Smoking Prevalence and Cessation Indicators across Glycemic States in U.S. Adults: NHANES 2011–2023

Introduction and Objective: Smoking is a major modifiable risk factor for cardiovascular disease and mortality and is particularly harmful in people with diabetes. We examined smoking burden and cessation indicators across no diabetes, prediabetes, controlled diabetes, and uncontrolled diabetes in U.S. adults. Methods: We conducted a cross-sectional study of adults aged ≥20 years in NHANES 2011-2023. Glycemic status was defined using hemoglobin A1c and self-reported diabetes, categorizing participants as no diabetes (A1c <5.7%), prediabetes (5.7-6.4%), controlled diabetes (diabetes with A1c <7.0%), or uncontrolled diabetes (diabetes with A1c ≥7.0%). Outcomes were current smoking, smoking intensity, past-year quit attempt among current smokers, and quit ratio among ever smokers. Survey-weighted estimates were calculated, and survey-weighted logistic regression examined associations between glycemic status and current smoking, quit attempts, and quit ratio. Results: Among 29,833 adults, 16,933 had no diabetes, 7,433 had prediabetes, 4,109 had controlled diabetes, and 1,358 had uncontrolled diabetes. Current smoking prevalence was 17.0% in no diabetes, 21.7% in prediabetes, 19.5% in controlled diabetes, and 24.6% in uncontrolled diabetes (P<0.001). The prevalence of heavy smoking was 25.6%, 28.8%, 38.1%, and 36.6%, respectively (P<0.001). Quit attempts differed across groups (48.4%, 56.6%, 47.5%, and 44.0%, respectively; P=0.030). Quit ratio also differed (56.7%, 49.2%, 59.1%, and 48.7%; P<0.001). Prediabetes and uncontrolled diabetes were associated with higher odds of current smoking vs no diabetes (AOR 1.31, 95% CI 1.10-1.57; and 1.37, 1.02-1.83, respectively). Prediabetes was associated with lower odds of quit ratio (AOR 0.80, 0.66-0.98). Conclusion: Smoking burden remains high in U.S. adults with prediabetes and uncontrolled diabetes. These findings support tailored cessation strategies across glycemic groups, particularly among people with prediabetes and uncontrolled diabetes. Disclosure: L. Liu: None. F. Wang: None.