Veterans more likely than general population to use all types of tobacco products, including the most harmful

A new study is the first since 2015 to examine differences in tobacco use by product type among military Veterans compared to civilians, finding that Veterans disproportionately use all commercial tobacco product types, including cigars and cigarettes.

Boston University School of Public Health

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Veterans More Likely than General Population to Use All Types of Tobacco Products, Including the Most Harmful

A new study is the first since 2015 to examine differences in tobacco use by product type among military Veterans compared to civilians, finding that Veterans disproportionately use all commercial tobacco product types, including cigars and cigarettes, which pose a range of serious health risks.

For many military members, tobacco use is a normalized activity that continues long after their military service ends, posing a lifelong danger to the health of military Veterans. Despite knowledge that tobacco use has been elevated among Veterans, most research on this subject relies on decade-old data that does not reveal differences in use of individual tobacco products, including newer products on the market.

A new study led by Boston University School of Public Health (BUSPH) researchers fills this gap, showing that Veterans continue to use tobacco and nicotine products at higher rates than the general population.

Published in the journal Nicotine & Tobacco Research, the study reveals new patterns of tobacco use among Veterans compared to civilians: Veterans are more likely to use all commercial tobacco products—including cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco. Veterans also had a higher risk for former and current tobacco use, as well as any combustible tobacco product use, and multiple product use. Almost 1 in 4 Veterans reported currently using tobacco and 19 percent currently use combustible tobacco products. Veterans are also more likely than civilians to use multiple tobacco products, which increases health risks. The study is the first analysis of tobacco use by Veteran status to consider product type since 2015.

Veterans’ increased risk for use of combustible tobacco products, including cigars and cigarettes, was particularly concerning to the researchers.

“These products are the most harmful tobacco products, and they pose the greatest health risks, including multiple cancers, as well as heart and lung diseases,” says study lead and corresponding author Dr. Jennifer Ross, associate professor of health law, policy & management at BUSPH. “Tobacco smoking among an already vulnerable population will further exacerbate existing health disparities for Veterans.”

While national surveys have not yet incorporated some of the newer tobacco products that have emerged, Dr. Ross says, “we can now begin to see how Veterans are currently using many types of these products, and how these trends may shift over time in response to ongoing changes to the industry and to the tobacco regulatory landscape.”

Current and former military members may use tobacco for many reasons, including to cope with stress, depression, or anxiety, as well as a way to foster social connections as this activity is widely ingrained in military culture. As Veterans remain an historically undertreated population, the researchers hope this updated knowledge of tobacco use patterns helps inform the development of smoking cessation interventions and educational opportunities about the harms of tobacco use to current and former military service members.

For the study, Dr. Ross and colleagues from BUSPH, the Uniformed Services University, and the University of Virginia utilized nationally representative survey data that revealed variations in tobacco use and product type based on military status, age, race, education level, and insurance status among more than 78,000 Veterans and civilians in the US from 2021 to 2023.

Within the Veteran sample, younger Veterans (18-34) had increased risk for specific tobacco products including cigars, e-cigarettes and multiple product use, while older Veterans had higher risk for use of cigarettes. Males were more likely than females to use any tobacco product. Veterans who use the Veterans Health Administration (VHA) for healthcare were more likely to smoke cigarettes and other combustible tobacco products than Veterans who sought care from non-VHA providers.

“We now understand that risk for using specific tobacco products varies by age within the Veteran population,” says study senior author Dr. Rachel Sayko Adams, research associate professor at BUSPH. “This suggests that the newer and younger cohort of post-9/11 Veterans who served in the Afghanistan/Iraq conflicts may be at highest risk for using new and emerging tobacco products, while older Veterans continue to be at highest risk for cigarette use. Targeted Veteran-specific tobacco intervention programs are needed that consider types of tobacco products being used to improve the health of the full population of Veterans.”

In October 2024, after this study period ended, the VHA implemented new requirements for tobacco screenings, as well as brief counseling or treatment for Veterans who use the VHA. The researchers hope their findings will inform continued education campaigns on tobacco and nicotine use, as well as encourage expanded treatment options and prevention programs, both within and outside of the VHA, as more than half of the Veterans are not enrolled in VHA healthcare.

Accurate messaging that conveys the relative harms of tobacco products is also critical to correct or prevent misconceptions about these products. For example, a 2023 study also led by Dr. Ross found that many younger adults believe that cigars are less harmful than cigarettes, even though cigars pose similar health risks and contain higher levels of certain chemicals, such as carbon monoxide. Similarly, e-cigarettes may pose a less-harmful alternative to current and former military who have not been able to quit smoking combustible cigarettes or cigars.

“Taken together, our findings suggest that we should think more strategically about intervening often and early for tobacco and nicotine use within military and Veteran populations,” says Dr. Adams. “We need coordinated efforts between the Department of Defense, Veterans Health Administration, and organizations that serve Veterans to screen and intervene for tobacco use, and to provide Veteran-centric cessation programs to reduce tobacco-related harms for those who served.”

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About Boston University School of Public Health

Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.

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Journal

Nicotine & Tobacco Research

DOI

10.1093/ntr/ntaf142 

Method of Research

Survey

Subject of Research

People

Article Title

Tobacco Product Use and Type by Military Veteran Status: Findings from the National Health Interview Survey, 2021–2023

Article Publication Date

2-Oct-2025

 

Do stranded dolphins have Alzheimer’s disease?

Brain Chemistry Labs

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image: 

Dr. David Davis examining neuropathology using a digital Huron TissueScope LE at the Brain Chemistry Labs.

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Credit: Paul Alan Cox

One of the most heartbreaking occurrences for nature lovers is to discover a beached marine mammal such as a dolphin or whale. If the animal is still alive, marine biologists assisted by citizen volunteers try to protect the beached marine mammal from sun exposure and skin desiccation by pouring buckets of sea water on them and sometimes covering them with wet blankets. Other volunteers try to find ways to help the animal return to their native ocean habitat when the tide rises.

Unfortunately, some beached marine mammals are discovered after they have died. Such unsettling events give rise to a broader question: why do dolphins and whales become stranded on shore in the first place?

A group of scientists ranging from Florida to Wyoming have come up with an unusual hypothesis: just as some adult humans with dementia are occasionally found wandering far from their homes, perhaps dolphins become similarly disoriented by suffering from a form of Alzheimer’s disease. In the case of marine mammals, it appears that Alzheimer’s-type neuropathology and disorientation may result from chronic exposure to toxic molecules produced by cyanobacteria.

Studies of villagers on the island of Guam show that chronic dietary exposure to cyanobacterial toxins are associated with misfolded tau proteins and amyloid plaques characteristic of Alzheimer’s disease. The cyanobacterial toxin β-N-methylamino-L-alanine (BMAA), as well as its isomers 2,4-Diaminobutyric acid (2,4-DAB), and N-2-aminoethylglycine (AEG), have been found to be extremely toxic to neurons. BMAA triggers Alzheimer’s-like neuropathology and cognitive loss in experimental animals. These toxins can be biomagnified up the food chain in the marine ecosystem.

A study of twenty common bottlenose dolphins stranded in the Indian River Lagoon in eastern Florida showed that their brains contained BMAA and its isomers, particularly 2,4-DAB. Dolphins stranded during the summer cyanobacterial bloom season contained 2,900 times the concentration of 2,4-DAB than those from non-bloom seasons. Brain neuropathology similar to Alzheimer’s patients including β-amyloid plaques and hyperphosphorylated tau proteins were found in the dolphin brains. In addition, TDP-43 protein inclusions characteristic of a particularly severe form of Alzheimer’s were also found in the dolphin brains. During bloom seasons, the same dolphins showed 536 differentially expressed genes associated with Alzheimer’s disease.

The duration of cyanobacterial blooms is increasing with climate warming and nutrient inputs associated with agricultural runoff and sewage discharges. Cyanobacterial-laden waters have often been released down the St. Lucie River from Lake Okeechobee into the Indian River Lagoon. “Since dolphins are considered environmental sentinels for toxic exposures in marine environments,” Dr. David Davis at the Miller School of Medicine explains, “there are concerns about human health issues associated with cyanobacterial blooms.”

In 2024, Miami Dade County had the highest prevalence of Alzheimer’s disease in the United States. “Although there are likely many paths to Alzheimer’s disease, cyanobacterial exposures increasingly appear to be a risk factor,” adds Dr. Davis.

“Among Guam villagers, exposure to cyanobacterial toxins appeared to trigger neurological disease,” said Dr. Paul Alan Cox of the Brain Chemistry Labs in Jackson Hole.

This research was published in the current Nature journal Communication Biology by researchers at Hubbs-SeaWorld Research Institute in Melbourne Beach, Florida, The Blue World Research Institute in Cocoa, Florida, The University of Miami Miller School of Medicine, Miami, Florida, Brain Chemistry Labs, Jackson Hole, Wyoming, Rosenstiel School of Marine, Atmospheric, and Earth Science, University of Miami, Miami, Florida.

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Journal

Communications Biology

DOI

10.1038/s42003-025-08796-0 

Method of Research

Experimental study

Subject of Research

Animals

Article Title

Alzheimer’s disease signatures in the brain transcriptome of Estuarine Dolphins

Article Publication Date

30-Sep-2025

c: Beta-amyloid pathology in a stranded dolphin brain; g: hyperphosphorylated tau protein in the brain of a stranded dolphin

Comparative Alzheimer's pathways in dolphins in bloom season.

Credit

David Davis

Bottlenose dolphins in Florida

Credit

Wendy Noke Durden

 

System lets people personalize online social spaces while staying connected with others

By enabling users to easily create social apps that serve communities’ needs, the Graffiti framework aims to promote healthier online interactions.

Massachusetts Institute of Technology

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Cambridge, MA – Say a local concert venue wants to engage its community by giving social media followers an easy way to share and comment on new music from emerging artists. Rather than working within the constraints of existing social platforms, the venue might want to create its own social app with the functionality that would be best for its community. But building a new social app from scratch involves many complicated programming steps, and even if the venue can create a customized app, the organization’s followers may be unwilling to join the new platform because it could mean leaving their connections and data behind.

Now, researchers from MIT have launched a framework called Graffiti that makes building personalized social applications easier, while allowing users to migrate between multiple applications without losing their friends or data.

“We want to empower people to have control over their own designs rather than having them dictated from the top down,” says electrical engineering and computer science graduate student Theia Henderson.

Henderson and her colleagues designed Graffiti with a flexible structure so individuals have the freedom to create a variety of customized applications, from messenger apps like WhatsApp to microblogging platforms like X to location-based social networking sites like Nextdoor, all using only front-end development tools like HTML.

The protocol ensures all applications can interoperate, so content posted on one application can appear on any other application, even those with disparate designs or functionality. Importantly, Graffiti users retain control of their data, which is stored on a decentralized infrastructure rather than being held by a specific application.

While the pros and cons of implementing Graffiti at scale remain to be fully explored, the researchers hope this new approach can someday lead to healthier online interactions.

“We’ve shown that you can have a rich social ecosystem where everyone owns their own data and can use whatever applications they want to interact with whoever they want in whatever way they want. And they can have their own experiences without losing connection with the people they want to stay connected with,” says David Karger, professor of EECS and a member of the Computer Science and Artificial Intelligence Laboratory (CSAIL).

Henderson, the lead author, and Karger are joined by MIT Research Scientist David D. Clark on a paper about Graffiti, which will be presented at the ACM Symposium on User Interface Software and Technology.

 

Personalized, integrated applications

With Graffiti, the researchers had two main goals: to lower the barrier to creating personalized social applications and to enable those personalized applications to interoperate without requiring permission from developers.

To make the design process easier, they built a collective back-end infrastructure that all applications access to store and share content. This means developers don’t need to write any complex server code. Instead, designing a Graffiti application is more like making a website using popular tools like Vue.

Developers can also easily introduce new features and new types of content, giving them more freedom and fostering creativity.

“Graffiti is so straightforward that we used it as the infrastructure for the intro to web design class I teach, and students were able to write the front-end very easily to come up with all sorts of applications,” Karger says.

The open, interoperable nature of Graffiti means no one entity has the power to set a moderation policy for the entire platform. Instead, multiple competing and contradictory moderation services can operate, and people can choose the ones they like. 

Graffiti uses the idea of “total reification,” where every action taken in Graffiti, such as liking, sharing, or blocking a post, is represented and stored as its own piece of data. A user can configure their social application to interpret or ignore those data using its own rules.

For instance, if an application is designed so a certain user is a moderator, posts blocked by that user won’t appear in the application. But for an application with different rules where that person isn’t considered a moderator, other users might just see a warning or no flag at all.

“Theia’s system lets each person pick their own moderators, avoiding the one-sized-fits-all approach to moderation taken by the major social platforms,” Karger says.

But at the same time, having no central moderator means there is no one to remove content from the platform that might be offensive or illegal.

“We need to do more research to understand if that is going to provide real, damaging consequences or if the kind of personal moderation we created can provide the protections people need,” he adds.

 

Empowering social media users

The researchers also had to overcome a problem known as context collapse, which conflicts with their goal of interoperation.

For instance, context collapse would occur if a person’s Tinder profile appeared on LinkedIn, or if a post intended for one group, like close friends, would create conflict with another group, such as family members. Context collapse can lead to anxiety and have social repercussions for the user and their different communities.

“We realize that interoperability can sometimes be a bad thing. People have boundaries between different social contexts, and we didn’t want to violate those,” Henderson says.

To avoid context collapse, the researchers designed Graffiti so all content is organized into distinct channels. Channels are flexible and can represent a variety of contexts, such as people, applications, locations, etc.

If a user’s post appears in an application channel but not their personal channel, others using that application will see the post, but those who only follow this user will not.

“Individuals should have the power to choose the audience for whatever they want to say,” Karger adds.

The researchers created multiple Graffiti applications to showcase personalization and interoperability, including a community-specific application for a local concert venue, a text-centric microblogging platform patterned off X, a Wikipedia-like application that enables collective editing, and a real-time messaging app with multiple moderation schemes patterned off WhatsApp and Slack.

“It also leaves room to create so many social applications people haven’t thought of yet. I’m really excited to see what people come up with when they are given full creative freedom,” Henderson says.

In the future, she and her colleagues want to explore additional social applications they could build with Graffiti. They also intend to incorporate tools like graphical editors to simplify the design process. In addition, they want to strengthen Graffiti’s security and privacy.

And while there is still a long way to go before Graffiti could be implemented at scale, the researchers are currently running a user study as they explore the potential positive and negative impacts the system could have on the social media landscape. 

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DOI

10.1145/3746059.3747627 

 

Heart disease risk increases for US immigrants the longer they live in US

Adopting US dietary and lifestyle habits, stress, and barriers to preventative care contribute to increased risk

American College of Cardiology

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Foreign born immigrants to the United States have a lower risk of cardiovascular disease than their U.S.-born counterparts; however, that advantage diminishes the longer they live in the U.S., according to a study presented at the American College of Cardiology’s Middle East 2025 Together with 16th Emirates Cardiac Society Conference taking place October 3-5, 2025, in Dubai, UAE.

“We see that as immigrants are exposed to U.S. dietary and lifestyle habits for prolonged periods of time, it has a negative effect on their heart health,” said Krishna Moparthi, a medical student at John. F. Kennedy University School of Medicine and co-author of the study. “There is a need for targeted public health interventions that address the evolving cardiovascular health risks among immigrant populations and raise awareness on effective prevention strategies.”

Researchers analyzed data from 15,965 adults in the 2011-2016 National Health and Nutrition Examination Survey (NHANES), focusing on cardiovascular disease risk factors including BMI, diabetes, hypertension, dyslipidemia and smoking. Participants were categorized by U.S.-born or foreign-born status and further segmented by how long they have lived in the U.S. (less than 15 years vs. more than 15 years).

They found 86.4% of U.S.-born individuals and 80.1% of foreign-born individuals had at least one CVD risk factor. Foreign-born adults residing in the U.S. for less than 15 years had a lower adjusted prevalence of hypertension (38.3% vs. 48.5%), hypercholesterolemia (27.8% vs. 30%), and smoking (12.5% vs. 19.9%) compared to U.S.-born adults. However, foreign-born individuals living in the U.S. for more than 15 years had an increased prevalence of diabetes (15.4% vs. 11.2%) and hypercholesterolemia (29.4% vs. 30%) compared to their U.S.- born counterparts.

The study also highlighted that foreign-born, non-Hispanic Asian adults had a significantly higher prevalence of diabetes (14.5% vs. 6%) and a lower prevalence of smoking (8.2% vs. 12.5%) compared to U.S.-born, non-Hispanic Asians.

According to researchers, there are several reasons why immigrants’ CVD risk is rising the longer they live in the U.S.

1. Lifestyle acculturation: Over time, immigrants may adopt dietary patterns higher in processed foods, sugars and fats, along with more sedentary behaviors.
2. Stress and socioeconomic factors: Chronic stressors such as discrimination, financial hardship or unstable work conditions can worsen cardiovascular risk.
3. Loss of protective cultural practices: Traditional diets, physical activity habits and community/social support networks that initially confer health benefits may decline with prolonged U.S. residence.
4. Health care access and utilization: Barriers to preventive care can delay diagnosis or treatment, contributing to rising risk factors.

Researchers said clinicians should consider an immigrant’s duration of residence in the U.S. as a meaningful factor in immigrant patients’ risk profiles and emphasize early screenings, culturally sensitive counseling and preventive interventions to preserve heart health.

“Immigrants arrive with a cardiovascular health advantage, but this fades the longer they reside in the U.S. due to acculturation, stress and lifestyle changes,” Moparthi said. “Immigrants should proactively protect their health through screenings and maintaining protective behaviors, while clinicians must recognize duration of U.S. residence as a risk factor and provide culturally tailored prevention strategies.”

For embargoed copies of abstracts or media registration for the conference, contact Katie Glenn at kglenn@acc.org.

The American College of Cardiology (ACC) is a global leader dedicated to transforming cardiovascular care and improving heart health for all. For more than 75 years, the ACC has empowered a community of over 60,000 cardiovascular professionals across more than 140 countries with cutting-edge education and advocacy, rigorous professional credentials, and trusted clinical guidance. From its world-class JACC Journals and NCDR registries to its Accreditation Services, global network of Chapters and Sections, and CardioSmart patient initiatives, the College is committed to creating a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at www.ACC.org or connect on social media at @ACCinTouch.

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