The research, published as an open-access paper in the journal Heliyon, was carried out by a team at the University of Queensland led by Min-Tz Weng and Kathryn Steadman. It is the first investigation to compare the nicotine metabolite ratio, a standard biomarker of nicotine metabolism, between cigarette smokers and users of nicotine vaping products in an Australian population. The finding aligns with three earlier studies from the United States and Spain, which likewise reported no difference in metabolism speed between the two consumer groups.

The biology behind the measurement hinges on a single liver enzyme. Roughly 70 to 80 percent of the nicotine absorbed from any inhaled product is converted into a compound called cotinine, and the same enzyme, CYP2A6, then transforms cotinine into 3-hydroxycotinine. Because cotinine is only turned into 3-hydroxycotinine through CYP2A6 activity, the ratio of total 3-hydroxycotinine to free cotinine in urine, known as the nicotine metabolite ratio or NMR, provides a reliable window into how quickly a person processes nicotine. A high ratio marks a fast metaboliser; a low ratio marks a slow one.

Decades of research in smokers have shown that this ratio matters clinically. People with higher NMR values tend to smoke more cigarettes, absorb more nicotine, and struggle more when attempting cessation, because their nicotine levels drop faster and trigger stronger cravings. In principle, a simple urine test could help clinicians match would-be quitters to the most effective therapies, with fast metabolisers often faring better with certain forms of nicotine replacement than others. Sex and ethnicity also leave fingerprints on the ratio: women typically metabolise nicotine faster than men, and White and Latino populations faster than Asian and African-American populations, partly reflecting inherited differences in CYP2A6 genes.

What has been missing is data on vapers, and on Australian users generally. Previous comparisons of NMR between smokers and vapers had been limited to a large cohort of primarily White women in the US, a smaller group from the American Indian population, and an adult sample in Barcelona measured through saliva. The only prior Australian measurement came from a methods-validation study of 280 Tasmanian smokers, without any within-cohort comparisons. The Queensland team set out to fill both gaps at once.

The researchers recruited 44 adults in Brisbane who used either conventional cigarettes or nicotine vaping products exclusively, at least daily. Each participant kept a three-day diary recording brands, strengths, flavours and consumption, then collected every drop of urine over a full 24-hour period on the third day. After excluding two vapers whose cotinine levels fell below a biochemical threshold confirming active nicotine use, the final analysis covered 42 people: 22 smokers and 20 vapers. Most were male, aged 18 to 29, and ethnically diverse, including Asian, White, Latino and one Australian Aboriginal participant.

The laboratory work was exacting. Urine samples were diluted, split, and analysed by liquid chromatography with tandem mass spectrometry, a technique sensitive enough to detect metabolites at concentrations below a tenth of a microgram per litre. Half of each sample was treated with an enzyme that strips off glucuronide conjugates, allowing the team to measure total nicotine, cotinine and 3-hydroxycotinine, six compounds in all, summed as total nicotine equivalents. Creatinine measurements normalised the results for differences in hydration. The overall mean NMR of 2.71 sat comfortably within the range of 1.7 to 5.2 reported in earlier populations worldwide.

The headline result was a null finding with real weight: urinary NMR did not differ between smokers and vapers. Metabolism speed, it appears, is a property of the person, not the product. But exposure told a different story. Vapers excreted significantly higher concentrations of cotinine and 3-hydroxycotinine, and consequently higher total nicotine equivalents, whether expressed per milligram of creatinine or per 24-hour urine volume. The authors suggest this reflects the higher nicotine content of vaping liquids and their enhanced palatability, which can encourage more frequent and deeper intake. Consistent with national Australian survey data, the vapers were also significantly younger than the smokers, averaging 26 years against 34.

Within the cohort, the expected demographic patterns emerged. Women averaged an NMR of 3.49 compared with 2.43 in men, a statistically significant difference, and participants of White background averaged 2.99 against 1.94 for those of Asian descent, echoing the known prevalence of reduced-function CYP2A6 variants among Asian populations. Splitting the group at the median ratio of 2.31, the researchers found that faster metabolisers carried higher concentrations of cotinine, 3-hydroxycotinine and total nicotine equivalents than slower ones, exactly as predicted by the wider literature. Intriguingly, the single Australian Aboriginal participant, a woman using cigarettes, posted one of the highest ratios recorded, at 5.25, a hint of variation in a population for which no NMR data previously existed.

The authors are candid about the study’s limits. Forty-two participants is a small sample, and the sex and ethnicity subgroup analyses are exploratory. Factors known to shift the ratio, such as menthol ingredients, CYP2A6-altering medications, pregnancy and alcohol, were not assessed, and the unsupervised at-home urine collections mean the 24-hour totals deserve cautious interpretation. Still, the message for the fast-growing population of vapers is clear: their bodies handle nicotine no differently than smokers’ bodies do, even as modern devices deliver a heavier dose. If the nicotine metabolite ratio proves useful for tailoring cessation therapy, that guidance should apply equally to anyone trying to give up vaping.

Subject of Research: Nicotine metabolism rate measured by urinary nicotine metabolite ratio in cigarette smokers versus nicotine vaping product users

Article Title: Exploring nicotine metabolism among people who smoke and vape

Article References: Weng, M.-T., Zheng, Q., Deng, Y., Shrestha, S., Fan, W., Thai, P. K., Gartner, C. E., & Steadman, K. J. (2026). Exploring nicotine metabolism among people who smoke and vape. Heliyon, 12(15), Article e45549. https://doi.org/10.1016/j.heliyon.2026.e45549

Image Credits: AI Generated

DOI: 10.1016/j.heliyon.2026.e45549

Keywords: nicotine metabolism, CYP2A6, nicotine metabolite ratio, cotinine, 3-hydroxycotinine, vaping, cigarette smoking, smoking cessation, LC-MS/MS, urine biomarkers, Australia, nicotine exposure

The research, led by James D. Sargent of Dartmouth College’s Geisel School of Medicine, set out to correct what the authors see as a systematic blind spot in decades of prior work. Most earlier studies measured smoking narrowly — often comparing only current smokers with former or never smokers — and frequently included young adults, in whom the effects of smoking on quality of life are still small. Worse, many analyses statistically adjusted for smoking-related diseases such as cancer, cardiovascular disease, and chronic lung disease. But those diseases lie on the causal pathway between smoking and diminished wellbeing, the authors argue, so adjusting for them effectively erases much of smoking’s true impact before the analysis even begins.

To capture the full burden, the team constructed an 11-point lifetime cigarette smoke exposure index, or LCSEI, drawing on data from Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study, collected in 2018 and 2019. The index combined five components: current smoking status, the heaviness of current smoking, cumulative pack-years of smoking, whether a person started smoking before age 15, and weekly hours of exposure to secondhand smoke. A score of zero represents a never-smoker with no secondhand exposure, while a score of 11 describes a heavy current smoker who began in childhood, accumulated more than 40 pack-years, and spends more than 20 hours a week breathing other people’s smoke.

The study sample comprised 7,001 adults aged 40 and older, weighted to represent the US population. In this group, 6.7 percent had smoked during childhood and 16.9 percent were current smokers, with 10 percent smoking more than 20 cigarettes a day. Among those who had ever smoked, the average pack-year total was 32.9, and more than one in five had amassed more than 40 pack-years. Quality of life was measured with the PROMIS Global-10 questionnaire, which yields separate scores for global physical health and global mental health, both validated against the widely used EuroQOL-5D instrument.

The results showed a strikingly clean pattern: both physical and mental quality-of-life scores declined in a nearly perfect linear fashion as lifetime smoke exposure rose. In the bivariable analysis, each additional point on the index corresponded to a loss of roughly 0.28 points in physical health scores and 0.30 points in mental health scores. After adjusting for age, gender, race, income, education, geography, body mass index, and weekly exercise, the association remained robust, with each point on the index costing about 0.20 points of physical and 0.22 points of mental quality of life — a magnitude similar to that associated with a decade of aging, being female for mental health, or dropping one income category.

The headline finding comes from comparing the extremes. Adults at the highest possible exposure score had mean global physical health 14.5 percent lower, and global mental health 15.2 percent lower, than those at the lowest score. By contrast, the difference between adults who had not finished high school and those holding a bachelor’s or advanced degree amounted to only 3.0 percent for physical and 5.3 percent for mental health. The gap between households earning under $25,000 a year and those earning $100,000 or more was 10.9 percent and 11.4 percent — meaning lifetime smoking exposure carries a burden that rivals poverty itself, and far exceeds the burden of low educational attainment.

The team ran a series of sensitivity analyses to test whether the findings could be artifacts. When respondents with incomplete smoking histories — about 82 percent of the originally excluded cases — were added back into the models, the results barely moved. An E-value analysis, which quantifies how strong unmeasured confounding or misclassification would need to be to explain away an association, yielded a value of 4.29 for the lower confidence bound, a level generally considered to require implausibly strong bias to account for the observed effect. And when the researchers added an 18-item index of smoking-related diseases — including COPD, diabetes, cancer, heart failure, and stroke — the smoking association shrank by roughly half but remained statistically significant, confirming that chronic disease mediates much, but not all, of smoking’s impact on wellbeing.

That residual association is intriguing in itself. It could reflect concurrent effects of cigarette smoke on the body that operate independently of diagnosed disease, or damage from smoke exposure during adolescent development that shapes how adults perceive their own health decades later. Previous work by some of the same researchers found that childhood smoking onset is associated with chronic obstructive pulmonary disease independent of pack-years and current smoking intensity, lending plausibility to the idea that early-life exposure leaves marks that persist even after accounting for total dose. The authors call for more research to disentangle these mechanisms.

Perhaps the most consequential implication concerns inequality. Smoking prevalence follows a well-documented socioeconomic gradient, with lower-income adults smoking at higher rates and accumulating more lifetime exposure. The new findings suggest that disadvantage delivers a double blow to quality of life: directly, through the material hardships of poverty, and indirectly, through greater lifetime exposure to cigarette smoke. Framed this way, tobacco control is not merely a public health measure but an equity intervention — one whose benefits would flow disproportionately to older adults already bearing the heaviest burdens of poor health.

The study does carry limitations. It is cross-sectional, so it captures a single moment in time, and it relies on retrospective recall of smoking behavior reaching back to childhood. The authors point to multiple validation studies showing that recalled smoking histories, while imperfect at the individual level, are not systematically linked to health outcomes, meaning such errors would tend to shrink rather than inflate observed associations. Loss to follow-up and missing item responses also trimmed the analytic sample, though sensitivity analyses that restored most missing cases left the primary findings intact. Even with those caveats, the message is stark: for older Americans, a lifetime of cigarette smoke has quietly exacted a price on daily wellbeing that rivals poverty itself — and the surest way to promote healthy aging, the authors conclude, is to eliminate cigarettes altogether.

Subject of Research: Association between lifetime cigarette smoke exposure and health-related quality of life among older US adults

Article Title: Comprehensive assessment of lifetime cigarette smoking and its association with health-related quality of life among older US adults

Article References: Sargent, J. D., Ozga, J. E., Stanton, C. A., Tang, Z., & Paulin, L. M. (2026). Comprehensive assessment of lifetime cigarette smoking and its association with health-related quality of life among older US adults. PLOS Aging and Health, 1(3), e0000043. https://doi.org/10.1371/journal.page.0000043

Image Credits: AI Generated

DOI: 10.1371/journal.page.0000043

Keywords: cigarette smoking, quality of life, healthy aging, PATH Study, secondhand smoke, pack-years, health disparities, PROMIS, tobacco control, socioeconomic inequality, chronic disease, older adults

The paper, titled “Universal Strategies to End Appeal of Firearms in America,” is in press in the American Journal of Preventive Medicine and is available as a journal pre-print. Romer’s central claim is that existing approaches to firearm violence, which largely target people believed to be at risk of harming themselves or others, remain important but could be complemented by population-level interventions that change how Americans think about guns in the first place. The model for such an approach, he argues, is the sustained campaign against cigarettes, which combined public education about health consequences with measures that curbed the promotion and glamorization of tobacco in popular culture.

Personal protection is now the most commonly cited reason for owning a firearm in the United States, and that framing matters well beyond marketing. It has shaped constitutional law. In New York State Rifle & Pistol Association v. Bruen, the Supreme Court described handguns as the “quintessential self-defense weapon” and used that characterization as part of its justification for extending Second Amendment protection to carrying handguns in public. In Romer’s view, this makes the self-protection narrative a strategic target: if the perception that firearms are a safe and effective means of protecting oneself and others could be challenged with evidence, the consumer appeal that underpins both the market and the jurisprudence might begin to erode.

One concrete target Romer identifies is the portrayal of guns in movies and television. Entertainment, he writes, frequently depicts firearms as reliable tools for subduing adversaries and defending one’s family, and it does so in ways that sanitize the consequences. “Those shows make it seem that it is easy to hit their targets with effects that appear bloodless,” Romer writes in the paper. “A young person viewing these portrayals could easily get the impression that handguns are a simple and effective way to protect oneself.” The concern echoes a well-documented dynamic from tobacco research: when smoking was routinely glamorized on screen, adolescent exposure to those portrayals was associated with increased smoking initiation.

The evidence base for an analogous effect with guns is still developing, but several findings are suggestive. Earlier research by the policy center’s Annenberg Health and Risk Communication Institute found that the rise in firearm use in popular movies and television crime dramas is associated with an increase in firearm homicides, particularly among young people ages 15 to 24. A separate analysis found that the increase in firearm use in popular movies from 2000 to 2021 closely tracked increased handgun purchases over the same period. Romer is careful to note the limits of these data: they parallel what was once observed for adolescent exposure to movie portrayals of cigarettes, but more research is needed to determine the causal impact of exposure to firearms in movies, in the way that was ultimately done for tobacco.

The tobacco campaign offers a technical template for how that causal case was built and how policy followed. Anti-smoking efforts combined several mutually reinforcing elements: epidemiological evidence linking smoking to disease, mass-media education campaigns that debunked the image of smoking as glamorous or safe, regulation of advertising, and the elimination of paid tobacco product placement in entertainment. As those measures took hold, portrayals of smoking in popular movies declined, and they declined in tandem with population smoking rates. The lesson Romer draws is that changing the cultural environment around a consumer product, not only informing individual consumers, can shift population-level behavior.

Translated to firearms, similar strategies could be studied, Romer argues. These include reducing firearm product placement and portrayals in entertainment, educating the public about the risks associated with firearm ownership, and emphasizing the specific dangers of leaving firearms unsecured in the home. Each element mirrors a component of the tobacco effort: product placement restrictions correspond to the entertainment-side interventions, ownership-risk education corresponds to health-hazard messaging, and unsecured-firearm warnings correspond to targeted safety communication. The paper frames these as research priorities rather than ready-made policies, stressing that their effectiveness for firearms has not yet been demonstrated.

The consumer-product framing is the paper’s most distinctive analytical move. Tobacco control succeeded, in part, because advocates reframed cigarettes from an ordinary commodity into a dangerous product whose marketing deserved scrutiny. Romer suggests that firearms, and handguns in particular, could be examined through the same lens, with attention to how they are advertised, depicted, and normalized. “The public health approach to cigarettes as a consumer product demonstrated how various forms of public education can debunk the claim that owning a firearm is worth the risks that accompany widespread possession,” Romer says. Whether that debunking can succeed in a cultural and legal environment so different from the one tobacco faced is an open empirical question, and the paper does not claim otherwise.

The distinction between universal and targeted strategies carries practical weight. Targeted interventions, such as crisis intervention programs, extreme risk protection orders, and violence interruption efforts aimed at people at elevated risk, address the sharpest harms but leave untouched the broader market dynamics that put handguns in millions of homes. A universal approach, by contrast, operates on the entire population, aiming to lower demand at the source. Romer acknowledges that further research is needed to determine whether such strategies would be effective for firearms, but he points to the historical record as grounds for optimism. “The success of the universal public health approach to cigarettes serves as a model for the reduction of the consumer appeal of firearms,” he writes.

Published as a commentary in the American Journal of Preventive Medicine, with the article dated 23 September 2026, the paper is positioned as an argument for a research agenda rather than a legislative proposal. Its measurable claims are specific: firearm portrayals in entertainment have risen alongside handgun purchases and firearm homicides among young people; the self-defense rationale dominates ownership motivations and has been endorsed by the Supreme Court; and the tobacco precedent shows that education plus cultural de-normalization can reduce a product’s appeal. What remains untested is causality and intervention efficacy, and Romer’s paper explicitly calls for the kind of rigorous studies that eventually justified tobacco’s entertainment restrictions. For researchers, the immediate task is to establish whether screen exposure to firearms shapes attitudes and behavior the way screen exposure to smoking once did. For policymakers, the paper suggests that the tools of public health, evidence, education, and cultural change, may offer a path that complements, rather than replaces, the targeted violence-prevention efforts already in place.

Subject of Research: Applying tobacco-control-style public health strategies to reduce the consumer appeal and use of firearms in the United States

Article Title: Public health strategies used against cigarettes could help reduce appeal of firearms, paper argues

Article References: Public health strategies used against cigarettes could help reduce appeal of firearms, paper argues. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: firearms, gun violence, public health, tobacco control, cigarette smoking, handguns, self-defense, entertainment media, movie portrayals, Annenberg Public Policy Center, American Journal of Preventive Medicine, consumer products

The study, led by David A. Stupplebeen of the University of Hawaiʻi at Mānoa, with Candice D. Donaldson and Tam D. Vuong of the California Department of Public Health and UC Davis Comprehensive Cancer Center, drew on pooled data from the 2022 and 2023 cycles of the Online California Adult Tobacco Survey. That survey is designed to be representative of California adults, and the researchers restricted their analysis to people between the ages of 18 and 64, yielding a weighted analytic sample of 10,332 respondents. Because the data were weighted, the findings are intended to reflect the broader adult population of the state rather than just the people who happened to answer the questionnaire.

What sets this investigation apart is its measurement strategy. Rather than simply recording whether respondents belonged to a racial or ethnic minority group or identified as sexual or gender minorities, the researchers measured discrimination directly using the Everyday Discrimination Scale, a widely used instrument that asks about routine experiences of being treated with less courtesy or respect, being insulted, or being perceived as less capable. Respondents were then classified into categories based on the type of discrimination they attributed their experiences to: none at all, discrimination related to something other than race or sexual orientation, racial or ethnic discrimination only, sexual orientation discrimination only, or the joint experience of both racial-ethnic and sexual orientation discrimination.

The researchers also captured a dimension that is often overlooked in health disparities research: frequency. Experiencing discrimination once is not the same as living with it as a chronic, repeating feature of daily life. By standardizing discrimination scores and modeling both the type and the reported frequency of discriminatory experiences, the team could ask whether the chronicity of mistreatment mattered independently of its kind. The answer, according to their statistical models, was yes, and the patterns were strikingly different across categories.

The core results come from logistic regression models that adjusted for a range of demographic and socioeconomic factors, allowing the researchers to isolate the association between discrimination and tobacco use from confounders such as age, income, education, and other characteristics. Compared with adults who reported no discrimination, those who experienced discrimination tied to other reasons had 32 percent higher odds of current cigarette use, with an adjusted odds ratio of 1.32 and a 95 percent confidence interval of 1.11 to 1.57. Those who experienced sexual orientation discrimination alone faced roughly double the odds of smoking, with an adjusted odds ratio of 2.05 and a confidence interval of 1.47 to 2.85, the single largest effect observed in the study.

Perhaps the most counterintuitive finding involved people who reported experiencing both racial-ethnic and sexual orientation discrimination. Their adjusted odds of smoking were elevated, at 1.26 with a confidence interval of 1.10 to 1.45, but the effect was smaller than for sexual orientation discrimination alone. The same held true for vaping: joint discrimination was associated with 31 percent higher odds of current vaping, while racial-ethnic discrimination alone carried 53 percent higher odds and other discrimination 37 percent higher odds. The researchers interpret this not as evidence that intersectional discrimination is somehow protective, but as a reminder that the relationship between layered prejudice and health behavior is not a simple additive one, where each additional form of discrimination mechanically stacks risk on top of risk.

Across both outcomes, the direction of association was consistent: more discrimination, and more frequent discrimination, went together with higher odds of tobacco product use. For vaping, the adjusted odds ratios were 1.37 for other discrimination, 1.53 for racial-ethnic discrimination only, and 1.31 for joint discrimination, all with confidence intervals that excluded the null value of 1.0. The consistency of the positive association across two distinct tobacco products, one a combustible product with a century of epidemiological baggage and the other a relatively recent phenomenon, suggests that the underlying mechanism is not specific to any single delivery device but may relate to how people cope with chronic social stress.

The biological plausibility for such a link comes from a substantial body of research on minority stress and allostatic load. Chronic exposure to discriminatory treatment is thought to activate the body’s stress response systems repeatedly, elevating cortisol and sympathetic nervous system activity over time. Tobacco use, in this framework, can function as both a pharmacological coping mechanism, delivering nicotine that temporarily blunts negative affect, and a behavior embedded in social environments where stress and marketing pressure converge. The California findings cannot prove causation, since the data are cross-sectional and discrimination and tobacco use were measured at the same time, but they add to a growing pattern of evidence that perceived discrimination behaves like a modifiable risk factor for one of the world’s leading causes of preventable death.

The methodological implications may be as important as the substantive ones. Public health surveillance has long relied on demographic categories, race, ethnicity, sexual orientation, gender identity, to identify populations at elevated risk. Those categories are useful but blunt, and they describe characteristics that are immutable. By measuring the actual experience of discrimination, including its type and its frequency, the study demonstrates a way to identify risk that tracks something potentially changeable. If discrimination contributes to tobacco use, then reducing discrimination, through policy, enforcement, or community intervention, becomes a legitimate tobacco control strategy, not merely a matter of social justice pursued for its own sake.

The authors are careful about the limits of their work. The study is observational, the discrimination measures rely on self-report, and the attribution of discriminatory treatment to a specific cause, race versus sexual orientation versus something else, is inherently subjective. The analysis was also restricted to California adults of working age, and patterns could differ elsewhere. Still, the study, which was funded in part by the California Department of Public Health and reviewed as exempt by the University of Hawaiʻi at Mānoa Institutional Review Board, offers a template for future research: model discrimination as an exposure with both a type and a chronicity, rather than as a proxy embedded in demographic labels. If replicated, the finding that sexual orientation discrimination alone roughly doubles the odds of cigarette smoking would rank among the strongest social-environmental correlates of tobacco use ever quantified at the population level, and it would give tobacco control programs a concrete, measurable target in their efforts to close the gaps in health that demographics alone cannot explain.

Subject of Research: The association between racial/ethnic and sexual orientation discrimination and tobacco product use among California adults

Article Title: Tobacco product use at the intersection of racial/ethnic and sexual orientation discrimination among California adults, 2022–2023: an observational study

Article References: Stupplebeen, D. A., Donaldson, C. D., & Vuong, T. D. (2026). Tobacco product use at the intersection of racial/ethnic and sexual orientation discrimination among California adults, 2022–2023: an observational study. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03054-z

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03054-z

Keywords: tobacco use, discrimination, health disparities, sexual orientation, race and ethnicity, cigarette smoking, vaping, minority stress, California, epidemiology, public health, equity