30-Second Takeaway
- State smoking gaps are driven more by higher smoking propensity in disadvantaged groups than by population mix alone.
- Duration-based lung cancer screening around 35 years’ smoking can match current guideline efficiency with simpler implementation.
- Psychosocial adversity across the life course elevates dementia and stroke risk, partly via depression, expanding prevention targets.
Week ending January 31, 2026
Targeted prevention levers: tobacco disparities, screening redesign, and upstream social determinants
Smoking disparities between high- and low-burden US states reflect higher propensity in older and less-educated adults
In this 2023–2024 rapid-response survey of 12,300 adults in 13 high- and 4 low-burden states, subnational smoking gaps were decomposed using Oaxaca-Blinder methods. Differences in smoking propensity by characteristics, not composition, explained 56.7% of the disparity, driven by higher smoking among adults aged 40–65 years and those with <high-school education. Population composition, including larger proportions with less than college education in high-burden states, contributed 22.9% of the gap. Unmeasured macrolevel factors, such as policies or norms, accounted for the remaining 20.4%.
Duration-based criteria can preserve lung cancer screening efficiency while simplifying eligibility
Three CISNET models compared smoking duration–based lung cancer screening with current pack-year and risk-based strategies for 1960 and 1970 US birth cohorts. Risk-based eligibility produced the most lung cancer deaths averted and life-years gained but also the most overdiagnosis. A 35-year duration cut-off achieved similar lung cancer deaths averted, life-years gained, and benefit-to-harm ratios per screen as current US guidelines. Scenarios using a 20-year duration threshold substantially increased the number of screenings but provided only modest additional benefit with lower efficiency.
Life-course psychosocial adversity increases dementia and stroke risk, partly mediated by depression
In 11,601 Chinese adults aged ≥45 years followed for about 5 years, most reported at least one adverse childhood or adulthood experience. Both adverse childhood and adulthood experiences were associated with higher hazards of incident dementia, while only adulthood adversity predicted higher stroke risk. Individuals in high-risk groups for both childhood and adulthood adversity had substantially increased hazards of dementia and stroke. Depression mediated meaningful proportions of these associations for dementia and stroke, indicating a key pathway from adversity to cerebrovascular and cognitive outcomes.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.