median score of PASI among patients changed from 11.1 (interquartile range, IQR: 7.9-16.6) at baseline to 6.2 at week 4 and 3.1 at week 8, and 13.8% and 47.3% of patients with psoriasis achieved PASI75 at weeks 4 and 8, respectively. Logistic regression indicated that patients without tobacco smoking had a higher proportion of PASI75 achievement at week 8. The adjusted odds ratio (AOR) was 11.43 (95% CI: 6.91-18.89), 14.14 (95% CI: 8.27-24.20), and 3.05 (95% CI: 1.20-7.76) for non-smokers compared with smokers, current smokers, and former smokers, respectively. Moreover, former smokers had higher PASI75 achievement than current smokers (AOR=3.37), and patients with younger smoking initiation age, longer smoking duration, and higher smoking intensity had lower PASI75 achievement. CONCLUSIONS Tobacco smoking was negatively associated with PASI75 achievement both in current and former smokers, and former smokers had higher PASI75 achievement than current smokers. The implementation of tobacco control measures is beneficial for improving treatment responses. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking prevalence is high in China, and healthcare workers are important for tobacco control. This study aimed to determine the smoking status, cognition of tobacco hazards, and smoking cessation-related knowledge among respiratory healthcare workers, and to explore their ability to provide smoking cessation assistance. METHODS A cross-sectional study was conducted in 2021 among 1028 respiratory healthcare workers from 89 hospitals in Fujian Province, China. A self-designed electronic questionnaire was used to collect data on smoking status, knowledge of smoking hazards, and smoking cessation knowledge. Descriptive statistics were calculated for all questions. Logistic regression analysis was used to explore the relationship between awareness of the tobacco control goals of Healthy China 2030 and demographic characteristics. RESULTS Among the healthcare workers surveyed, 3.4% were smokers, all of whom were male. Most respondents (99.4%) were aware of smoking as a cause of lung cancer, but awareness of smoking as a cause of non-respiratory cancer was lower. The awareness rate of smoking cessation support was high (>90%), but only 40.0% of participants were aware of the Healthy China 2030 tobacco control targets. Male (HR=2.16; 95% CI: 1.69-2.80) and participation in the cessation clinic (HR=1.47; 95% CI: 1.10-1.96) were associated with higher awareness of the targets. CONCLUSIONS Respiratory healthcare workers in Fujian Province demonstrated a high level of awareness regarding behavioral and pharmacotherapy support for smoking cessation. In order to enable healthcare workers to play a more active role in tobacco control, there is a need to increase public awareness of smoking cessation services in Fujian Province. [ABSTRACT FROM AUTHOR]

Migrant workers in China are experiencing social isolation caused by institutional and non-institutional barriers. This paper explores the relationship between social isolation and migrants' smoking behavior as well as gender differences in smoking. Migrants' social isolation is systematically measured from the structural and qualitative perspective. Using the survey data of 2,188 rural-to-urban migrants in China in 2016, the prevalence of smoking among migrants is 38.21%, with 51.70% for males and 4.06% for females. Migrants with social isolation, such as migration instability, lack of ties with family and fellow migrants, and life dissatisfaction in migrant cities, are more likely to smoke and the impacts vary by gender. The income and price elasticities of cigarette demand show that male migrant smokers are more sensitive to income and price changes than female migrant smokers. Boosting rural migrants' integration into the local community will reduce smoking prevalence, improving the overall health of the society. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking conventional cigarettes or vaping (SV) poses significant health threats to adolescents. School climate and school identification are key elements of the school environment and potential factors of SV. Based on the Stress Coping Theory, the mediations between school climate/school identification and SV, via perceived stress/active coping, were examined. METHODS A cross-sectional survey was conducted among secondary school students from February to March 2022 in Taizhou, China. Structural equation modeling was used. RESULTS The prevalence of SV among the 7526 participants was 4.7% (singular use of conventional cigarettes: 3.2%; singular use of electronic cigarettes: 3.6%; dual use: 2.1%). School climate, school identification, and active coping were positively, and perceived stress (family stress, academic stress, and peer-related stress) were negatively associated with SV. The association between school climate and SV was fully mediated via: 1) school climate → perceived stress → SV; 2) school climate → active coping → SV; and 3) school climate → perceived stress → active coping → SV. The effect sizes were 52.1%, 43.8%, and 6.3%, respectively. Similar partial mediation mechanisms were found between school identification and SV, with relatively small effect sizes (<10%). CONCLUSIONS This study observed the prevalence of SV among Chinese secondary school students. School climate and school identification had both significant direct and indirect (via perceived stress/active coping) effects on SV. Positive school environments may reduce students' stress and promote active coping. The stress coping mechanisms explained the association between school climate and SV better than between school identification and SV. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study explores the association of individual cognition and social environment of smoking with autonomy over tobacco, providing evidence and insights to help smokers effectively prevent and reduce tobacco dependence. METHODS Data were collected from 1389 participants, aged ≥15 years, by face-toface interviews from June 2018 to November 2019 in central China. We assessed autonomy over tobacco using the Autonomy Over Smoking Scale (AUTOS), including Withdrawal Symptoms (WS), Psychological Dependence (PD) and Cueinduced Cravings (CC), and examined factors of individual cognition and social environment, as well as covariates, including demographic characteristics, health status, and smoking behavior. RESULTS AUTOS total score was 16.92 ± 9.05, WS score was the lowest (4.40 ± 3.36) in the three subscales, and CC score was the highest (6.88 ± 3.2). After adjustment, WS score of having a greater awareness of smoking hazards to one's own health was lower than those who had no awareness (β=0.14; 95% CI: -0.31-- 0.00), and the total score of AUTOS, the score of PD and CC for those who thought smoking was 'more helpful (high)' to interpersonal communication were higher than 'not helpful (not at all)' (β=0.14; 95% CI: 0.01--0.28 with β=0.16; 95% CI: 0.02--0.29; and β=0.14; 95% CI: 0.00--0.28; respectively). Having a greater difficulty in smoking cessation was associated with higher AUTOS total and subscale scores (p<0.001). Notably, none of the social-environmental factors included had a significant association with AUTOS scores. CONCLUSIONS Interventions targeting individual cognitive factors of tobacco dependence seem to be more effective in smoking cessation. Future research may explore the influence of family and workplace among social environmental factors, which may reveal the effect of a binding force. [ABSTRACT FROM AUTHOR]

INTRODUCTION Heightened levels of distress among Asian Americans during the initial phases of the pandemic may be associated with current smoking behavior. In this study, we examine differences in current smoking among Asian Americans from two different ethnic backgrounds before and during the COVID-19 pandemic. METHODS We analyzed cross-sectional survey data (n=202) from Chinese and South Asian adults in Chicago, collected between February and May 2020. We conducted logistic regression models to estimate the relationship between exposure to the COVID-19 pandemic and current smoking. We tested whether the association varied by Asian American ethnic group, unemployment, racial discrimination, and depression symptoms. RESULTS We found that current smoking increased from 28% to 48% among Asian Americans (i.e. Chinese and South Asians) during the pandemic. We found a statistically significant interaction between the COVID-19 period indicator variable and current smoking by Asian American ethnic groups (p=0.014), such that current smoking was lower for Chinese compared to South Asians before COVID-19, but was comparable for both groups during the pandemic. We also found a statistically significant interaction between the period indicator variable and current smoking by racial discrimination (p=0.047) and depression symptoms (p=0.02). Results from these interactions suggest that Asian Americans who experienced racial discrimination and depression during the pandemic may be more likely to be current smokers compared to their pre-pandemic counterparts. CONCLUSIONS The findings of the study highlight the need for culturally tailored smoking cessation interventions for Asian American communities that address pandemic-related stressors such as discrimination that may trigger cigarette use. [ABSTRACT FROM AUTHOR]

INTRODUCTION Managing chronic diseases and tobacco use is a formidable challenge in low- and middle-income countries (LMICs) with limited health literacy and access to quality healthcare. This study examines the empirical evidence from China, utilizing quasi-experimental approaches to assess the causal effect of chronic disease diagnoses on smoking behavior. METHODS Employing the diagnosis of chronic disease in the older cohorts of the population as a natural experiment, this study utilizes recent advancements in difference-in-difference estimation methods (CS-DID) to investigate the effect of a diagnosis on smoking behavior. Self-reported new diagnoses of conditions ascertained chronic disease diagnoses. CS-DID was run using the study sample from the 2011 to 2018 waves of the China Health and Retirement Longitudinal Study, comparing results with traditional two-way fixed effects and event-study models. RESULTS The average treatment effect (ATT) of CS-DID is slightly greater than the effects reported using conventional difference-in-difference methods. We found that diagnoses of cancer, heart disease, and stroke reduced smoking rates by 16% (95% CI: -24 -- -8), smoking intensity by 0.31 (95% CI: -0.46 -- -0.15), and had lasting impacts on smoking cessation behavior (one wave after diagnosis ATT= -0.17; 95% CI: -0.34 -- -0.00, two waves after diagnosis ATT= -0.17; 95% CI: -0.37--0.03). A diagnosis of a mild chronic disease, such as hypertension, diabetes, asthma, chronic lung disease, liver disease, or gastric disease, had more negligible and transient effects on smoking behavior. CONCLUSIONS Efforts to enhance smoking cessation in middle-aged and elderly patients with chronic diseases are crucial to improving health outcomes. The 'teachable moment' of chronic disease diagnosis should be seized to provide smoking cessation assistance to achieve the goal of healthy ageing. [ABSTRACT FROM AUTHOR]

Tobacco use is associated with an annual global economic cost of two trillion dollars and mortality of half of its regular users. Tobacco leaf cultivation is the starting point of the tobacco cycle. Tobacco farming employs millions of small-scale tobacco farmers around the globe, most of whom are out growers who rely on the tobacco industry. This paper aims to map the regions of greatest tobacco production globally (i.e., the US, Brazil, China, Indonesia, India, and Zambia) and tobacco use rates in these locations. Smoking rates were higher in those areas, except for India, where important population subgroups reported an upward trend for tobacco smoking. In general, there was a relationship between tobacco farming and tobacco smoking. Tobacco farming may lead to a higher risk of tobacco use and lower adherence to tobacco control policies. Therefore, promoting viable alternative livelihoods for tobacco farmers must have dual benefits. Additionally, specific health prevention policies might be necessary for those populations reporting higher tobacco use and lower perception of tobacco-related health risks. [ABSTRACT FROM AUTHOR]

INTRODUCTION Although the negative impact of smoking on health has been confirmed in various studies, few have explored psychological factors mediating the relationship between smoking and health-related quality of life (HRQOL). This study aimed to investigate the relationship between smoking and HRQOL in the Chinese population and the mediating role of negative emotions (NEs). METHODS Survey data were derived from a cross-sectional study conducted in China from 20 June to 31 August 2022. We recruited participants from 148 cities across the country using a stratified multistage sampling method. The HRQOL of the dependent variable was measured using the Chinese version of European Quality of Life-5 Dimensions (EQ-5D-5L). The Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Perceived Stress Scale (PSS-4) were used to measure NE parameters including depression, anxiety, and perceived stress, as the intermediate variables. A multiple parallel mediation model was used to analyze the mediating role of NEs in smoking and HRQOL. RESULTS A total of 21916 valid questionnaires were collected, of which 3010 (13.7%) and 18906 (86.3%) were categorized into smokers and non-smokers, respectively. The HRQOL (EQ-VAS score) of smokers (71.70 ± 23.08) was lower than that of non-smokers (73.69 ± 21.32), whereas the depression and anxiety levels of smokers were higher than those of non-smokers (all p<0.001). Moreover, smoking, NEs (depression and anxiety), and HRQOL showed pairwise correlations. According to the mediation analysis, depression (β= -0.461; 95% BCa CI: -0.664 -- -0.268) and anxiety (β= -0.279; 95% BCa CI: -0.435 -- -0.138) mediated the relationship between smoking and HRQOL after adjusting for demographic and life factors. CONCLUSIONS These findings emphasize the necessity of studying the interaction between smoking, HRQOL, and Nes, and complementing the research on the impact of psychological factors on the HRQOL of smokers. Public health activities should focus on mental health and take targeted measures for the prevention, treatment, and rehabilitation of smokers. [ABSTRACT FROM AUTHOR]

INTRODUCTION Raising the price of cigarettes via taxation has been promoted by the World Health Organization as an important tobacco control strategy. Price elasticity of cigarettes is not uniform and is dependent upon individual and environmental determinants. Many studies have examined the determinants of price-induced smoking, taking into account sociodemographic characteristics and consumption patterns. Little research has been conducted on the association between anti-smoking environments and price-induced smoking behavior. This study addresses the deficit within the Chinese context. METHODS Participants were 2852 male smokers identified through a multi-stage survey sampling process encompassing 6 cities in China between July and December 2016. A standardized questionnaire tapped price-induced smoking reduction and related information. Both unadjusted and adjusted logistic regression methods were applied in the analyses. RESULTS In all, 25.5% (95% CI: 22.5-27.9) of smokers in this study decreased their smoking expenditures following the 2015 excise tax increase. The adjusted logistic regression analysis showed that increased exposures to an anti-smoking information environment (AOR=1.39; 95% CI: 1.10-1.79), restricted smoking in their home (AOR=1.67; 95% CI: 1.32-2.08) and workplace (AOR=1.43; 95% CI: 1.09-1.85) were more likely to report diminished cigarette smoking following the tax increases. CONCLUSIONS This study adds to understanding price-induced smoking behavior among urban male Chinese smokers. Strengthening of excise tax policies needs to intensify environmental smoking restrictions and public education campaigns to increase the sensitivity of cigarette price changes among smokers. [ABSTRACT FROM AUTHOR]

INTRODUCTION In China's aging population, hypertension, aggravated by smoking, constitutes a substantial health concern. However, the effectiveness of the national public health interventions for smoking cessation under the Essential Public Health Services remains unverified. Our aim was to examine smoking prevalence, the proportion of individuals receiving smoking cessation advice, its impact on successful cessation among Chinese hypertensive patients aged >45 years, and to discern disparities in the coverage and efficacy of smoking cessation interventions between primary care facilities and hospitals. METHODS Employing a longitudinal cohort approach, we examined four waves (2011-2018) of the China Health and Retirement Longitudinal Study (CHARLS). We surveyed a nationally representative cohort of hypertensive individuals, accounting for smoking status, cessation advice, healthcare preferences, and 11 pertinent covariates. RESULTS Among the 4269 hypertensive patients, smokers were predominantly male, aged <65 years, with lower education and lower wealth. Smoking prevalence decreased from 25.2% in 2011 to 21.1% in 2018. The incidence of physician-provided smoking cessation advice reached a peak of 60.3% in 2015, decreasing to 54.8% in 2018. Visitors to primary care facilities reported the highest rate of advice reception. While patients receiving advice exhibited a higher smoking prevalence, instrumental variable regression and subgroup analyses found no significant correlation between advice receipt and successful cessation. CONCLUSIONS We observed a substantial smoking prevalence among older hypertensive Chinese individuals and limited effectiveness of existing cessation programs. This underscores the necessity for augmenting primary care and devising a comprehensive health policy for more successful smoking cessation interventions, particularly considering China's rapidly aging population. [ABSTRACT FROM AUTHOR]

INTRODUCTION Quitting smoking can lead to substantial health gains, even later in life. Many smokers who attempt to quit experience several relapses before achieving sustainable cessation. This study aims to ascertain the differences between quitters with short and long abstinence time and to explore relapse reasons among smokers with cessation experience in Shanghai. METHODS From January to December 2022, 1745 current smokers were recruited in Minhang, Jiading, Qingpu and Songjiang districts of Shanghai. We used an electronic questionnaire to collect data. We implemented logistic regression for odds ratio (OR) and 95% confidence interval (CI) calculation to explore factors associated with long cessation time among smokers with cessation experience of >3 months, >6 months, and >12 months. RESULTS: Of the 1745 smokers included, 1452 (83.2%) were males, with an average age of 44.2 years, and 48.0% (838/1745) had cessation experience but relapsed. Logistic regression indicated that smokers aged ≥45 years had a longer cessation duration (adjusted odds ratio, AOR=3.10; 95% CI: 1.97-4.88). Moreover, longer cessation duration among smokers was positively associated with low education level of junior high or lower (AOR=2.30; 95% CI: 1.42-3.72) and senior high (AOR=2.19; 95% CI: 1.53-3.15), older age at first tobacco smoking (AOR=1.62; 95% CI: 1.1.16-2.25), but was negatively associated with longer smoking duration (AOR=0.67; 95% CI: 0.43-0.00) and higher smoking burden (AOR=0.44; 95% CI: 0.28-0.72). The main reasons for cessation relapse were social interaction needs (34.5%) and discomfort due to abstinence (29.1%). CONCLUSIONS: The relapse rate was high among smokers even after 12 months of abstinence. Smokers with older age, lower education level, shorter smoking duration and lower tobacco burden had longer cessation duration. Social interaction needs and withdrawal symptoms were the main relapse reasons. It is highly recommended that health bureaux consistently conduct tobacco control initiatives to spread awareness about the detrimental effects of tobacco smoke and the advantages of quitting smoking, even after achieving cessation. [ABSTRACT FROM AUTHOR]

INTRODUCTION Multi-morbidity is a public health priority as it is associated with an increased risk of mortality and a substantial healthcare burden. Smoking is considered a predisposing factor for multi-morbidity, but evidence for an association between multi-morbidity and nicotine dependence is insufficient. This study aimed to explore the association between smoking status, nicotine dependence, and multi-morbidity in China. METHODS We recruited 11031 Chinese citizens from 31 provinces in 2021 using a multistage stratified cluster sampling strategy to ensure the study population represented national population characteristics. The association between smoking status and multi-morbidity was analyzed using binary logistic regression and multinomial logit regression models. We then analyzed the associations between four kinds of smoking status (age at smoking initiation, cigarette consumption per day, smoking when ill in bed, and inability to control smoking in public places), nicotine dependence, and multi-morbidity among participants who were current smokers. RESULTS Compared with non-smokers, the odds of multi-morbidity were higher among ex-smokers (adjusted odd ratio, AOR=1.40, 95% CI: 1.07-1.85). The risk of multi-morbidity was greater in participants who were underweight/overweight/ obese (AOR=1.90; 95% CI: 1.60-2.26) compared with those who were normal weight. and also greater for drinkers (AOR=1.34; 95% CI: 1.09-1.63) than nondrinkers. Compared with children who began smoking at the age of <15 years, participants aged >18 years had a lower likelihood of multi-morbidity (AOR=0.52; 95% CI: 0.32-0.83). People who consumed ≥31 cigarettes per day (AOR=3.77; 95% CI: 1.47-9.68) and those who smoked when ill in bed (AOR=1.70; 95% CI: 1.10-2.64) were more likely to have multi-morbidity. CONCLUSIONS Our findings show that smoking behavior, including initiation age, frequency of daily smoking, and still smoking during illness or in public, is a critical risk factor for multi-morbidity, especially when combined with alcohol consumption, physical inactivity, and abnormal weight (underweight, overweight, or obese). This highlights the crucial effect of smoking cessation in the prevention and control of multi-morbidity, especially in patients with three or more diseases. Implementing smoking and lifestyle interventions to promote health would both benefit adults and prevent the next generation from initiating habits that increase the risk of multi-morbidity. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking prevalence is disproportionately higher in those with psychiatric symptoms. Smokers with psychiatric symptoms are less likely to have an intention to quit smoking and attain eventual smoking abstinence. This study presents the relationship between depressive/anxiety symptoms and the intention to quit smoking and related influencing factors. METHODS A cross-sectional study recruited 931 current smoking individuals covering two provinces in China in July 2022. The online survey comprised questions concerning sociodemographic characteristics, smoking conditions and psychiatric symptoms. Chi-squared analyses and moderation analyses were applied. RESULTS The proportion of smokers who had the intention to quit smoking within six months was 46.1%. In comparison with subjects without depressive/anxiety symptoms, individuals who had both psychiatric symptoms were less likely to have the intention to quit smoking (39.3% vs 49.8%, χ2=9.130, p=0.028). As for the moderating model of depression, the interaction term of depressive symptoms and smoking regularly was significant (β=0.554, t=3.260, p=0.001). For those who were occasional smokers, depressive symptoms significantly lowered their quitting intentions. The regularity of smoking similarly moderated the effect of anxiety symptoms on quitting intentions. When the number of cigarettes used weekly served as the moderator, the interaction of this number and depressive symptoms was significant, as well as for anxiety (p<0.001), indicating that the volume of cigarette consumption moderated the relationship between depressive/ anxiety symptoms and intention to quit smoking. CONCLUSIONS Psychiatric symptoms were significant factors in reducing the willingness of smokers to quit smoking, and the effects were moderated by smokers' cigarette consumption conditions. Interventions are urged to enhance quitting intentions of these vulnerable smokers. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study was conducted to explore the characteristics and risk factors of e-cigarette use in adolescents, aiming for tobacco control and reducing e-cigarette use in this population. METHODS Using 1:1 matching, 88 students from three vocational high schools in Shanghai were recruited to conduct a case (using e-cigarettes) - control (not using e-cigarettes) study. Group interviews and questionnaire surveys were used for this qualitative and quantitative mixed-methods study. The keywords were extracted from the interview data and analyzed by the Colaizzi seven-step method. RESULTS The characteristics of adolescents' use of e-cigarettes include young age at first use, consumption of a large amount, as well as smoking in discrete locations in order to hide from adults. The reasons for using e-cigarettes include curiosity and wanting to replace traditional cigarettes. The risk factors of using e-cigarettes include insufficient understanding of the harm of e-cigarettes at the individual level (The positive outcome expectancy points: Z= -3.746, p<0.001; The negative outcome expectancy points: Z= -3.882, p<0.001), peer influence at the interpersonal level (χ²=6.510, p<0.01), and the influence of social and environmental factors such as e-cigarette sales in the stores and WeChat Moments (p<0.05 for all associations). CONCLUSIONS Having friends who use e-cigarettes, curiosity and sales exposure about e-cigarettes are important factors affecting the use of e-cigarettes by adolescents. It is necessary to strengthen the publicity of the potential hazards of e-cigarettes and to reduce overall usage by improving relevant laws and regulations. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study aimed to investigate the impact of smoking on physical activity level, emotional status, and cardiopulmonary endurance in healthy young Chinese college students in order to develop future nicotine dependence management solutions. METHODS This survey-based study was conducted in college students aged 19-26 years who were currently smoking. Cardio-respiratory endurance was assessed by estimating VO2max. Participants were given a questionnaire containing five factors from the Cigarette Dependence Scale-5 (CDS-5), also assessed were variables for physical activity level, using the Global Physical Activity Questionnaire (GPAQ), and emotional status. The sports training behavior was assessed using the Coaching Behavior Scale for Sport (CBS-S). RESULTS A total of 400 participants were randomly selected and included in the study. All of them were current smokers. The highest percentage of participants had a score of 4 on the CDS-5 (n=93, 23.2%), scored 3-5 on each module of sports training, and experienced negative emotions, particularly depression (n=172; 43.0%) and anger (n=162; 40.5%). VO2max levels were significantly lower in participants with high nicotine dependence (CDS-5 score 4-5), and they correlated negatively with CDS-5 scores (r= -0.883, p<0.001). Nicotine dependence scores were negatively correlated with physical activity levels (r= -0.830, p<0.001), and high nicotine dependence scores were independently related to low physical activity (adjusted odds ratio, AOR=14.66; 95% CI: 4.98- 43.19, p<0.001). CONCLUSIONS Tobacco smoking has a negative impact on emotional status. It also reduces cardiopulmonary endurance by reducing VO2max levels and negatively affects physical activity. Accordingly, it is critical to implement effective tobacco prevention programs for college students, such as a smoking warning system and physical exercise training, as well as to educate them on how to quit smoking. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking has been proven to increase the risk of cervical cancer, but it is still controversial whether smoking reduces women's ability to clear human papillomavirus (HPV) infection. This study investigated the association between smoking behaviors during follow-up and clearance of HPV infection in women with HPV-positive and pathologically normal uterine cervix in China, using a propensity score matching (PSM) analysis. METHODS The present prospective study included data from women examined in the Gynecology Department of Shanghai General Hospital from January 2018 to June 2020. Twenty patients who smoked throughout follow-up were selected and matched with 60 patients using the 1:3 PSM method on age, marital status, and whether infected with high-risk HPV (HR-HPV). At each visit, smoking and sexual behaviors were collected. The Kaplan--Meier method and a Cox proportional hazard regression model were used to evaluate the probability of clearing HPV infection within a 2-year follow-up. RESULTS A total of 80 patients were included in the study, all of whom were infected with at least one HR-HPV type at baseline. Current smokers had a lower likelihood of clearing the HPV infection than current non-smokers, after adjusting for a history of sexually transmitted diseases (STD), HPV infection status, and sexual behaviors during follow-up (AHR=0.478; 95% CI: 0.239--0.958, p=0.037). Additionally, longer duration, higher frequency and larger doses of smoking correlated with the lower clearance possibility of HPV infection (p for trend=0.029, 0.022 and 0.026, respectively). CONCLUSIONS This study showed that the use of tobacco throughout follow-up could increase the risk of a persistent HPV infection, this risk being higher for smokers with heavier tobacco consumption. Our results should alert HPV-positive women to reiterate the advice to cut-back on or stop smoking. [ABSTRACT FROM AUTHOR]

INTRODUCTION Significant changes occurred in the way people socialize and interact with each other since China reported its first COVID-19 cases. However, little is known about how smoking behaviors may have changed due to the COVID-19 pandemic in China. The aim of this study was to assess changes in smoking behavior and intention to quit during the early stage of the COVID-19 pandemic in China and to investigate the associated factors. METHODS An online cross-sectional survey was conducted among Chinese adult smokers. Participants were recruited through snowball sampling from 19 March to 2 April 2020. RESULTS A total of 1388 smokers participated in this study. Of those, 1014 (73.0%) reported not changing their cigarette consumption, 104 (7.5%) reported smoking more and 268 (19.3%) reported smoking less due to the pandemic. Average daily cigarette consumption among all participants decreased from 15.0 (IQR: 10.0--20.0) to 13.0 (IQR: 8.0-20.0) (W=6.919, p<0.001). For intention to quit, 270 (19.5%) respondents reported becoming more willing to quit, and 91 (6.6%) reported becoming less willing to quit. Multivariate analyses showed that tobacco addiction, overall knowledge about the relationship between smoking and COVID-19, level of attention devoted to COVID-19, anxiety, living alone, and number of smokers in the family were significantly correlated with cigarette consumption and intention to quit, and living alone was the strongest factor associated with increased cigarette consumption (AOR=5.29; 95% CI: 1.51-18.56). CONCLUSIONS The COVID-19 pandemic led to a slight decrease in cigarette consumption and an increase in quitting intention among Chinese smokers. During the early stages of the pandemic, it was important to focus on the anxiety of smokers, dispel smokers' misunderstandings of smoking and COVID-19 and create a supporting environment in the family to help smokers quit. [ABSTRACT FROM AUTHOR]

INTRODUCTION Alzheimer's disease (AD) is a disease caused by many factors including occupational and environmental factors. Secondhand smoke (SHS) can affect cognitive function. However, there is limited recent epidemiological research on how SHS and occupational factors affect AD in Zhejiang province. METHODS We established a cohort of an AD high-risk population. In 2018, a cohort of 1742 elderly aged ≥60 years was established. In 2020, the cohort was followed up, and a total of 1545 people participated in the two surveys. Data collection included demographic and economic information such as age, gender, occupation, education level etc., and relative health behavior information such as smoking, drinking and tea drinking, etc. Basic physical examination data included height, weight, blood pressure, etc. At the same time, related cognitive status was assessed. Cox proportional hazards regression models, both unadjusted and adjusted models, were used to determine associations between cohort characteristics and AD. RESULTS The results showed that SHS exposure and occupational characteristics were associated with an increased risk of cognitive impairments in seniors. Subgroups who used to work as blue-collar workers, who never worked, who kept standing for most of the time at work, and who were engaged in hard physical labor prior to retirement, had high incidence rates of AD. CONCLUSIONS It was revealed that SHS, standing for most of the time and hard physical labor were associated risk factors of AD among seniors, compared with white-collar work. We recommend that the government establish a community supervisory mechanism to persuade smokers to quit or control smoking. [ABSTRACT FROM AUTHOR]

Introduction: China consumes 44% of the world's cigarettes. Robust tobacco control measures are needed to contain the trend of increasing cigarette consumption. This paper examines the effectiveness of policy interventions introduced in China on reducing the country's tobacco use., Methods: The paper uses data on China's monthly cigarette consumption per capita from January 2000 to June 2017 to estimate the impact of specific policies on China's tobacco consumption. Tobacco consumption is calculated from monthly sales data from the China National Tobacco Corporation and demographic data from the China National Bureau of Statistics. The policies studied include the WHO Framework Convention on Tobacco Control (FCTC), national tobacco-related policy changes and two tobacco tax increases implemented in China during the study period. Segmented regression analysis is used to estimate the immediate effects of the policies studied and changes in the time trends resulted from these policy changes., Findings: The impact of national policy changes in China is almost 20 times greater than the impact of the WHO FCTC treaty itself, and national policy changes in tobacco control are a determining factor in reversing the trend of increasing tobacco consumption in China. The 2015 tax increase, which raised retail cigarette prices, produced both immediate and trend effects, with a total incremental effect 7.8 times that of the 2009 tax increase, which did not result in higher cigarette prices for the consumer., Interpretations: Translating global tobacco control policies into domestic policies will generate a much greater impact on reducing average cigarette consumption, and tobacco taxes that are reflected in the retail prices of cigarettes will be more effective in reducing cigarette consumption., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

This paper aims at investigating how the media coverage and smoking cessation treatment should be implemented, for a certain period, to reduce the numbers of smokers and patients caused by smoking while minimizing the total cost. To this end, we first propose a new mathematical model without any control strategies to investigate the dynamic behaviors of smoking. Furthermore, we calculate the basic reproduction number ℛ 0 is more than 1, which reveals that smoking is one of the enduring problems of the society. Hence, we introduce two control measures (media coverage and smoking cessation treatment) into the model. Finally, in order to investigate their effects in smoking control and provide an analytical method for the strategic decision-makers, we apply a concrete example to calculate the incremental cost-effectiveness ratios and analyze the cost-effectiveness of all possible combinations of the two control measures. The results indicate that the combination of media coverage and smoking cessation treatment is the most cost-effective strategy for tobacco control.ℛ 0 is more than 1, which reveals that smoking is one of the enduring problems of the society. Hence, we introduce two control measures (media coverage and smoking cessation treatment) into the model. Finally, in order to investigate their effects in smoking control and provide an analytical method for the strategic decision-makers, we apply a concrete example to calculate the incremental cost-effectiveness ratios and analyze the cost-effectiveness of all possible combinations of the two control measures. The results indicate that the combination of media coverage and smoking cessation treatment is the most cost-effective strategy for tobacco control.

INTRODUCTION China has recently introduced a range of e-cigarette control policies with a focus on addressing an increase in youth vaping. This study aimed to investigate a wide range of e-cigarette-related attitudes and behaviors in a national sample of Chinese adolescents and young adults to obtain insights into their exposure to, experiences with, and attitudes to e-cigarettes on the cusp of new regulations coming into force. METHODS An online survey was administered to a sample of 1062 adolescents and young adults (aged 15-30 years) in China in November-December 2021. Quotas were applied to achieve an approximately equal gender split, representation across age sub-groups (15-17, 18-20, 21-23, 24-26, and 27-30 years), and approximately two-thirds representing low- and middle-income groups. Adjusted odds ratios (AORs) were also calculated. RESULTS Just under half (47%) reported no knowledge of e-cigarettes and/or vaping. One in five reported ever using e-cigarettes ('even once or twice'), 8% reported being current users, and 3% reported being daily users. Around two-thirds of those who had heard of e-cigarettes/vaping had friends who vaped and had seen e-cigarette advertising. Fruit flavors were most popular, and the most frequently nominated reasons for vaping were to cut down on cigarette smoking and because a friend used them. The factors positively associated with ever use of e-cigarettes were current tobacco smoking (AOR=68.26) or previous tobacco smoking (AOR=39.15) and having friends who vape (AOR=1.76). Perceptions of addictiveness were negatively associated with ever use (AOR=0.47). Strong support was evident for most assessed e-cigarette control policies. CONCLUSIONS The results indicate that young people in China have been able to access and use e-cigarettes, although rates of regular use are low. Generally, high levels of expressed support for a range of e-cigarette control policies among members of this age group suggest the new regulatory environment is consistent with their policy preferences. [ABSTRACT FROM AUTHOR]

Background Suboptimal health status (SHS) is a non-clinical or pre-disease state between optimal/ideal health and disease. While its etiology remains unclear, lifestyle is considered one of the most important risk factors. We aimed to examine the effects of lifestyles on SHS through a nationwide survey in China. Methods We conducted a cross-sectional survey in 148 cities across China between 20 June and 31 August 2022, on 30505 participants from rural and urban communities gathered through stratified quota sampling. We measured SHS with the Short-Form Suboptimal Health Status Questionnaire (SHSQ-SF). We gathered information on participants' lifestyles (ie, smoking, alcohol consumption, breakfast habits, weekly food delivery frequency, intermittent fasting, sleep duration and physical activities) through face-to-face interview. We determined the relationship between lifestyle and SHS logistic regression analysis by based on odds ratios (ORs) and 95% confidence intervals (CIs). Results We included 22897 participants (female: 13056, male: 9841), 12 108 (52.88%) of whom reported exposure to SHS. After adjusting for demographic characteristics, individuals who currently smoked (OR = 1.165; 95% CI = 1.058-1.283) and those who drank alcohol (OR = 1.483; 95% CI = 1.377.1.596) were at a higher risk of SHS than those who have never done either. In a dose-response way, takeaway food consumption was associated with a higher risk of SHS, while increased frequency of breakfast and mild-intensity exercise conversely reduced said risk. Individuals with shorter sleep duration had a higher risk of SHS when compared to those who slept for more than seven hours per day. Conclusions We observed a relatively high prevalence of SHS across China, highlighting the importance of lifestyle in health promotion. Specifically, adopting healthy dietary habits, engaging in regular physical activity, and ensuring high-quality sleep are key in preventing SHS. [ABSTRACT FROM AUTHOR]

Background To identify the prevalence of sleep disorders in China through a large sample study. To explore the relevant social determinants affecting residents' sleep status at both individual and provincial levels based on the theoretical framework of the Dahlgren-Whitehead model. Methods A nationwide cross-sectional web-based survey was conducted from January 20 to February 28, 2019 across 31 provinces of China. The Pittsburgh Sleep Quality Index was used to evaluate residents' sleep quality. Multilevel linear regression analysis was used to analyse the influencing factors of sleep disorder. Results A sample of 107 650 residents completed the survey, and 94 454 questionnaires were included in the final analysis. The crude incidence rate and the age-adjusted rate of sleep disorder in Chinese residents were 19.16% and 21.25%, respectively. Those who were older, female, smokers, drinkers, married, divorced, or widowed, retired, more educated (regression coefficient (b) = 0.172, P < 0.05), had worse self-perceived economic status, and lived far away from community health services (b = 0.758, P < 0.05) were more likely to have sleep problems. Physical exercise, social support (b = -1.705, P < 0.05), and greening coverage of residential areas (b = -1.769, P < 0.05) were protective factors for residents' sleep quality. Conclusions Sleep disorders are prevalent in the Chinese population, with varying incidence rates across provinces. To improve sleep quality, the Chinese government and health management departments should pay more attention to vulnerable groups and promote healthy lifestyles through education. Additionally, the social network can be utilized to provide social support. Improving the ecological environment and daily living environment is also essential. [ABSTRACT FROM AUTHOR]

Background The co-existence of undernutrition and overweight/obesity has been recognised as a severe challenge in China, with substantial urban-rural disparity. We evaluated short- and long-term associations of urban-rural locality on body mass index (BMI) in Chinese adults overall and stratified by sex, focusing on whether dietary knowledge plays a mediating role. Methods We used cross-sectional and longitudinal study designs with structural equation modelling based on the 2004 (T1) and 2015 (T2) waves of the China Health and Nutrition Survey. We adjusted the models for covariates and performed sensitivity analyses. Results We cross-sectionally analysed 8932 (53.1% women) and 11 216 adults (54.3% women) at T1 and T2, respectively, and longitudinally investigated 4073 adults (55.6% women) in both T1 and T2. The estimated average dietary knowledge and mean BMI increased from T1 to T2. At each time point, we found significant indications of direct (e.g. urban-rural locality to BMI, urban-rural locality to dietary knowledge, and dietary knowledge to BMI) and indirect associations (e.g. urban-rural locality to dietary knowledge to BMI) overall and for men and women (except that urban-rural locality to BMI) separately. The long-term association between urban-rural locality and BMI attenuated over time and was not mediated by dietary knowledge change alone. Nevertheless, dietary knowledge interacted with BMI, which acted as a pathway from urban-rural locality to BMI in the long term. Conclusions Urban-rural disparity in BMI persists in Chinese adults and is mediated by dietary knowledge. Policy and educational efforts to improve dietary knowledge among rural people may reduce China's urban-rural disparity in BMI. [ABSTRACT FROM AUTHOR]

INTRODUCTION Tobacco smoke contains a large number of harmful substances and carcinogens. Smoking and secondhand smoke cause a variety of cancers and diseases, seriously endangering human health. However, the status and characteristics of the awareness of hazards due to tobacco among people aged ≥15 years in Chongqing, China, are still unknown. METHODS A multistage stratified cluster random sampling method was used to select ten districts and counties in Chongqing Municipality, China and a total of 6622 people were investigated between August and October 2020. The chi-squared test was used to analyze the awareness of hazards due to tobacco in various populations after the data had been cleaned and weighted. RESULTS In 2020, the awareness rates of people aged ≥15 years in Chongqing, China, about a specific disease caused by smoking were lung cancer (77.1%), heart disease (45.1%), stroke (40.1%), and penile erectile dysfunction (24.2%). However, only 22.1% of the respondents knew that smoking could simultaneously lead to all four diseases mentioned above. Adult lung cancer was the disease with the highest awareness rating (72.5%), followed by children's lung disease (54.2%) and adult heart disease (46.1%). A total of 42.0% of respondents knew that secondhand smoke could cause the three diseases simultaneously. Only 22.0% of those correctly understood the harm of low-tar cigarettes. The logistic regression results showed that education level and occupation were risk factors for lack of awareness of hazards due to tobacco. In contrast, media campaigns on tobacco control were a protective factor. CONCLUSIONS The awareness of hazards due to tobacco among people aged ≥15 years in Chongqing, China, still needs to be improved. More graphic health warning labels and mass media campaigns about the hazards of tobacco should be carried out to raise people's awareness and warn about the health risks of smoking. [ABSTRACT FROM AUTHOR]

INTRODUCTION While many studies have confirmed that smoking is causally associated with various diseases, some have found an association between smoking and human functional impairment. Relationships between smoking and poor health-related quality of life (HRQoL) have been investigated in general populations. However, these studies have examined only individual-level correlates. This study examined the association between smoking and poor HRQoL, at both the individual and contextual levels, in university settings across China. METHODS Large-scale survey sampling was conducted among 11659 health-profession students from 31 Chinese universities. HRQoL was measured by the EQ-5D instrument. This multilevel, multivariable analysis utilized unadjusted and adjusted methods. RESULTS Prevalence of poor HRQoL in this study was 2.7% (95% CI: 1.9--3.5). Multilevel logistic regression analysis revealed that frequent (OR=3.18; 95% CI: 2.35--4.33) and occasional smokers (OR=2.73; 95% CI: 1.61--4.65) and universities with high (OR=2.68; 95% CI: 1.34--5.35) and medium smoking prevalence (OR=1.49; 95% CI: 0.95--5.35) had excess odds of poor HRQoL compared to their respective referents, non-smokers and universities with a low smoking prevalence. CONCLUSIONS This multilevel study provides new evidence that smoking is associated with poor HRQL. Findings underscore the importance of alerting the populace that functional impairment is linked to smoking. [ABSTRACT FROM AUTHOR]

Introduction: Lung cancer is a significant cause of mortality, especially among smokers. Lung cancer and smoking are strongly associated, according to numerous studies. Methods: Publications related to smoking and lung cancer were retrieved from the Science Citation Index Expanded (SCIE) database of the Web of Science Core Collection for the period 1994–2023. Descriptive and visual analyses were performed on the topics, journals, countries, institutions, authors, and citations of the publications. Results: A total of 728 articles were retrieved from the Web of Science (WOS) SCIE database for the period January 1994 to December 2023, and the number of publications in the relevant literature demonstrated a progressive increase with time. A total of 647 articles were classified as experimental, while 81 were classified as reviews. The studies were published in 200 journals. The three journals that published the most articles were the American Journal of Epidemiology with 82 articles, Lung Cancer with 34 articles, and Cancer Causes and Control with 26 articles. The three most prolific countries were the United States (286 articles, 38.3%; 15879 citations), China (116 articles, 15.9%; 2911 citations), and France (75 articles, 10.3%; 3694 citations). The four most popular keywords in this field are 'early cancer detection', 'experimental', 'CT', and 'survival rate'. Conclusions: The findings of our study revealed key areas for focus in smoking and lung cancer research, having a view of supplying important data and motivation for further investigations. [ABSTRACT FROM AUTHOR]

Background The American Heart Association recently released an updated algorithm for evaluating cardiovascular health—Life's Essential 8 (LE8). However, the associations between changes in LE8 score over time and risk of cardiovascular disease (CVD) remain unclear. Methods We investigated associations between 6-year changes (2006–12) in LE8 score and risk of subsequent CVD events (2012–20) among 53 363 Chinese men and women from the Kailuan Study, who were free from CVD in 2012. The LE8 score was calculated based on eight components: diet quality, physical activity, smoking status, sleep health, body mass index, blood lipids, blood glucose and blood pressure. Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results We documented 4281 incident CVD cases during a median of 7.7 years of follow-up. Compared with participants whose LE8 scores remained stable in a 6-year period, those with the large increases of LE8 score over the 6-year period had a lower risk of CVD, heart disease and stroke in the subsequent 8 years [HRs and 95% CIs: 0.67 (0.64, 0.70) for CVD, 0.65 (0.61, 0.69) for heart disease, 0.71 (0.67, 0.76) for stroke, all P trend < 0.001]. Conversely, those with the large decreases of LE8 score had 47%, 51% and 41% higher risk for CVD, heart disease and stroke, respectively. These associations were consistent across the subgroups stratified by risk factors. Conclusions Improving LE8 score in a short- and moderate-term was associated with a lower CVD risk, whereas decreased LE8 score over time was associated with a higher risk. [ABSTRACT FROM AUTHOR]

INTRODUCTION Preventing youth from tobacco use is a priority for tobacco control in China, and the government has taken many measures such as introducing tobacco control in the health education curriculum, banning smoking in school, promoting smoke-free household, and advocacy campaigns. The objective of this study was to understand the availability and affordability of cigarettes for middle school (MS) and high school (HS) students in China. METHODS The data were extracted from the 2019 China National Youth Tobacco Survey, which was a school-based cross-sectional survey with a nationally representative sample of 288192 MS and HS students. The survey employed a randomized multistage stratified cluster sampling design with probability proportional to size sampling method and used an anonymous self-administrated questionnaire to collect data. The availability and affordability of cigarettes were analyzed, and all parameter estimates were weighted to account for the complex sampling design. RESULTS In 2019, an estimated 80.5% of current smokers who were aged <18 years bought cigarettes in the past 30 days. Among them, 83.3% (83.0% of males and 85.2% of females; and 76.5% in MS and 87.6% in HS) had not been refused purchase of cigarettes because they were underage, with 84.1% in urban and 82.9% in rural areas, and 87.3% in central, 83.4% in eastern, and 80.5% in western regions of China. Among current smokers who bought cigarettes in the past 30 days, 77.3% had bought a pack of cigarettes (20 cigarettes) costing >10 RMB and at least 61.4% had more pocket money per week than the cost of a pack of cigarettes. Although 84.2% of current smokers bought cigarettes by the pack, 9.2% of current smokers reported that they bought cigarettes as sticks. CONCLUSIONS Although the youth smoking rate dropped down from 2014 to 2019, the proportion of youth smokers that bought cigarettes was still high in China. Due to the high amount of pocket money, the current cigarette price was not an effective price barrier to prevent youth smoking. Selling cigarettes by the stick worsens the situation. Strengthening the enforcement of the 2021 Law on the Protection of Minors, increasing tobacco taxes and prices, and forbidding the selling of cigarette sticks, might assist the progress in youth tobacco control. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study aims to estimate the impact of smoking-attributable mortality of selected cancers, in the period 2010-2019 in Tianjin, China. METHODS A case-control study was conducted to assess the smoking-attributed major causes of cancer deaths. Unmatched multiple logistic regression was used to calculate mortality risk ratios. RESULTS Smoking-attributable cancer deaths were 23709 (28.87%) among adult males and 8648 (13.37%) among adult females in the period 2010-2019 in Tianjin, China. Lung cancer remains the largest cause of smoking-attributable deaths; among men, the death rates were 49.06% of lung cancers, 27.55% of mouth, pharynx, larynx, or esophagus cancers, 13.56% of kidney and other urinary cancers, and 10.11% of liver cancers; among women the corresponding death rates were 31.56% of lung cancers and 10.59% of the mouth, pharynx, larynx, or esophagus cancer, 10.56% of bladder cancers. Smoking-attributed cancer deaths in men increased from 1817 in 2010 to 2695 in 2019; for women, the number remained stable at just over 800 per year during the past decade. CONCLUSIONS At least one in three cancer deaths in men and one in six in women would be potentially preventable through appropriate control of tobacco smoking in Tianjin, China. Effective control programs against tobacco smoking should be further implemented. [ABSTRACT FROM AUTHOR]

INTRODUCTION The study focused on the influence of tar concentrations, smoking regimen, and smoking behavior, on benzo[a]pyrene (B[a]P) emission from cigarette mainstream smoke and related health hazards to determine the key factors influencing B[a]P reduction and protection of the smoker's health. METHODS A locally popular brand of cigarettes in Beijing was selected with tar concentrations of 1, 3, 5, 8, 10, and 11 mg/cigarette. Two different machine smoking regimens, the Canada Intense (HCI) regimen and the International Organization for Standardization (ISO) regimen, were adopted to collect the cigarette mainstream smoke. The B[a]P emission concentrations were then measured by gas chromatography and mass spectrum. RESULTS The average B[a]P emission was 8.14--17.6 ng/cigarette for the HCI regimen and 0.92--3.46 ng/cigarette for the ISO regimen. As expected, the tar concentrations and B[a]P emissions exhibited a positive relation in both the HCI and ISO regimens, the cancer risk and non-cancer risk increased with an increase in tar concentrations for both the ISO and HCI regimens, and the smoking behavior also affected the B[a]P emissions with a tendency of VB (ventilation blocking) > HVB (half ventilation blocking) > DP (deep puff), under the same smoking regimen. Under the same conditions, the cancer risk and non-cancer risk in men were 1.19 and 1.11 times, respectively, higher than in women. CONCLUSIONS The smoking regimen influences the B[a]P emission relatively more than the cigarette tar concentration and smoking behavior. The cancer risk and non-cancer risk are higher in men than in women that possibly due to longer smoking duration and greater smoking intensity. [ABSTRACT FROM AUTHOR]

Aims: This paper presents updated prevalence estimates of awareness, ever‐use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. Design, Setting, Participants and Measurements: A cross‐sectional analysis of adult (≥ 18 years) current smokers and ex‐smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013–17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country‐specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non‐daily). Findings NVP awareness and use were lowest in NRP countries. Generally, ever‐ and current use of NVPs were lower in MRP countries (ever‐use = 7.1–48.9%; current use = 0.3–3.5%) relative to LRP countries (ever‐use = 38.9–66.6%; current use = 5.5–17.2%) and RP countries (ever‐use = 10.0–62.4%; current use = 1.4–15.5%). NVP use was highest among high‐income countries, followed by upper–middle‐income countries, and then by lower–middle‐income countries. Conclusions: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products. [ABSTRACT FROM AUTHOR]

INTRODUCTION E-cigarettes were invented in China, and most of the world's e-cigarettes have been produced in China. However, awareness and use of e-cigarettes in China are lower than in Europe and America. Against the backdrop of the increasing use of e-cigarettes, the supervision of e-cigarettes in China has been almost non-existent. METHODS A literature search was carried out in five popular Chinese and English databases. These databases were PubMed, EMBASE, the Cochrane Library, China national knowledge infrastructure (CNKI), and Wan-fang database. RESULTS Twenty-one studies were identified, and a comprehensive analysis of e-cigarette awareness ratio was conducted for different regions of China and according to gender, age group, and smoking status. We also examined e-cigarette use and associated risk factors, and the relationship between e-cigarette use and smoking cessation. In 2015, the prevalence of 'ever use' and 'current use' of e-cigarettes in China were 3.1% and 0.5%, respectively. The review indicates that the awareness ratio of e-cigarettes was about 66% in Hong Kong, whereas the ratio for Tianjin was lower (43.6%). Online sales were the main channel for selling e-cigarettes to 80% of the users. Awareness of e-cigarettes has been increasing in China. Awareness was higher in men compared to women in all age groups. Nevertheless, e-cigarette use in China was lower than in developed countries. E-cigarette users were more likely to try to quit smoking, but the relationship between e-cigarette use and smoking cessation is still unclear. Governance is necessary for e-cigarette use and marketing effort. CONCLUSIONS This study investigated the awareness and use of e-cigarettes in China and the existing regulations for e-cigarette use and marketing. The lack of regulations for e-cigarette use and the unrestricted practice encourage the increase in adoption of e-cigarettes and misconceptions of the benefits of using e-cigarettes. Hence, it is crucial that the government of China prioritize the establishment and implementation of regulations for e-cigarette use and marketing. [ABSTRACT FROM AUTHOR]

INTRODUCTION Cigarette and tobacco use is a leading cause of chronic obstructive pulmonary disease, lung cancer, and other malignant tumors. In China, people prefer to engage in mental activities (gambling, overtime work, playing video games, or other mental activities) on the weekends or during spare time, especially in the evening before they prepare for bed. In China, smokers frequently consume tea while smoking. The relationship between smokers who consume tea, engage in mental activities after dinner, or both (drinking tea and engaging in cognitive activities after dinner together), and daily cigarette smoking or nicotine addiction must be clarified. METHODS A total of 438 smokers were included in the study. Age, gender, body mass index (BMI), smoking habits, Fagerström test for nicotine dependence scores, and behaviors, were recorded. The study excluded smokers with a Fagerström score <1 or with a mental disorder diagnosis. The smokers were divided into four groups based on their behaviors: those who did not drink tea, did not engage in mental activities after dinner, those who drank tea only, those who engaged in mental activities only, and those who engaged in both. RESULTS Only drinking tea or doing mental activities after dinner cannot increase cigarettes per day (22.20 ± 10.143 vs 23.49 ± 11.966, p=0.362; 22.20 ± 10.143 vs 22.66 ± 1.192, p=0.750) or FTND scores [6.0 (4.0; 7.0) vs 6.0 (4.0; 7.75), p=0.941; 6.0 (4.0; 7.0) vs 6.0 (4.25; 7.75), p=0.980]. People who drink tea and engage in mental activities after dinner smoke more (22.20 ± 10.143 vs 30.75 ± 17.264, p<0.0001) and have higher nicotine dependence levels [6.0 (4.0; 7.0) vs 7.0 (5.0; 8.0), p=0.015]. CONCLUSIONS The consumption of tea or a mental activity after dinner is not associated with daily smoking or nicotine dependence. There is an association between the combined behaviors (tea drinking and mental activity after dinner) and the daily consumption of cigarettes, and the degree of nicotine dependence. [ABSTRACT FROM AUTHOR]