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Interindividual differences in drug disposition are important causes for adverse drug reactions and lack of drug response. The majority of phase I and phase II drug-metabolizing enzymes (DMEs) are polymorphic and constitute essential factors for the outcome of drug therapy. Recently, both genome-wide association (GWA) studies with a focus on drug response, as well as more targeted studies of genes encoding DMEs have revealed in-depth information and provided additional information for variation in drug metabolism and drug response, resulting in increased knowledge that aids drug development and clinical practice. In addition, an increasing number of meta-analyses have been published based on several original and often conflicting pharmacogenetic studies. Here, we review data regarding the pharmacogenomics of DMEs, with particular emphasis on novelties. We conclude that recent studies have emphasized the importance of CYP2C19 polymorphism for the effects of clopidogrel, whereas the CYP2C9 polymorphism appears to have a role in anticoagulant treatment, although inferior to VKORC1. Furthermore, the analgesic and side effects of codeine in relation to CYP2D6 polymorphism are supported and the influence of CYP2D6 genotype on breast cancer recurrence during tamoxifen treatment appears relevant as based on three large studies. The influence of CYP2D6 polymorphism on the effect of antidepressants in a clinical setting is yet without any firm evidence, and the relation between CYP2D6 ultrarapid metabolizers and suicide behavior warrants further studies. There is evidence for the influence of CYP3A5 polymorphism on tacrolimus dose, although the influence on response is less studied. Recent large GWA studies support a link between CYP1A2 polymorphism and blood pressure as well as coffee consumption, and between CYP2A6 polymorphism and cigarette consumption, which in turn appears to influence the lung cancer incidence. Regarding phase II enzyme polymorphism, the anticancer treatment with mercaptopurines and irinotecan is still considered important in relation to the polymorphism of TPMT and UGT1A1 , respectively. There is a need for further clarification of the clinical importance and use of all these findings, but the recent research in the field that encompasses larger studies and a whole genome perspective, improves the possibilities be able to make firm and cost-effective recommendations for drug treatment in the future.

Background:  Modelling disease risk from e-cigarette use requires knowing how much e-cigarette uptake affects a smoker's cigarette consumption.  From Waves 1-3 of the US PATH study and other evidence, we sought answers to three questions: (Q1) Does consumption differ between dual users and exclusive smokers?  (Q2) Does initiating e-cigarettes affect cigarette consumption?  (Q3) Is baseline consumption related to later initiation of e-cigarettes? Methods:  Consumption data from PATH were corrected for clear recording errors, with e-cigarette use classified as established or every day, and adjustment made for demographics, use of alcohol, drugs and other tobacco products, and age of starting smoking.  Searches identified other studies published since 2008, with Q1 answered from cross-sectional studies, and Q2 and Q3 also from prospective studies.  Results: (Q1) In PATH, consumption in current every day e-cigarette users was 2-3 cigarettes per day lower in dual users, with no difference seen in established users.  From 31 published studies, consumption was no lower in dual users for current or ever e-cigarette users.  (Q2) In PATH study consistent decreases in consumption occurred in those becoming every day dual users with increases seen in those reverting to exclusive smoking.  Thirteen published studies consistently showed reduced consumption in those becoming dual users.  (Q3) Three studies consistently showed greater consumption in smokers subsequently initiating e-cigarettes, but no significant difference was seen for PATH.  Conclusions:  Assessment is complicated by the few every day e-cigarette users in PATH, and between-study variability in quantifying e-cigarette use and presentation of results. As taking up e-cigarettes is associated with reducing consumption, finding no clear cross-sectional difference between dual users and exclusive smokers suggests smokers taking up e-cigarettes had higher consumption initially, limited evidence supporting this.  Given the much lower disease risk of e-cigarettes vs. cigarettes, smokers becoming dual users should somewhat reduce their disease risk.

Background: In 2011, the courts ruled in favor of tobacco companies in preventing the implementation of graphic warning labels (GWLs) in the US, stating that FDA had not established the effectiveness of GWLs in reducing smoking. Methods: Data came from various sources: the WHO MPOWER package (GWLs, MPOWER policy measures, cigarette prices), Euromonitor International (smoking prevalence, cigarette consumption), and the World Bank database (countries’ demographic characteristics). The datasets were aggregated and linked using country and year identifiers. Fractional logit regressions and OLS regressions were applied to examine the associations between GWLs and smoking prevalence and cigarette consumption, controlling for MPOWER policy scores, cigarette prices, GDP per capita, unemployment, population aged 15–64 (%), aged 65 and over (%), year indicators, and country fixed effects. Results: GWLs were associated with a 0.9–3 percentage point decrease in adult smoking prevalence and were significantly associated with a reduction of 230–287 sticks in per capita cigarette consumption, compared to countries without GWLs. However, the association between GWLs and cigarette consumption became statistically insignificant once country indicators were included in the models. Conclusions: The implementation of GWLs may be associated with reduced cigarette smoking.

Background European Union public healthcare expenditure on treating smoking and attributable diseases is estimated at over €25bn annually. The reduction of tobacco consumption has thus become one of the major social policies of the EU. This study investigates the effects of price hikes on cigarette consumption, tobacco tax revenues and smoking-caused deaths in 28 EU countries. Methods Employing panel data for the years 2005 to 2014 from Euromonitor International, the World Bank and the World Health Organization, we used income as a threshold variable and applied threshold regression modelling to estimate the elasticity of cigarette prices and to simulate the effect of price fluctuations. Results The results showed that there was an income threshold effect on cigarette prices in the 28 EU countries that had a gross national income (GNI) per capita lower than US$5418, with a maximum cigarette price elasticity of −1.227. The results of the simulated analysis showed that a rise of 10% in cigarette price would significantly reduce cigarette consumption as well the total death toll caused by smoking in all the observed countries, but would be most effective in Bulgaria and Romania, followed by Latvia and Poland. Additionally, an increase in the number of MPOWER tobacco control policies at the highest level of achievment would help reduce cigarette consumption. Conclusions It is recommended that all EU countries levy higher tobacco taxes to increase cigarette prices, and thus in effect reduce cigarette consumption. The subsequent increase in tobacco tax revenues would be instrumental in covering expenditures related to tobacco prevention and control programs.

Background Tobacco vaporizers heat tobacco without burning it, to produce an inhalable aerosol. Various models have recently appeared on the market, mostly manufactured by the tobacco industry, but few of the studies published on tobacco vaporizers are independent from the manufacturers. The goals of this study were to explore who uses tobacco vaporizers, how these products are used, reasons for utilization, perceived advantages and risks. Methods Online questionnaire collected from October 2016 to January 2018 in self-selected visitors aged > 18 to an anti-addiction website. Results We obtained 170 valid responses, of whom 104 were using tobacco vaporizers. For homogeneity, we included only the 102 users of the Brand 1 tobacco vaporizer in our analysis, as there were only two users of other vaporizers. Among these 102 vaporizer users, about half were current cigarette smokers (57%), the rest were former cigarette smokers. The median age was 41, and the median duration of utilization was 9 months. Most (88%) used the vaporizer daily, 8% were occasional users and 4% were past users. Among current smokers, 80% were currently trying to reduce their cigarette consumption and 29% were trying to quit. The vaporizer was used mainly to replace cigarettes (94%), because it was perceived to be less toxic than cigarettes (89%), to help stop smoking or to avoid starting smoking again (72%), or to reduce cigarette consumption (71%). Current smokers who were daily or occasional vaporizer users reported smoking a median of 8.0 cigarettes per day, compared with 20.0 per day before they started to use the vaporizer ( p  < .0001, Wilcoxon signed-rank test). Conclusions In this online sample of early adopters, Brand 1 was by far the most frequently used tobacco vaporizer. It was used by current or former smokers only, mainly to replace cigarettes, and satisfaction ratings were good. Users considered the tobacco vaporizer to be less toxic than cigarette smoke and perceived it to be helpful for reducing or stopping smoking.

This paper investigates the impact of cigarette taxation on consumption and fiscal outcomes in Jordan, where smoking prevalence is high and reliance on tobacco revenues is substantial. Using quarterly data from 2008-2023 and General-to-Specific Ordinary Least Squares (GTS-OLS) and Vector Autoregression (VAR) models, the analysis captures short-run and dynamic effects. Results show higher excises significantly reduce consumption, with an immediate effect of -1.42 percentage points in cigarette consumption growth per 1 Jordanian Dinars (JD) increase, a portion of this decline is offset in subsequent quarters, reflecting behavioural inertia, stockpiling, or substitution into illicit products. The sustained impact of taxation accounts for 8-9% of consumption variance over a 4 to 10 quarters horizon. Revenues remain closely tied to consumption, with a 1 percentage-point rise in consumption growth linked to a 0.82 percentage-point increase in revenue growth, illustrating the fiscal-health policy dilemma. Overall, taxation is effective but requires sustained, inflation-adjusted reforms, stronger enforcement, and complementary measures to align public health with fiscal stability. Using quarterly data from 2008Q1-2023Q4, this study provides robust empirical evidence on how cigarette excise taxes shape smoking behaviour and fiscal outcomes in Jordan. The results show that tax increases immediately reduce cigarette consumption, but part of this effect reverses in subsequent quarters due to behavioural inertia and stockpiling, highlighting the need for regular, inflation-indexed excise adjustments rather than infrequent hikes. At the same time, revenue growth remains strongly dependent on consumption growth, underscoring Jordan's fiscal-health policy dilemma and the importance of strengthening enforcement and anti-illicit-trade mechanisms to safeguard both public-health gains and the integrity of fiscal revenues. These findings provide actionable guidance for policymakers, demonstrating that effective tobacco taxation requires a coordinated approach: sustained excise reforms to maintain behavioural impact, and parallel enforcement measures to prevent erosion of both health outcomes and tax revenues.

ObjectivesTo investigate associations of dual use of e-cigarettes and cigarettes with subsequent quitting activity (smoking reduction, quit attempts and use of evidence-based cessation aids). To overcome potential confounding by factors associated with use of pharmacological support, we selected dual use of over-the-counter nicotine replacement therapy (OTC NRT) and cigarettes as a behavioural control.DesignProspective cohort study with 6-month follow-up.SettingEngland, 2014–2016.Participants413 current smokers participating in the Smoking Toolkit Study, a representative survey of adults in England, who reported current use of e-cigarettes or OTC NRT and provided data at 6-month follow-up.Main outcome measuresThe exposure was dual use of e-cigarettes or OTC NRT at baseline. Outcomes were change in cigarette consumption, quit attempts and use of evidence-based cessation aids during quit attempts over 6-month follow-up. Relevant sociodemographic and smoking characteristics were included as covariates.ResultsAfter adjustment for covariates, dual e-cigarette users smoked two fewer cigarettes per day at follow-up than at baseline compared with dual OTC NRT users (B=2.01, 95% CI −3.62; −0.39, p=0.015). While dual e-cigarette users had 18% lower odds than dual OTC NRT users to make a quit attempt at follow-up (risk ratio (RR) 0.82, 95% CI 0.67 to 1.00, p=0.049), the groups did not differ in use of cessation aids (RR 1.06, 95% CI 0.93 to 1.21, p=0.388).ConclusionsDual use of e-cigarettes is associated with a greater reduction in cigarette consumption than dual use of OTC NRT. It may discourage a small proportion of users from making a quit attempt compared with dual OTC NRT use but it does not appear to undermine use of evidence-based cessation aids.

China is world's largest market of machine-made cigarettes. In 2015, more than 315 million or around 26.9% of the adult population in China were smokers-50.6% among men and 2.2% among women. Growing affordability of cigarettes led to increased cigarette consumption in China to the detriment of public health. This study investigated whether the level and growth in cigarette affordability in China was equally shared by smokers from all demographic and socio-economic statuses (SES) and across all price tiers of cigarette brands. The data came from the urban smoker sample (≥18 years) of the International Tobacco Control China Surveys conducted in five waves over 2006-2015. Cigarette affordability was measured by Relative Income Price-percentage of per capita household income needed to purchase 100 cigarette packs of the last purchased brand. Overall and group-specific trends in affordability by age, gender, SES (e.g., income, education, and employment status), and price tiers were analyzed using generalized estimating equations method. Cigarette affordability was higher among older, female, and higher-SES smokers, and for cheaper brands. It increased overall and across all groups over time. The increase was significantly larger among younger and lower-SES smokers, a trend that poses an added challenge to tobacco control and health equity. To reduce cigarette affordability and consumption among these vulnerable groups, a uniform specific excise system should be introduced in place of the existing tiered ad valorem excise. The specific excise should be periodically adjusted to inflation and per capita income growth observed among younger and lower-SES people, who can potentially experience faster income growth than the national average. The excise tax policy can also be complimented with minimum price regulations and restrictions on price promotions.

Little is currently known about the relationships between neighborhood deprivation (ND) and smoking behavior in Asia. Thus, we investigated (a) these relationships using current smoking, daily smoking, and past 30-day cigarette consumption among South Korean adults and (b) sex differences in these relationships. We conducted multilevel analyses: (a) multiple logistic regression analyses for current smoking ( N  = 83,048 lifetime smokers) and daily smoking ( n  = 41,260 current smokers) and (b) a multiple negative binomial regression analysis for past 30-day cigarette consumption ( n  = 41,260 current smokers). We found that people residing in more deprived neighborhoods (a) were at greater risk of engaging in current and daily smoking and (b) consumed more cigarettes. Also, we found a significant sex difference: a stronger relationship between ND and current smoking among females than among males. Our findings strongly indicate the necessity of implementing neighborhood-level smoking cessation interventions, while considering the sex difference.

China is in the midst of an epidemic of non-communicable diseases (NCDs), which has increasingly accounted for a growing share of disease burden, due in part to China’s ongoing rapid socioeconomic changes and population aging. Smoking, the second leading health risk factors associated with NCDs in China, disproportionately affects the old population more than their younger counterparts. Using survey data from the China Health and Retirement Longitudinal Study (CHARLS), this study evaluated the impact of changes in cigarette affordability on smoking behavior among middle-aged and elderly (age 45 and older) smokers. Self-reported cigarette price and disposable income were used to calculate cigarette affordability. Cigarette consumption was measured using the number of cigarettes smoked per day reported by the survey respondents. The correlation between cigarette affordability and cigarette consumption was estimated using generalized estimating equations adjusting for demographics, socioeconomic status, geolocations, and cigarette price tiers, as well as year fixed effects. The estimated overall conditional cigarette affordability elasticity of demand was –0.165, implying a 10% decrease in cigarette affordability would result in a reduction in cigarette consumption by 1.65%. The cigarette affordability responsiveness differs by demographics, socioeconomic status, geolocations, and cigarette price tiers. This study provides evidence that tax/price policies that reduce cigarette affordability could lead to a decrease in cigarette consumption among middle-aged and elderly smokers in China. Smoke-free laws, as well as minimum price regulations, may be needed to compliment excise tax policy to target specific smoking subgroups whose cigarette consumption is less sensitive to changes in cigarette affordability.