The Healthy Smoker Paradox: Socioeconomic status as a fundamental cause of reversed anemia risk among Yemeni youth

Radfan Saleh Abdullah, Naif Taleb Ali and Mansour Abdelnabi H. Mehdi

PLOS ONE, 2026, vol. 21, issue 4, 1-18

Abstract: Background: While tobacco smoking biologically elevates hemoglobin through chronic hypoxia, this study investigates an unexpected paradoxical reversal in conflict-affected Yemen, testing whether socioeconomic status may override biological pathways in extreme resource-limited settings. Methods: We conducted a multi-center cross-sectional study of 600 Yemeni university students (aged 18–25). Data on smoking, socioeconomic proxies, and hematological parameters were collected. We employed multivariate logistic regression, causal mediation analysis with bootstrapping, and E-value sensitivity analysis. Results: Non-smokers had substantially higher odds of abnormal hemoglobin (adjusted Odds Ratio [aOR] = 11.25, 95% CI: 3.45--36.70, p

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0348146

DOI: 10.1371/journal.pone.0348146

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