{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T23:08:54Z","timestamp":1782428934680,"version":"3.54.5"},"reference-count":48,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiologia"],"abstract":"<jats:p>Background: Robust evidence demonstrates that tobacco use acts as a causal and, therefore, modifiable risk factor for the development of type 2 diabetes mellitus (T2DM). However, its specific population-level impact in Mexico has not yet been quantified. Objective: This study aimed to estimate the population attributable fraction (PAF) of T2DM associated with tobacco use among Mexican adults, utilizing data from the 2021 National Health and Nutrition Survey (ENSANUT). Methods: A nested case\u2013control analysis was conducted within the complex sampling design of the ENSANUT. Adults aged 20 years or older were included. Cases were defined as individuals with a self-reported medical diagnosed T2DM diagnosis; controls were individuals without T2DM. Exposure status was categorized as current person who smokes, former person who smokes, and never person who smokes. A logistic regression model was employed, adjusting for key covariates including age, sex, socioeconomic status, and comorbidities. The PAF was subsequently calculated using the Miettinen formula. Results: The adjusted PAF for T2DM attributable to smoking was 10.1% (95% CI: 4.07\u201314.97). This finding suggests that approximately one in eight T2DM cases could be prevented through the elimination of tobacco use. The association was more pronounced among men and individuals with a history of heavy tobacco use. Conclusion: The estimated PAF for T2DM due to tobacco use underscores the significant contribution of policies established within the WHO Framework Convention on Tobacco Control to the prevention of chronic diseases. The implementation and strengthening of such policies, including increased tobacco taxes, comprehensive smoking bans in public places, on-package warnings, and advertising prohibitions, would prove highly beneficial. These findings show a strong population-level association between tobacco use and T2DM, but causality cannot be established. Future longitudinal studies in Mexico are needed to confirm these results.<\/jats:p>","DOI":"10.3390\/epidemiologia6040084","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T15:30:07Z","timestamp":1765207807000},"page":"84","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Population Attributable Fraction of Tobacco Use and Type 2 Diabetes Mellitus: An Analysis of the ENSANUT 2021"],"prefix":"10.3390","volume":"6","author":[{"given":"Julio Cesar","family":"Campuzano","sequence":"first","affiliation":[{"name":"Investigador en Ciencias M\u00e9dicas, Instituto Nacional de Salud P\u00fablica de M\u00e9xico, Cuernavaca 62100, MOR, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7301-7706","authenticated-orcid":false,"given":"Jorge Martin","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Instituto de Salud P\u00fablica, Pontificia Universidad Javeriana, Bogot\u00e1 110231, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5350-0928","authenticated-orcid":false,"given":"Luz Myriam","family":"Reynales","sequence":"additional","affiliation":[{"name":"Investigador en Ciencias M\u00e9dicas, Instituto Nacional de Salud P\u00fablica de M\u00e9xico, Cuernavaca 62100, MOR, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anaid","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Universidad Latino Americana, Cuernavaca 62290, MOR, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5754-3474","authenticated-orcid":false,"given":"Diana Carolina","family":"Urrego","sequence":"additional","affiliation":[{"name":"Investigadora Organizaci\u00f3n Panamericana de la Salud-OPS, Bogot\u00e1 57-601, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"04054","DOI":"10.7189\/jogh.13.04054","article-title":"Burden of non-communicable diseases and behavioural risk factors in Mexico: Trends and gender observational analysis","volume":"13","author":"Miranda","year":"2023","journal-title":"J. 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