Search Results (318)

Background/Objectives: Hearing loss is a disorder that develops because of being exposed to high noise levels affecting the quality of life among affected individuals. A review of the literature was conducted to explore the prevalence of hearing loss and its associated factors among workers in the metal industry. Methods: The literature search was conducted on ScienceDirect, Google Scholar, Pub Med, ResearchGate and African Journals Online databases to identify articles according to the Preferred Reporting Items for Systematic Reviews and Meta analyses (PRISMA) guidelines. The studies published in scientific journals between January 2014 and December 2024 describing hearing loss and its associated factors among workers in the metal industry were considered for inclusion in the review. The articles were screened by the author. The Critical Appraisal Skills Programme (CASP) quality assessment tool with modified checklist questions was used to evaluate the quality of studies. Results: Following the literature search and using the relevant inclusion criteria, a total of 127 articles were identified, and 8 articles with a total of 2605 participants were included in the review. The sample sizes ranged from 93 to 606. The participants’ age ranged from 19 to 65 years. A review of studies showed varying prevalence of hearing loss ranging from 13.8% to 59%. Furthermore, the studies have found working experience, advanced age, cigarette smoking, tinnitus, working in areas of high noise levels and not using hearing protective devices to be associated with a risk of developing hearing loss. Conclusions: The review found that workers in the metal industry are at risk of developing hearing loss and, therefore, implementation of control measures to prevent the occurrence of hearing loss is necessary. Full article

Background: Cardiovascular morbidity and mortality are alarmingly high in Bulgaria, partly due to behavioral risk factors such as smoking. Purpose: This study aimed to assess and compare smoking habits, second-hand smoke exposure, and attitudes of Bulgarian and foreign medical students to better understand smoking behavior in this population. Methods: A cross-sectional survey was conducted among 1063 medical students at the Medical University of Plovdiv (60.8% women; 53% Bulgarian). Results: More Bulgarian students were active smokers and ever-smokers than foreign students (24.7% vs. 14% and 29.3% vs. 18.8%, p < 0.001). Bulgarian women smoked nearly as much as Bulgarian men (24.1% vs. 25.6% for active smokers, p > 0.05), whereas foreign women smoked less than foreign men (15.7% vs. 23.7%, p = 0.034). Women more often replaced classic cigarettes with tobacco heating systems (THSs) than men (40.7% vs. 25.3%, p = 0.020). Nearly 85% of the respondents started smoking by the age of 19. Exposure to second-hand smoke among friends, among colleagues, and in the family was associated with a higher risk of being an ever-smoker (ORs ~8.9; 3.4 and 3.7, respectively). About 20% of students were unsure or disagreed that smoking fewer cigarettes, THSs, or e-cigarettes posed health risks. The majority (61.3%) of active smokers acknowledged negative health effects. Conclusions: These findings highlight a concerning smoking prevalence among Bulgarian medical students and emphasize the need to strengthen medical education and health policies with updated tobacco risk information and targeted prevention programs to reduce smoking and improve future physicians’ cessation counseling skills. Smoking likely contributes significantly to Bulgaria’s high cardiovascular morbidity. Full article

Background/Objectives: Electronic cigarettes (e-cigarettes) have gained popularity among young adults globally, but only limited research exists on usage patterns in Saudi Arabia. This study investigated the prevalence, patterns, and factors associated with e-cigarette use initiation and transition to cigarette smoking among university students in Saudi Arabia. Methods: A cross-sectional survey was conducted among 537 university students in Al-Madinah city during the 2024–2025 academic year. Data were collected using a self-administered online questionnaire assessing e-cigarette use patterns, motivations, susceptibility to future cigarette smoking, and demographic characteristics. Multivariable logistic regression analysis was used to identify factors associated with e-cigarette use. Results: E-cigarette prevalence was substantial: 11.7% of participants were current users, 5.4% were former users, and 27.9% were ever-users, compared with 5.8% current cigarette smokers. Males had significantly higher use rates than females (20.9% vs. 4.6%; p < 0.001). Senior students showed the highest current use (21.1%). Among ever-users, the primary motivations were enjoyment (29.3%), the possibility of use where smoking is banned (26.1%), and social acceptability (21.7%). Most users (73.0%) used high-nicotine liquids (≥20 mg/mL), and 55.4% vaped daily. Multivariable logistic regression revealed that e-cigarette use was independently associated with male gender (adjusted OR = 4.0), higher academic year (OR = 1.24), current smoking (adjusted OR = 3.45; 95 CI: 1.54–7.82), and lower harm perception (adjusted OR = 1.69; 95 CI: 1.16–2.51). Susceptibility to future cigarette smoking was 18.9% overall but much higher among current e-cigarette smokers (59.5%; p < 0.001). Conclusions: E-cigarette use was prevalent among Saudi university students, particularly males and senior students, with patterns suggestive of nicotine dependence. Strong associations with cigarette smoking and high-concentration nicotine use raise concerns about dual use and addiction potential. Full article

Tobacco control policies have aimed to reduce the global prevalence of smoking. Unfortunately, the recent survey data shows that about 24% of Europeans still smoke. Although combustible cigarettes remain the most used tobacco product, the tendency made evident in the prevalence of smoking-alternative nicotine-containing products increases. Studies that can objectively assess the long-term health effects of the latter products are lacking, so assessing toxic substances associated with smoking-alternative products and comparing them to substances from combustible cigarettes could inform future public health efforts. The manufacturers of these alternative products claim that the use of alternatives to combustible cigarettes reduces exposure to toxic compounds, but the reality is unclear. This study compares the concentrations of toxic substances in generated aerosols and performs calculations based on mainstream cigarette smoke and aerosols from smoking-alternative products. It summarizes the amounts of harmful and potentially harmful constituents per single puff. Alternative smoking products are undoubtedly harmful to non-smokers. Still, based on the analysis of the latest independent studies’ empirical data, the concentrations of inhaled HPHCs using heated tobacco products or e-cigarettes are reduced up to 91–98%, respectively; therefore, for those who cannot quit, these could provide a less harmful alternative. However, more well-designed studies of alternative product emissions are needed, including an analysis of the compounds that are not present in conventional tobacco products (e.g., thermal degradation products of propylene glycol, glycerol, or flavorings) to evaluate possible future health effects objectively. Full article

Chronic obstructive pulmonary disease (COPD), whose main risk factor is cigarette smoking, is among the most prevalent diseases worldwide. Previous studies have shown that cigarette smoke extract (CSE) can directly affect pulmonary artery function independently of hypoxia resulting from the airway obstruction. In addition, CSE also affects bronchial smooth muscle, leading to airway hyper-responsiveness. However, its specific impact on the contractile machinery of this compartment remains unclear. In this study, using in vitro experiments with human bronchial smooth muscle cells (hBSMCs), we found that CSE exposure disrupted calcium homeostasis, increased ROS and lipid peroxidation, and reduced cell antioxidant defenses. Furthermore, CSE exposure altered the cell contractile apparatus by decreasing key cytoskeletal proteins and impairing actin dynamics, potentially contributing to the dysregulated contractile response of cells. Notably, these effects were significantly attenuated by antioxidant drugs such as mitoTEMPO and N-acetylcysteine, as well as by the inhibition of the endoplasmic reticulum (ER) calcium channels with 2-aminoethoxydiphenyl borate (2-APB). More importantly, mitoTEMPO partially restored the contractile response of bronchus upon CSE challenge. Collectively, our findings give evidence that CSE-mediated increase in ROS and intracellular calcium contribute to cytoskeletal disruption and functional impairment in airway smooth muscle. Moreover, these results also point to potential therapeutical approaches for mitigating the harmful effects of cigarette smoke in the lung. Full article

Major mutations of SERPINA1, the gene encoding alpha1-antitrypsin (A1AT), are known to cause severe emphysema. Our study aimed to investigate the role of major mutations modulating A1AT levels in several lung pathologies and control groups. Blood samples were collected from healthy non-smokers (N⁰ = 85), healthy smokers (N⁰ = 291), healthy ex-smokers (N⁰ = 127), smokers with chronic obstructive lung disease (COPD, N⁰ = 187), ex-smokers with COPD (N⁰ = 64), and patients with asthma (N⁰ = 194), interstitial lung disease (ILD) (N⁰ = 93), sarcoidosis (N⁰ = 30) and cystic fibrosis (N⁰ = 26). Clinical and respiratory parameters, A1AT levels, the extent of emphysema and comorbidities on low-dose CT scans were evaluated, and patients answered a smoking history and comorbidity questionnaire. A1AT single-nucleotide polymorphisms were determined for the S, Z, M2/M4, 0 and eQTL locations by SNP probes using real-time PCR. A1AT levels showed significant differences between cigarette smoke-induced and other lung diseases. Compared to controls, A1AT levels were found to be lower in sarcoidosis and increasingly higher in smokers and patients with COPD, ILD and CF, respectively. The presence and pattern of emphysema were found to influence A1AT levels: lower values were observed in COPD patients without emphysema, while higher values were observed in patients with central and panlobular emphysema. Antitrypsin levels increased with COPD GOLD stages and asthma GINA stages. Variable A1AT levels were also found in ILD subgroups. The distribution of variants at the S, Z, M2/M4 and 0 polymorphic sites and the eQTL location showed no significant differences between patient groups with impaired lung function, except for Z heterozygotes, which were prevalent in patients with severe asthma. The eQTL TT genotypes had higher A1AT levels and the occurrence of emphysema and/or bronchitis was increased. A1AT levels correlated with several clinical and respiratory parameters in pulmonary patients, while FEV1/FVC inversely correlated with levels of A1AT. Molar antielastase activity was increased in smokers and patients with lung diseases; however, in COPD, antielastase activity decreased. The most reduced antielastase activity could be found in CF. Certain genotypes were characterized by increased cardiovascular comorbidity scores and antitrypsin levels. Our data suggest that in addition to emphysema, A1AT may play an important role in the development of a wide variety of lung diseases and cardiovascular comorbidities. Further research is needed to clarify the role of A1AT and its regulation in lung pathologies. Full article

The prevalence of e-cigarette use (vaping) in young adults is concerning, particularly because the initiation of combustible tobacco use is higher in e-cigarette vapers. It is unclear why young, never-smoker vapers decide to start smoking cigarettes, but they may be influenced by perceptions of health risks and accessibility. We designed a social media questionnaire to assess factors driving the initiation of combustible tobacco use by e-cigarette vapers (multi-inhalant use) and switches between inhalant types. Respondents reported an earlier initiation of combustible tobacco versus vaping (18 vs. 19, respectively, p < 0.0001), greater ease of obtaining combustibles versus vaping products (p < 0.01), and pleasure of vaping being equivalent to that of smoking. The majority of subjects (57%) reported smoking first prior to adding vaping devices, 32% reported initiating both smoking and vaping within 12 months of one another, and 11% reported initiating vaping first. Among respondents (n = 864) who switched from vaping to smoking (n = 104), the primary reasons included 1. the perception that smoking was healthier (44%) and 2. greater accessibility of cigarettes (40%). For those who switched from smoking to vaping (n = 178), the predominant motivations included 1. having friends or family who vape (40%) and 2. the perception that vaping was healthier (36%). Among multi-inhalant users (n = 223), key factors driving this behavior included 1. increased enjoyment (47%) and 2. greater variety (42%). Our findings imply that there is no single, dominant reason driving the initiation of combustible use or switching from one inhalant to another. Further, tobacco users are receiving mixed messaging, leading many to believe that combustible tobacco is the healthier option. Public health interventions are needed to prevent the initiation of e-cigarette vaping by youth and to educate the public about the health effects of tobacco products. Full article

Objective: This study aimed to explore the association between adolescents’ health risk behaviours (excessive use of alcohol, (e)cigarette smoking, cannabis use) and familial factors. A special objective of this study was to compare findings between Bulgarian and Lithuanian adolescents aged 15 years. Material and Methods: National samples from the WHO Health Behaviour in School-aged Children (HBSC) survey in 2021/2022 were analysed. The focus was on adolescents aged 15 (n = 64,349), including those from Bulgaria (n = 793) and Lithuania (n = 1137). The set of outcome variables included drunkenness, smoked cigarettes, e-cigarettes, and used cannabis (all variables were measured during the last 30 days); their indicators were child’s talking separately to their father and separately to their mother, as well as the four-item family support scale. All variables were dichotomised and their associations were analysed using Structural Equation Modelling with a WLSMV estimator. Results: In the total sample, the prevalence of drunkenness was 14.9%, cigarette smoking at 12.6%, e-cigarette smoking at 18.4%, and cannabis use at 5.9%; while in Bulgaria, in contrast to Lithuania, these behaviours were much more prevalent, at 27.0%, 29.9%, 29.8%, and 11.1%, respectively. The use of substances was significantly associated with selected familial factors, which were more pronounced among girls than boys in most subsamples. Low family support showed the strongest association with increased substance use (in the total sample, regression weight B varied from 0.231 to 0.382). Adolescents’ difficulty in talking to mother was more pronounced (B = 0.123 to 0.204) than difficulty in talking to their father (B = 0.058 to 0.140). Comparison of data samples from Bulgaria and Lithuania showed stronger relationships in Bulgarian adolescents compared to other countries, which are more pronounced among boys. In addition, among Bulgarian adolescents, easy communication with their father had an inverse association (increasing prevalence) with cannabis use. Conclusions: Adolescent health risk behaviours, such as use of substances, are associated with familial factors, including parent–teen communication and family support. Generally, these associations are more pronounced among girls than boys, and more evident among Bulgarian adolescents than their Lithuanian counterparts. Identifying environmental factors in families helps to plan interventions to prevent development of multiple health risk behaviours in adolescents. Full article

Xenobiotics are non-natural chemical compounds to which the human population is exposed. Chronic exposure to certain xenobiotics is associated with various diseases, including cancer development. Anelloviruses (AVs), including Torque Teno Virus (TTV), Torque Teno Mini Virus (TTMV), and Torque Teno Midi Virus (TTMDV), are ubiquitous viruses found in the general population. As no disease has been definitively associated with AVs, they are sometimes referred to as “viruses awaiting a disease”. This review explores the potential roles of xenobiotics and AVs in colorectal cancer (CRC) development and suggests a potential interplay between them. Evidence suggests an association between certain xenobiotics (like pesticides, cigarette smoke components, and dietary factors) and CRC, while such an association is less clear for AVs. The high prevalence of AVs suggests these infections alone may be insufficient to disrupt homeostasis; thus, additional factors might be required to promote disease, potentially including cancer. Full article

(1) Background: This narrative review examines in-vehicle tobacco smoke exposure among private, occupational, and commercial drivers, focusing on prevalence, nicotine biomarkers, and health consequences. (2) Methods: A comprehensive search on the PubMed, Scopus, and Embase databases was used to identify peer-reviewed, full-text, and English articles published between 2014 and 2024. Search terms were related to motor vehicles, tobacco smoke exposure, and drivers. Articles were selected for inclusion based on their relevance to in-vehicle smoking and second- or third-hand smoke exposure attributable to tobacco cigarettes through article title, abstract, and full-text screening. (3) Results: This review highlights the dangers of in-vehicle second- or third-hand smoke exposure, evidenced by the 17 articles included. Significant second-hand smoke exposure and biomarkers were revealed mostly among adolescents and children. However, a gap exists in addressing tobacco smoke exposure among occupational/commercial drivers, specifically, long-haul truck drivers (LHTDs), who have heightened exposure due to their work environment—the truck cabin—which may increase their lung cancer risk. (4) Conclusions: There is a significant literature gap regarding in-vehicle tobacco smoke exposure in occupational/commercial drivers. Future research should include nicotine biomarker usage to quantify nicotine exposures and smoking cessation intervention development tailored to LHTDs. Full article

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disorder characterized by persistent airway inflammation and progressive airflow limitation, resulting in a significant global health burden and high mortality. This narrative review synthesizes the current evidence on the roles of leukocyte subtypes—including neutrophils, monocytes, lymphocytes, eosinophils, and basophils—in the pathogenesis and clinical management of COPD. Relevant original studies and reviews are included, providing data on leukocyte functions, associated biomarkers, and therapeutic implications. Neutrophils contribute to airway damage and remodeling by releasing proteases and reactive oxygen species, particularly in response to environmental exposure such as cigarette smoke or air pollution. Lymphocytes, especially CD8⁺ T cells, drive chronic inflammation and immune dysregulation. Monocytes differentiate into macrophages that promote airway fibrosis and persistent inflammation, further impairing lung function. Eosinophils, though classically linked to asthma, are now recognized for their role in eosinophilic COPD, where they are associated with an increased exacerbation risk and corticosteroid responsiveness. Basophils, though less studied, may influence airway inflammation through interactions with eosinophils and cytokine release. Understanding these immune cell dynamics provides insights into the heterogeneity of COPD and highlights potential targets for precision therapy. Tailored interventions based on inflammatory phenotypes may improve clinical outcomes and advance personalized treatment strategies. Full article

Cannabis use among young adults in the U.S. has nearly doubled in recent years, driven by diverse methods of consumption and evolving cannabis legalization. Multi-modal cannabis use among young adults is an emerging public health issue that remains underexplored. This study examines the prevalence, patterns, and predictors of multi-modal cannabis use, defined as the use of two or more administration methods of cannabis use (e.g., smoking, vaping, edibles, dabbing, other forms) in the past month, among U.S. young adults aged 18–34 years. Data from the 2022–2023 Behavioral Risk Factor Surveillance System (BRFSS) across 23 states (n = 7635; weighted n = 7,482,134) show that 57% of young adults reporting current cannabis use engaged in multi-modal use, with dual- and triple-mode use being the most common. Factors associated with higher odds of multi-modal use include sexual minority status, poor physical health, frequent cannabis use, and co-use of electronic cigarettes and alcohol. Recreational cannabis legalization (RCL) is significantly linked to higher odds of multi-modal use. These findings underscore the interplay between individual risk factors and cannabis policy environments in shaping multi-modal cannabis use behaviors. To mitigate potential harms, targeted prevention strategies should prioritize young adults at risk for cannabis use, addressing both personal and policy-related factors influencing multi-modal cannabis use. Full article

Objective: Working physical activity, physical fitness and energy intake were studied for their effect on all-cause mortality and age at death in residential cohorts followed-up for 61 years. Material and Methods: There were two residential cohorts of middle-aged men examined in 1960 with a total of 1712 subjects, and three indexes were measured, i.e., physical activity by a questionnaire (three classes—sedentary, moderate, vigorous: Phyac), physical fitness, estimated by combining arm circumference, heart rate, and vital capacity by Principal Component Analysis, whose score was divided into three tertile classes (low, intermediate, and high: Fitscore), and energy intake in Kcalories, estimated by dietary history divided into three tertile classes (low, intermediate, high: Calories), plus five traditional cardiovascular risk factors (age, cigarette smoking, body mass index, systolic blood pressure, and serum cholesterol). Cox models were used to predict all-cause mortality as a function of those adjusted indexes. Multiple linear regression models were used to predict age at death as a function of the same co-variates and a larger number of them. At the 61-year follow-up, 1708 men had died. Results: There were large correlations across the three indexes. Prediction of all-cause mortality showed the independent and complementary roles of the three indexes to all be statistically significant and all protective for their highest levels. However, the Fitness score outperformed the role of Phyac, while the role of Calories was unexpectedly strong. The same outcome was found when predicting age at death, even in the presence of 25 covariates representing risk factors, personal characteristics, and prevalent major diseases. Conclusions: Working physical activity, a score of physical fitness and energy intake, seems directly related to lower all-cause mortality and to higher age at death, thus suggesting a large part of independence. Full article

Current lifestyles bring about an increasing prevalence of unhealthy habits that can negatively affect male fertility. Cigarette smoking, alcohol intake, stress, inadequate physical activity, an unequilibrated diet leading to obesity, and use of mobile telephones and portable electronic devices can affect the male reproductive system through multiple mechanisms. Moreover, the modern man is often exposed to environmental factors independent of his will, such as air pollution, exposure to heat or toxicants in his workplace, or the presence of harmful chemicals in food, beverages, agricultural and industrial products, etc. The susceptibility to these factors depends on genetic and epigenetic predisposition, potentially present systemic disease and medication, and local affections of the genitourinary system. The multifaceted nature of both the causative factors and the susceptibility background makes the resulting fertility disturbance highly individual and variable among different men exposed to the same conditions. This paper critically reviews the current knowledge of different causative and susceptibility factors with a special attention to the molecular mechanisms of their action. Finally, strategies for the prevention of abnormalities due to lifestyle and environmental factors and available treatment modalities for already-present abnormalities are exposed. Full article

Background/Objectives: The rising popularity of e-cigarette use is creating new challenges for oral healthcare. Factors such as targeted marketing, appealing flavors, and the perception that e-cigarettes are a safer alternative to traditional smoking have contributed to their widespread adoption. This trend is particularly prevalent among young adults and teenagers, many of whom turn to e-cigarettes despite having no prior history of regular cigarette use. This study aimed to evaluate dentists’ knowledge and perceptions regarding e-cigarettes, focusing on their health effects, regulatory status, and potential risks to oral health. Assessing dentists’ knowledge of e-cigarette risks is important, as they guide patients on the potential oral health dangers of vaping. E-cigarette use has been linked to several oral health problems. Methods: A cross-sectional survey was conducted among 189 dentists in Kosovo, comprising both general dentists and specialists. The questionnaire assessed participants’ awareness of e-cigarettes’ FDA approval status, their perceptions of health impacts, and their understanding of e-cigarettes’ association with oral conditions such as caries, periodontal disease, and oral cancer. Data were analyzed using SPSS 22, with significance set at p < 0.05. Results: The findings revealed significant knowledge gaps, with 74.1% of respondents being uncertain about the FDA approval status of e-cigarettes and 82.0% recognizing their harmful effects on general and oral health. Nearly half (49.7%) of the participants identified e-cigarettes as a potential risk factor for caries, while 66.1% and 64.6% associated their use with oral cancer and periodontal disease, respectively. Gender and professional specialization did not significantly influence these perceptions. Conclusions: Dentists need better education on the risks of e-cigarette use, including their harmful effects on oral health. Incorporating this knowledge into dental curricula and professional training is essential to give dentists the information needed to advise patients effectively. Raising public awareness through dental health professionals can help mitigate the oral health risks associated with e-cigarettes. Full article