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Background Tobacco consumption is the leading cause of death worldwide. Overwhelming studies demonstrate graphic warning labels (GWLs) on cigarette packs are effective in eliciting negative response to tobacco smoking, modifying beliefs about tobacco dangers, and increasing reported intention to quit, but the estimated effect of GWLs on smoking cessation intention among smokers is still limited in China. In this study, we aim to understand the smoking intensity, smoking duration and smoking cessation intention among current smokers, and to explore how their smoking cessation intention would be influenced by the GWLs in Shanghai. Methods From January to June 2021, we totally recruited 1104 current smokers in Songjiang district and Fengxian district of Shanghai by multistage sampling design. We used Android pad assisted electronic questionnaire for data collection, and then implemented logistic regression for odds ratio (OR) and 95% confidence interval (CI) calculation to explore how smoking cessation intention would be influenced by the GWLs among current smokers. Results One thousand one hundred four current smokers included 914 males (82.79%), with an average age of 43.61 years. 58.06% of current smokers reported smoking cessation intention due to GWLs. Logistic regression indicated a higher percentage of smoking cessation intention due to GWLs was among female smokers [OR = 2.41, 95% CI (1.61–3.59)], smokers with smoking intensity Conclusions Smoking cessation intention due to the assumed GWLs on cigarette packs is high among current smokers in Shanghai, especially in female smokers, smokers with light tobacco burden and mild nicotine dependence. Incorporating smoking intensity as well as smoking burden into the implementation of GWLs as tobacco control measures would discourage smoking in China.

Introduction . Tobacco smoking is one of the main and independent risk factors for cardiovascular disease developing. Despite the fact that the main effects of tobacco use on human health are well known, the annual number of smokers on the planet is still growing. The aim of the study was to study the twenty-year dynamics of the prevalence of tobacco smoking among women aged 25–64 in the open population of a moderately urbanized city of Western Siberia. Material and methods . Within the regional program for monitoring the epidemiological situation in relation to the risk of developing CVD in 1996 and 2016. Two simultaneous epidemiological studies were carried out among persons from the Central Administrative District of Tyumen – a sample of 1000 women aged 25–64 years. The yield was 81.3 % ( n = 813) in 1996, and 70.3 % ( n = 703) in 2010. The prevalence of tobacco smoking was determined using a questionnaire developed in the former USSR by the Institute of Preventive Cardiology of the Academy of Medical Sciences (now FSBI «NIMTs TPM» of the Ministry of Health of Russia) as part of the implementation of the Cooperative Study on Multifactorial Prevention of cardiac ischemia. Results and its discussion . According to the results of 20-year monitoring among women aged 25–64 years of the open population of a medium-urbanized city of Western Siberia, an increase in the prevalence of tobacco smoking was established (23.1 % – 31.2 %, p = 0.0036). The highest prevalence of tobacco smoking was found in women in the third decade of life, a significant increase in the indicator during the 20-year monitoring of the open population - in the fourth to sixth decades of life. The established patterns in the dynamics of the increase in the prevalence of tobacco smoking among women aged 25–64 years in the open population of a mediumurbanized city of Western Siberia were determined by an increase in the proportion of women who smoke irregularly (11.4 % – 20.1 %, p = 0.0000) and who started smoking (27.7 % – 37.6 %, p = 0,0000). 20-year monitoring of the open population of a medium-urbanized city of Western Siberia showed some positive trends in the decrease in regular tobacco smoking among women in the third decade of life (25.1 % – 13.5 %, p = 0.0187). Conclusion . Thus, in the open population of a moderately urbanized city of Western Siberia over the period of 20-year monitoring among women aged 25–64 years, a negative epidemiological situation was established in terms of the dynamics of the prevalence of tobacco smoking due to the growth of irregular tobacco smoking and those who started smoking. Positive trends in the Tyumen population are determined by a decrease in the prevalence of regular tobacco smoking in one age group of 25–34 years.

Background:To understand a causal role of modifiable lifestyle factors in angiotensin-converting enzyme 2 (ACE2) expression (a putative severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] receptor) across 44 human tissues/organs, and in coronavirus disease 2019 (COVID-19) susceptibility and severity, we conducted a phenome-wide two-sample Mendelian randomization (MR) study.Methods:More than 500 genetic variants were used as instrumental variables to predict smoking and alcohol consumption. Inverse-variance weighted approach was adopted as the primary method to estimate a causal association, while MR-Egger regression, weighted median, and MR pleiotropy residual sum and outlier (MR-PRESSO) were performed to identify potential horizontal pleiotropy.Results:We found that genetically predicted smoking intensity significantly increased ACE2 expression in thyroid (β=1.468, p=1.8×10−8), and increased ACE2 expression in adipose, brain, colon, and liver with nominal significance. Additionally, genetically predicted smoking initiation significantly increased the risk of COVID-19 onset (odds ratio=1.14, p=8.7×10−5). No statistically significant result was observed for alcohol consumption.Conclusions:Our work demonstrates an important role of smoking, measured by both status and intensity, in the susceptibility to COVID-19.Funding:XJ is supported by research grants from the Swedish Research Council (VR-2018–02247) and Swedish Research Council for Health, Working Life and Welfare (FORTE-2020–00884).

Non-alcoholic fatty liver disease (NAFLD) is common among 30% of American adults. Former and current smokers are at higher risk for NAFLD compared to never smokers. The ratio of urine caffeine metabolites to caffeine intake—namely, urine caffeine metabolite indices—has previously been used as a proxy for CYP1A2 activity, which is one of the main liver metabolizing enzymes. CYP1A2 activity is associated with NAFLD progression. No studies to our knowledge have examined the associations of liver enzymes, smoking intensity, and secondhand smoke (SES) with CYP1A2 activity (using caffeine metabolite indices) across smoking status. We analyzed national representative samples from the 2009–2010 National Health and Nutrition Examination Survey (NHANES). Interestingly, even within a normal range, several liver enzymes were associated with caffeine metabolite indices, and patterns of many of these associations varied by smoking status. For instance, within a normal range, aspartate aminotransferase (AST) in never smokers and bilirubin in current smokers were inversely associated with 1-methyluric acid and 5-acetylamino-6-amino-3-methyluracil (URXAMU). Furthermore, we observed a common pattern: across all smoking statuses, higher AST/alanine aminotransferase (AST/ALT) was associated with 1-methyluric acid and URXAMU. Moreover, in current smokers, increased lifelong smoking intensity was associated with reduced caffeine metabolite indices, but acute cigarette exposure as measured by SES levels was associated with increased caffeine metabolite indices among never smokers. In summary, commonly used liver enzyme tests can reflect the CYP1A2 activity even within a normal range, but the selection of these enzymes depends on the smoking status, the associations between smoking and the CYP1A2 activity not only depend on the intensity but also the duration of tobacco exposure.

Introduction The COVID‐19 pandemic has led to a major shift in workspace from office to home. This report examined how telecommuting is related to smoking behavior of wage and salary workers. Methods Self‐reported smoking behavior of 1,390 U.S. wage and salary workers aged 16–64 years from the Tobacco Use Supplement of the Current Population Survey 2018/19 were linked to the 2018 American Time Use Survey. Weighted multivariate logistic regression predicting smoking probability and generalized linear regression predicting smoking intensity were used for analysis. Results Almost a fifth (19%) of wage and salary workers reported working from home and over a half (52%) reported working in telecommuting amenable occupations. Nearly 12% were current smokers, smoking 14.7 cigarettes daily on average. Compared to their counterparts, smoking prevalence (percentage points) was lower among those employed in telecommuting amenable occupations (−0.52, p

In order to analyze the smoking patterns in economically disadvantaged communities in South Africa, this paper examines the determinants of smoking intensity, using pooled data on price and non-price determinants of smoking from two cross-sectional surveys conducted in 2017 and 2018 to investigate the drivers of conditional cigarette demand among daily smokers. The analysis was done using a negative binomial regression. The results show that smokers reduce the number of cigarettes smoked daily when cigarette prices increase. The conditional price elasticity of cigarette demand of -0.295 for the overall sample shows that a 10% increase in cigarette price leads to a 2.95% decline in cigarette consumption among smokers. For young smokers, a 10% increase in cigarette price causes their smoking intensity to fall by 5%. Similar to other studies, the response of female smokers to cigarette price changes is statistically insignificant. Other factors affecting the conditional demand for cigarettes are education, race, single stick sales, gender, wealth, and age. We conclude that cigarette prices play a significant role in reducing smoking intensity among the South African poor. Since the magnitude of the price effect varies across age groups, races, and genders, the policy of higher tobacco excise taxes should be accompanied by interventions targeted at those less responsive to price-related measures.

Aim. To assess the association of smoking status and smoking intensity with general and abdominal obesity in a sample of middle-a ged men.Material and methods. This study was conducted as a part of the 32-year prospective cohort observation of males from childhood (11-12 years of age). The study included 301 (30,0%) representatives of the initial population sample aged 41-44 years. Age, anthropometric parameters, relationship of smoking status and smoking intensity with general (overweight/obesity) and abdominal obesity were analyzed.Results. Overweight/obesity were more common in former smokers (78,1%) compared with non-smokers (58,7%; pConclusion. High intensity of smoking among current smokers is associated with a higher probability of developing abdominal obesity, and in former smokers — with a higher probability of developing general and abdominal obesity. Former smokers, compared to current smokers, are at a lower risk of developing fatal cardiovascular diseases. Smoking cessation activities should be aimed at minimizing weight gain after quitting smoking and developing tobacco control programs.

Background Light and intermittent smoking has become increasingly prevalent as smokers shift to lower consumption in response to tobacco control policies. We examined changes in cigarette consumption patterns over a four-year period and determined which factors were associated with smoking transitions. Methods We used data from a cohort of smokers from the 2008–2012 ITC Mexico Survey administrations to investigate transitions from non-daily (ND; n = 669), daily light (DL; ≤5 cigarettes per day (cpd); n = 643), and daily heavy (DH; >5 cpd; n = 761) smoking patterns. To identify which factors (i.e., sociodemographic measures, perceived addiction, quit behavior, social norms) were associated with smoking transitions, we stratified on smoking status at time t (ND, DL, DH) and used multinomial (ND, DL) and binomial (DH) logistic regression to examine transitions (quitting/reducing or increasing versus same level for ND and DL, quitting/reducing versus same level for DH). Results ND smokers were more likely to quit at follow-up than DL or DH smokers. DH smokers who reduced their consumption to ND were more likely to quit eventually compared to those who continued as DH. Smokers who perceived themselves as addicted had lower odds of quitting/reducing smoking consumption at follow-up compared to smokers who did not, regardless of smoking status at the prior survey. Quit attempts and quit intentions were also associated with quitting/reducing consumption. Conclusions Reducing consumption may eventually lead to cessation, even for heavier smokers. The findings that perceived addiction and quit behavior were important predictors of changing consumption for all groups may offer insights into potential interventions., Highlights • Smoking transitions were evaluated in a cohort of Mexican smokers. • The cohort consisted mostly of understudied light and intermittent smokers (LITS). • Reductions in smoking intensity were found to facilitate smoking cessation. • Greater perceived addiction inhibited cessation for smokers at all levels of intensity. • LITS patterns warrant attention as number of low-intensity smokers worldwide grows.

Objectives We conducted a cross-sectional study to explore the effect of a hypothetical tobacco retail price increase on smoking habit change intention, and the role of smoking duration and intensity in smoking change intention. Methods In 2016 and 2017, we collected questionnaire data from 36,698 residents aged over 18 years in Songjiang district, Shanghai. Chi-square tests and weighted logistic regression were used for data analyses. Results The prevalence of current smoking was 19.78% (men: 48.36% and women: 0.22%). A total of 10.83% (men: 10.89% and women: 2.04%) and 9.39% of smokers (men: 9.42% and women: 6.12%) expressed the intention to smoke less or quit, respectively, given tobacco retail price increases. If the current tobacco retail price doubled, 75% of smokers stated that they would smoke less and 60% of smokers would consider quitting. Smokers with longer smoking duration and lower smoking intensity were more sensitive to tobacco price increases and more likely to change their smoking habits. Conclusions An increase in tobacco retail prices could induce some smokers to change their smoking behavior, particularly those with longer smoking duration and lower smoking intensity. A tobacco retail price increase is recommended, which should apply to all cigarette brands.

Aims To investigate to what extent the adoption of local smoke-free policies (SFPs) in Indonesia in 2007-13 was associated with changes in adult smoking behaviour. Design A quasi-experimental study. Setting Indonesia, 2007 and 2013. Participants A total of 1 052 611 > 25-year-old adults. Data were derived from the 2007 and 2013 Indonesian national health survey. Measurements For both years, provincial and district SFPs were identified from government documents in 497 districts in 33 provinces. Multi-level logistic regression analysis assessed the association of adoption of provincial and district SFPs between 2007 and 2013 with smoking continuation (among ever-smokers), current smoking and high smoking intensity (among current smokers). We controlled for survey year, SFP in 2007, socio-demographics and district characteristics. Findings Provincial SFP exposure was associated with lower odds of smoking continuation [strong SFP versus no SFP: odds ratio (OR) = 0.71, 95% confidence interval (CI) = 0.66-0.76] and smoking intensity (strong SFP: OR= 0.91, 95% CI = 0.86-0.97), but also with higher odds of current smoking (strong SFP versus no SFP: OR = 1.08; 95% CI = 1.04-1.12). District SFP exposure was associated with higher odds of smoking continuation (strong SFP versus no SFP: OR = 1.07, 95% CI = 1.01-1.14) and current smoking (strong SFP versus no SFP: OR = 1.09, 95% CI = 1.05-1.14), but with lower odds of smoking intensity (moderately strong SFP versus no SFP: OR = 0.95, 95% CI = 0.91-0.99). Conclusions There may be an association between the adoption of local smoke-free policies in Indonesia and decreased adult smoking intensity. However, the evidence is inconsistent, which may reflect problems with policy implementation and enforcement.

The present study aims to prospectively assess the influence of respiratory disorders on smoking cessation and re-initiation. Three population-based Italian cohorts answered a questionnaire on respiratory health and smoking habits during 1998&ndash, 2001 and after a mean follow-up (SD) of 9.1 (0.8) years. Out of 1874 current smokers and 1166 ex-smokers at baseline, 965 (51.5%) and 735 (63.0%) reported their smoking status at follow-up. From current smokers, 312 had stopped smoking at follow-up, while 86 ex-smokers had resumed smoking. People reporting asthma at baseline were more likely to stop smoking than the other subjects (48.6% vs. 31.7%), while people reporting allergic rhinitis or chronic cough/phlegm had a higher probability to resume smoking (16.7% vs. 10.5% and 20.7% vs. 10.4%, respectively). In the multivariable logistic model, smoking relapse strongly decreased with increasing abstinence duration in people without chronic cough/phlegm (OR for &ge, 7.5 years vs. &lt, 7.5 years = 0.23, 95% CI 0.20&ndash, 0.27), while no effect was detected in people with chronic cough/phlegm (p for interaction = 0.039). Smoking cessation was enhanced in asthmatic subjects, while people with allergic rhinitis or chronic cough/phlegm were at higher risk to resume smoking. Chronic cough/phlegm blunted the decrease in smoking resumption associated with longer abstinence duration.

Background In spite of the adverse health and financial implications of smoking, it still remains one of the leading causes of preventable diseases and deaths in the world. Key to discouraging the habit of smoking is knowledge of the drivers of smoking. In Ghana, though smoking behaviours are relatively more associated with adult males than youth and adolescents, studies on smoking behaviours of adult males are scant. This study, therefore, investigates the determinants of cigarette smoking and smoking intensity among adult males in Ghana. Methods Data were obtained from the most recent Ghana Demographic and Health Survey (DHS) conducted in 2014. Based on the 2014 GDHS, a negative binomial-logit hurdle model was estimated to explore the socioeconomic and demographic characteristics associated with cigarette consumption and smoking intensity among adult males in Ghana. To ensure robustness, separate estimations were performed for the respective logit and negative binomial models used in the two-part model. Results We find that men in lower socioeconomic category (poor and low education) have a higher likelihood to smoke. Also, age proved significant in explaining smoking behaviors in Ghana. Moreover, religion and region of residence are reported to affect cigarette consumption decision. Furthermore, we find that among the men who smoke, those between the ages of 44 and 60 years and have attained approximately primary education have a higher likelihood to smoke greater quantities of cigarette daily. Also, the smokers who reside in the Upper East and Upper West regions are reported to smoke more intensely than their counterparts in the Greater Accra region. Conclusion Since smoking remains one of the major causes of diseases and deaths the world over, the current study provides recent empirical evidence based on a nationally representative sample for public health policies geared towards smoking reduction and ultimately cessation. This study suggests that public policies that promote higher educational attainment and improved incomes (wealth) are crucial in smoking reduction and cessation in Ghana.

Introduction This study aimed to estimate the magnitude of tobacco smoking among healthcare workers (HCWs) and to assess the need to establish a smoking cessation program. Methods This is an institute survey that targeted HCWs from the following specialties: physicians, allied healthcare professionals and administrative workers who are affiliated to a tertiary healthcare institution in the western region of the Kingdom of Saudi Arabia (KSA). An electronic self-administrated questionnaire was distributed among the study subjects during the day shift from June to September, 2015. The analysis was descriptive, and comparison of the characters of smokers and nonsmokers was done. Results The total number of participating HCWs was 697 with about 62.3% response rate. Males (62.3%), allied health professionals (45.2%), and age group 19–30 years old (44.5%) dominated the sample. The crude prevalence of the current smoking was 18.4%, while 9.8% were past smokers, and 71.9% never smokers. Administrative workers, males and Saudis demonstrated significantly higher prevalence of current smoking (p>0.001). Approximately half of the current smokers had a mild smoking intensity and the subgroups did not show any significant differences for nicotine dependence (p>0.05). The results of the attitude towards smoking cessation showed that 80.3% of the currently smoking HCWs had positive attitudes and there were no statistically significant differences based on the characteristics of the participants (p>0.05). Conclusions The smoking prevalence among HCWs included in the study parallels nationally reported values. The results showed a need for the establishment of smoking cessation programs targeting HCWs, which eventually should make Mecca (Makkah) city truly free from smoking.

Objectives: At least 50% of smokers die prematurely. Those who smoke heavily are at an increased health risk. The purpose of the current report was to evaluate socio-demographic correlates of heavy smoking among employed men and women. Material and Methods: Data derive from the representative, household study – the Global Adult Tobacco Survey conducted in Poland over the years 2008–2010. Results: Of 14 000 households selected for the survey, 7840 sampled individuals completed the interviews. Among 1189 daily smokers, the rate of heavy smokers was 63.5% in males and 43% in employed females (p < 0.001). The study showed that age and age at the smoking onset were significantly associated with heavy smoking among both genders. Among males and females the heavy smoking rate was the highest in the subjects that started smoking at the age between 14–17 years compared to those who started smoking at the age ≥ 21 years (odds ratio (OR) = 3.3, 95% confidence interval (CI): 2–5.5, p < 0.001 and OR = 2.7, 95% CI: 1.4–5.3, p < 0.0001, respectively). The men with house rules that prohibited smoking with some exceptions were 2.4 times more likely to be heavy smokers in comparison with those having rules which completely prohibited it (p < 0.01). The men working in workplaces where smoking was prohibited in all indoor areas were at lower odds of heavy smoking relative to those working in areas where smoking was allowed everywhere (OR = 0.5, 95% CI: 0.3–0.9, p < 0.05). Among the men, there was also an association between job features and heavy smoking, which was not observed among the women. Conclusions: These findings should be taken into account while developing tobacco control measures addressed to economically active population.

The carcinogenic effect of smoking on laryngeal cancer is well established; however, the risk pattern for detailed smoking characteristics is less clear. Thus, the aim of this analysis was to quantify the impact of different inhalation behaviours on the risk of laryngeal cancer. We conducted a population-based case control study in Germany, frequency-matched for sex and age, using a standardized questionnaire covering lifelong smoking details, including age at start, time since quitting, types of smoking products, duration, intensity and inhalation behaviour. We found higher risks for increasing duration and intensity of smoking. A clear dose-response relationship was found in all inhalation subgroups, i.e., not only for deep inhalers, but also for those puffing on a cigarette. Clearly reduced risks could be observed for quitting smoking. Changing inhalation habits might be considered as a first step to reducing the risk of developing laryngeal cancer. However, the best way to effectively reduce laryngeal cancer risk is to quit smoking.

This paper examines the effect of job stress on two key health risk-behaviors: smoking and alcohol consumption, using data from the Canadian National Population Health Survey. Findings in the extant literature are inconclusive and are mainly based on standard models which can model differential responses to job stress only by observed characteristics. However, the effect of job stress on smoking and drinking may largely depend on unobserved characteristics such as: self control, stress-coping ability, personality traits and health preferences. Accordingly, we use a latent class model to capture heterogeneous responses to job stress. Our results suggest that the effects of job stress on smoking and alcohol consumption differ substantially for at least two "types" of individuals, light and heavy users. In particular, we find that job stress has a positive and statistically significant impact on smoking intensity, but only for light smokers, while it has a positive and significant impact on alcohol consumption mainly for heavy drinkers. These results provide suggestive evidence that the mixed findings in previous studies may partly be due to unobserved individual heterogeneity which is not captured by standard models.