Journal of Hazardous Materials Advances · Aug 2026
Life-course multi-modal tobacco exposure and chronic disease risk and the mitigating role of healthy lifestyle
By Liu H, Fang Y, Gu H et al.
Tobacco exposure at different stages of life may jointly influence chronic disease risk, but the burden associated with combined life-course exposure patterns remains incompletely characterized. Using prospective data from the UK Biobank, we examined the associations of in utero tobacco exposure, active smoking, and secondhand smoke with the incidence of diabetes, cardiovascular disease, chronic respiratory disease, chronic kidney disease, dementia, and all cancers. We further evaluated eight mutually exclusive exposure combinations, estimated population-attributable fractions, and examined physical activity and diet quality among tobacco exposed participants. Each exposure domain was associated with higher risks of several outcomes, with active smoking showing the strongest associations. Participants exposed to all three domains, defined as the “Triple Burden”, had the highest observed hazard ratios across all six outcomes, including chronic respiratory disease (HR: 2.52, 95% CI: 2.33-2.73). Despite its relatively low prevalence, the Triple Burden was associated with an appreciable model-based attributable burden. Within the three tobacco exposure groups, sufficient physical activity and higher diet quality were associated with lower risks of several chronic diseases, although the associations varied by exposure type and outcome. Together, these findings underscore the importance of preventing tobacco exposure throughout the life course and suggest that physical activity and diet quality may complement established strategies for tobacco control in exposed populations.