Decline In Smoking Prevalence Research Articles

Impact of tobacco control policies on adolescent smoking: findings from the Global Youth Tobacco Survey in Taiwan

To assess the impact of a set of comprehensive tobacco control policies implemented in Taiwan in 2009, including extensive smoke-free policy, advertisement ban, pictorial warning and price increase, on adolescent smoking prevalence. Five waves of cross-sectional surveys. Taiwan, 2004-11. Nationally representative sample of junior high schools aged 13-15 years, in a biennial survey, total sample size 101,100. Core questionnaire of the Global Youth Tobacco Survey, including ever smoking, 30-day smoking and number of cigarettes smoked. The magnitude of prevalence change before and after the 2009 policy implementation was quantified by adjusted odds ratios estimated by piecewise logistic regression models. The 30-day smoking prevalence demonstrated an upward trend [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.02-1.10] between 2004 and 2008. Significant decline in 30-day smoking prevalence after the 2009 law implementation was observed (OR = 0.84, 95% CI = 0.71-0.99). Those living in non-city areas demonstrated a greater magnitude of change. In addition to changes in prevalence, we observed some delay in the age starting smoking, reduction in smokers who smoke fewer than one cigarette per day, and decrease in smokers who did not buy cigarettes. The decline in smoking prevalence was contributed primarily by the reduction in experimenters. The comprehensive tobacco control programme introduced in Taiwan in 2009 was associated with a reduction in adolescent smoking, particularly among those in earlier stages of smoking and those who resided in non-city areas.

‘Roll-your-own’ cigarette smoking in South Africa between 2007 and 2010

BackgroundThe prevalence of smoking and consumption of cigarettes have decreased in South Africa over the last 20 years. This decrease is a result of comprehensive tobacco control legislation, particularly large cigarette tax increases. However, little attention has been given to the potential use of ‘roll-your-own’ cigarettes as cheaper alternatives, especially among the socio-economically disadvantaged population. This study therefore sought to determine socio-demographic correlates of ‘roll-your-own’ cigarette use among South African adults (2007–2010).MethodsThis secondary data analysis used a merged dataset from two nationally representative samples of 2 907 and 3 112 South African adults (aged ≥16 years) who participated in the 2007 and 2010 annual South African Social Attitude Surveys respectively. The surveys used a face-to-face interviewer-administered questionnaire. The overall response rates were 83.1% for 2007 and 88.9% for 2010. Data elicited included socio-demographic data, current smoking status, type of tobacco products used, past quit attempts and self-efficacy in quitting. Data analysis included chi-square statistics and multi-variable adjusted logistic regression analysis.ResultsOf the 1 296 current smokers in this study, 24.1% (n = 306) reported using roll-your-own cigarettes. Some of whom also smoked factory-made cigarettes. Roll-your-own cigarette smoking was most common among black Africans and was more common among male smokers than among female smokers (27% vs 15.8%; p < 0.01). Compared to smokers who exclusively used factory-made cigarettes, roll-your-own cigarette smokers were less confident that they could quit, more likely to be less educated, and more likely to reside in rural areas. The odds of use of roll-your-own cigarette were significantly higher in 2010 than in 2007 (OR = 1.24; 95% CI: 1.07-1.44).ConclusionsDespite an aggregate decline in smoking prevalence, roll-your-own cigarette smoking has increased and is particularly common among smokers in the lower socio-economic group. The findings also suggest the need for a more intensive treatment intervention to increase self-efficacy to quit among roll-your-own cigarette smokers.

Smoking Among Asian Americans

New York City (NYC) has experienced significant decline in smoking prevalence since its antismoking campaign; however, the rates among NYC's Asian communities have persisted since 2002. Using combined data from the REACH US Risk Factor Survey (2009-2011), this article examined ethnic- and gender-specific smoking behaviors and the effects of acculturation and location of residence on cigarette smoking behavior among Chinese, Korean, Asian Indians, and other Asian Americans. Results indicated that current smoking prevalence was higher for men than women among all four groups. Korean men and women had the highest current smoking rates whereas Indians had the lowest among the four subgroups. Asian American women reporting speaking only English at home had higher current smoking prevalence, but this was not observed for men. Living in Sunset Park, an emerging Asian ethnic enclave, was associated with higher odds of smoking than living in other locations in NYC. In conclusion, smoking prevalence varied across gender and ethnic subgroups among Asian Americans in NYC. A "one-size-fits-all" type of intervention strategy for "pan-Asians" could not be effective. Community-based culturally appropriate and gender-specific interventions for smoking cessation might be an option for Asian Americans residing in linguistically isolated ethnic enclaves.

Large-scale unassisted smoking cessation over 50 years: lessons from history for endgame planning in tobacco control

In the 50 years since the twentieth century's smoking epidemic began to decline from the beginning of the 1960s, hundreds of millions of smokers around the world have stopped smoking...

Sharp changes in tobacco products affordability and the dynamics of smoking prevalence in various social and income groups in Ukraine in 2008-2012.

BackgroundTo curb the tobacco epidemic, successful implementation of tobacco control measures should take into account how specific demographic groups react to particular policies. In 2005–2010, Ukraine experienced a sharp decline in smoking prevalence. In 2008–2010, several excise tax hikes combined with the economic recession resulted in a sharp reduction of tobacco product affordability, but in 2011–2012 tax increases were rather moderate. The aim of the current research was to investigate how smoking prevalence in various gender, social and income groups in Ukraine changed in response to differing tobacco taxation policies in 2008–2012.MethodsThe State Statistics Service of Ukraine annual household surveys among the population aged 12 years and older, which include questions about smoking, were used. The aggregate data from the annual household surveys datasets of 2008–2012 were analyzed.ResultsThe decline in general smoking prevalence was much steeper in 2008–2010 – 3.2 percentage points in two years, while in two subsequent years it constituted only 0.6 percentage points. Smoking prevalence declined in all age, social, and income groups in 2008–2010. However, in 2011–2012 smoking prevalence continued to decline mainly among young and poor people, while some older and more affluent smokers apparently relapsed to smoking.ConclusionsShort-term and long-term price responsiveness of tobacco demand by socioeconomic status of population groups in low--and middle--income countries like Ukraine could be rather different for poor and more affluent people. Tobacco excise tax hikes have great potential in reducing smoking prevalence, especially in young and less affluent people, however they should also be supported by effective and available smoking cessation services.

Estimating Benefits of Past, Current, and Future Reductions in Smoking Rates Using a Comprehensive Model With Competing Causes of Death

IntroductionDespite years of declining smoking prevalence, tobacco use is still the leading preventable contributor to illness and death in the United States, and the effect of past tobacco-use control efforts has not fully translated into improvements in health outcomes. The objective of this study was to use a life course model with multiple competing causes of death to elucidate the ongoing benefits of tobacco-use control efforts on US death rates.MethodsWe used a continuous-time life course simulation model for the US population. We modeled smoking initiation and cessation and 20 leading causes of death as competing risks over the life span, with the risk of death for each cause dependent on past and current smoking status. Risk parameters were estimated using data from the National Health Interview Survey that were linked to follow-up mortality data.ResultsUp to 14% (9% for men, 14% for women) of the total gain in life expectancy since 1960 was due to tobacco-use control efforts. Past efforts are expected to further increase life expectancy by 0.9 years for women and 1.3 years for men. Additional reduction in smoking prevalence may eventually yield an average 3.4-year increase in life expectancy in the United States. Coronary heart disease is expected to increase as a share of total deaths.ConclusionsA dynamic individual-level model with multiple causes of death supports assessment of the delayed benefits of improved tobacco-use control efforts. We show that past smoking reduction efforts will translate into further increases in life expectancy in the coming years. Smoking will remain a major contributor to preventable illness and death, worthy of continued interventions.

Smoking behavior of Mexicans: patterns by birth-cohort, gender, and education

Little is known about historical smoking patterns in Mexico. Policy makers must rely on imprecise predictions of human or fiscal burdens from smoking-related diseases. In this paper we document intergenerational patterns of smoking, project them for future cohorts, and discuss those patterns in the context of Mexico's impressive economic growth. We use retrospectively collected information to generate life-course smoking prevalence rates of five birth-cohorts, by gender and education. With dynamic panel data methods, we regress smoking rates on indicators of economic development. Smoking is most prevalent among men and the highly educated. Smoking rates peaked in the 1980s and have since decreased, slowly on average, and fastest among the highly educated. Development significantly contributed to this decline; a 1% increase in development is associated with an average decline in smoking prevalence of 0.02 and 0.07 percentage points for women and men, respectively. Mexico's development may have triggered forces that decrease smoking, such as the spread of health information. Although smoking rates are falling, projections suggest that they will be persistently high for several future generations.

Does Level of Tobacco Control Relate to Smoking Prevalence in Canada: A National Survey of Public Health Organizations

To describe levels of tobacco control “effort” in public health organizations across provinces, and to test the hypothesis that “effort” is associated with the prevalence of daily smoking. Data were drawn from a national survey (Oct 2004-Apr 2005) of all public health organizations engaged in chronic disease prevention in Canada in 2004. We investigated the association between “effort” and decline in smoking prevalence (CTUMS, 1 999-2009) across provinces in an écologie study design. “Effort” was assessed using two indicators: percent of public health organizations engaged in tobacco control, and mean level of involvement in engaged organizations. Of 216 organizations, 88% had undertaken tobacco control activities in the three years prior to data collection and were categorized as “engaged". Level of involvement in tobacco control was highest in community-at-large settings; and it was generally higher for population- than for individual-level strategies. Nova Scotia reported higher levels of involvement than other provinces. There was substantial variability in “effort” across provinces. High-"effort” provinces (BC, NS, ON, QC) experienced, on average, improvement in the “change in smoking prevalence” score (1999 to 2009). The findings provide evidence that provincial tobacco control “effort” relates to declines in smoking prevalence. Given that smoking remains a critical public health issue, the kinds of data reported herein are needed to inform the debate on how best to invest in tobacco control infrastructure to combat the most important public health threat of our times.

Does level of tobacco control relate to smoking prevalence in Canada: a national survey of public health organizations.

To describe levels of tobacco control "effort" in public health organizations across provinces, and to test the hypothesis that "effort" is associated with the prevalence of daily smoking. Data were drawn from a national survey (Oct 2004-Apr 2005) of all public health organizations engaged in chronic disease prevention in Canada in 2004. We investigated the association between "effort" and decline in smoking prevalence (CTUMS, 1999-2009) across provinces in an ecologic study design. "Effort" was assessed using two indicators: percent of public health organizations engaged in tobacco control, and mean level of involvement in engaged organizations. Of 216 organizations, 88% had undertaken tobacco control activities in the three years prior to data collection and were categorized as "engaged". Level of involvement in tobacco control was highest in community-at-large settings; and it was generally higher for population- than for individual-level strategies. Nova Scotia reported higher levels of involvement than other provinces. There was substantial variability in "effort" across provinces. High-"effort" provinces (BC, NS, ON, QC) experienced, on average, improvement in the "change in smoking prevalence" score (1999 to 2009). The findings provide evidence that provincial tobacco control "effort" relates to declines in smoking prevalence. Given that smoking remains a critical public health issue, the kinds of data reported herein are needed to inform the debate on how best to invest in tobacco control infrastructure to combat the most important public health threat of our times.

Smoking prevalence and perspectives on smoking on campus by employees in Australian teaching hospitals

Cigarette smoking prevalence has been declining over decades in Western countries especially in higher socioeconomic groups. Employees of Australian hospitals span the socioeconomic spectrum, but there are few data on smoking prevalence from these workplaces. Because smoking is a health hazard, some argue that it should be banned on hospital premises, but employees' opinions appear not to have been widely canvassed. Cigarette smoking is a particular problem in hospitals because of the need for prolonged abstinence by immobile patients and the stressors that accompany life-and-death events for patients and/or relatives. The Queen Elizabeth Hospital has had a Stop Smoking Service for >10 years, but how smoking prevalence has changed and how it compares with similar hospitals is unknown. The aims of this study were (i) to determine smoking prevalence by employees of The Queen Elizabeth Hospital and to compare this with employees of other hospitals and (ii) to ascertain employees' perspectives regarding smoking on hospital grounds. Single page questionnaires were forwarded to employees of four South Australian/Northern Territory hospitals enquiring about smoking status, employment category, views about smoking on hospital premises, etc. Responses were voluntary. Response rates were 39-59%. Smoking prevalence has steadily declined at The Queen Elizabeth Hospital and is now 8.4%. Prevalence at comparator hospitals was approximately double this value. Most staff thought the visibility of smoking was problematic, but support for providing smoking area/s was greater than for a hospital-wide ban. The ongoing decline in smoking prevalence at The Queen Elizabeth Hospital is probably the result of the Staff Stop Smoking Service.

A snapshot of the striking decrease in cigarette smoking prevalence in Brazil between 1989 and 2008

ObjectiveTo evaluate the differences in cigarette smoking prevalence rates in Brazil between 1989 and 2008. MethodologyWe calculated absolute and relative differences in smoking prevalences, overall and stratified by gender, age, place of residence, educational level and birth cohort. Data were obtained from random samples from two National Household Surveys (1989,n=39,969; 2008,n=38,461). GLM models were specified to obtain estimates and assess whether differences in proportions of smokers differed by categories of the stratification variables. ResultsAdjusted absolute and relative differences in smoking prevalence rates between 1989 and 2008 were, respectively, −12.4% and −41.0%. Individuals aged 15–34years and those with 9 or more years of education presented larger relative declines than their counterparts (ps≤0.001). After stratification by birth cohort, men presented larger reductions than women, only in the absolute scale (ps≤0.001), with the exception of the youngest birth cohort (i.e.,1965–1974). ConclusionsIn Brazil, several tobacco control measures have been adopted since 1986, in particular increasing taxation of tobacco products and strong health warnings, which may have contributed to the marked decline in smoking prevalence. It is important to understand the evolution of the tobacco epidemic to propose new actions to prevent initiation and encourage cessation among those who started/continued smoking.

Current and future avoidable cost of smoking – Estimates for Sweden 2007

Objective To estimate current and future avoidable smoking-attributable costs in Sweden for the year 2007. Design Disease specific smoking-attributable proportions were calculated for Swedish smoking patterns and applied to estimate costs for smoking-related diseases based on data from public registers. Avoidable future effects of smoking were calculated employing a Markov simulation model. Results The estimated total cost in 2007 was USD 1.6 billion, or USD 181 per capita. Healthcare (direct) cost accounted for 30% of the total cost. The number of deaths was 97 per 100,000 inhabitants (79 in 2001); the number of years of potential life lost 1,227 per 100,000 inhabitants (1012 in 2001); and the number of years of potential productive life lost 226 (185 in 2001) per 100,000 inhabitants. Avoidable future lifetime costs, per 100,000 inhabitants, amounted to USD 19 million (healthcare), 14,000 years of potential life lost, corresponding to a present value of USD 158 million. Total avoidable cost of current smoking amounted to USD 16 billion. Conclusion In spite of declining smoking-prevalence rates during the last 30 years, smoking-attributable deaths increased between 2001 and 2007. The number of life years lost per death decreased somewhat, indicating that the age distribution of those dying shifted further towards older age. Simulations indicate that smoking-cessation among young smokers yields considerable more benefits each year than smoking-cessation among older smokers. The health benefits that accrued in 2007, as a result of declining smoking prevalence since 1980, correspond to more than the total cost of smoking in that year.

P1-350 A snapshot of the striking decrease in cigarette smoking prevalence in Brazil between 1989 and 2008

ObjectiveTo evaluate the differences in cigarette smoking prevalence in Brazil between 1989 and 2008.MethodologyWe compared absolute and relative differences in smoking prevalence, overall and stratified by selected socio-demographic variables and...

Update in lung cancer and oncological disorders 2010.

Lung cancer remains the leading cause of cancer mortality in the world, with 157,000 deaths expected in the United States in 2010 (1). Despite the large death toll, there are reasons to be cautiously optimistic for a future with fewer lung cancer deaths. First, incidence and death rates are declining in U.S. men and are plateauing in women, following trends of declining smoking prevalence rates over the past 30 years (2). Second, recent studies of lung cancer screening, staging, drug development, and molecular diagnostics have demonstrated important advances that promise to decrease death rates over time (3). Third, epidemiological and bench science research have provided important insights into lung cancer susceptibility and pathogenesis. Recent advances in clinical and bench science directed toward diagnostics and therapy have had significant and often dramatic impacts on patient outcomes. These developments suggest that smoking prevention, chest computed tomography (CT) screening, and personalized approaches to treating lung cancer will significantly reduce lung cancer mortality. In this update, we present recent research findings and highlight future directions for lung cancer research and therapy.

Changes in smoking prevalence among U.S. adults by state and region: Estimates from the Tobacco Use Supplement to the Current Population Survey, 1992-2007.

BackgroundTobacco control policies at the state level have been a critical impetus for reduction in smoking prevalence. We examine the association between recent changes in smoking prevalence and state-specific tobacco control policies and activities in the entire U.S.MethodsWe analyzed the 1992-93, 1998-99, and 2006-07 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) by state and two indices of state tobacco control policies or activities [initial outcome index (IOI) and the strength of tobacco control (SOTC) index] measured in 1998-1999. The IOI reflects cigarette excise taxes and indoor air legislation, whereas the SOTC reflects tobacco control program resources and capacity. Pearson Correlation coefficient between the proportionate change in smoking prevalence from 1992-93 to 2006-07 and indices of tobacco control activities or programs was the main outcome measure.ResultsSmoking prevalence decreased from 1992-93 to 2006-07 in both men and women in all states except Wyoming, where no reduction was observed among men, and only a 6.9% relative reduction among women. The percentage reductions in smoking in men and women respectively were the largest in the West (average decrease of 28.5% and 33.3%) and the smallest in the Midwest (18.6% and 20.3%), although there were notable exceptions to this pattern. The decline in smoking prevalence by state was correlated with the state's IOI in both women and men (r = -0.49, p < 0.001; r = -0.31, p = 0.03; respectively) and with state's SOTC index in women(r = -0.30, p = 0.03 0), but not men (r = -0.21, p = 0.14).ConclusionState level policies on cigarette excise taxes and indoor air legislation correlate strongly with reductions in smoking prevalence since 1992. Strengthening and systematically implementing these policies could greatly accelerate further reductions in smoking.

Effect of Smoke-Free Legislation on Adult Smoking Behaviour in England in the 18 Months following Implementation

BackgroundComprehensive smoke-free legislation covering all enclosed public places and workplaces was implemented in England on 1 July 2007. This study examines the impact of this legislation on smoking prevalence, number of cigarettes smoked and location of smoking, controlling for secular trends through the end of 2008.Method and FindingsRepeat cross sectional survey using nationally representative data from the Health Survey for England (HSE). In total there are 54,333 respondents from 2003–2008. Logit and linear regression models were used to examine the effect of the legislation on smoking prevalence and the number of cigarettes smoked daily among continuing smokers which took the underlying trend into account. Our finding suggest that smoking prevalence (current smoker) decreased from 25% in 2003 to 21% in 2008 (AOR = 0.96 per year, 95% CI = 0.95–0.98, P<0.01) and the mean number of cigarettes consumed daily by smokers decreased from 14.1 in 2003 to 13.1 in 2008 (coefficient for time trend = −0.28±0.06 SE cig/day per year, P<0.01). After adjusting for these trends the introduction of smoke-free legislation was not associated with additional reductions in smoking prevalence (AOR = 1.02, 95% CI = 0.94–1.11, P = 0.596) or daily cigarette use in smokers (0.42±0.28 SE; P = 0.142). The percentage of respondents reporting smoking ‘at work’ and ‘inside pubs or bars’ decreased significantly from 14% to 2% (p<0.001) and from 34% to 2% (p<0.001), respectively, after the legislation. The percentage reporting smoking ‘inside restaurants, cafes, or canteens’ decreased significantly from 9% to 1% (p<0.001) and ‘inside their home’ decreased significantly from 65% to 55% (p<0.01).ConclusionThere is widespread compliance with the smoke-free legislation in England, which has led to large drops in indoor smoking in all venues, including at home. Declines in smoking prevalence and consumption continued along existing trends; they did not accelerate during the 18 months immediately following implementation.

Does the introduction of comprehensive smoke‐free legislation lead to a decrease in population smoking prevalence?

To investigate changes in population smoking prevalence in jurisdictions which have implemented comprehensive smoke-free legislation, taking into account long-term trends in smoking behaviour. Interrupted time series analysis of population-level survey data using segmented regression. Twenty-one countries, American states or Canadian provinces which have implemented comprehensive smoke-free legislation. Respondents sampled in large representative surveys of smoking prevalence. For each jurisdiction, segmented regression models quantify any upwards or downwards trend in smoking prevalence prior to the introduction of smoke-free legislation, any immediate change in the level of smoking prevalence at the time smoke-free legislation was introduced, and any change in the trend in smoking prevalence post-legislation compared to the pre-legislation period. In all but three locations there was a statistically significant decline in smoking prevalence prior to the introduction of smoke-free legislation. In two locations, Washington and the Republic of Ireland, there was an immediate decline in the level of smoking prevalence at the introduction of legislation. In six American states there was a significant change in the rate of decline in smoking prevalence, with smoking prevalence declining more steeply in the post-legislation period compared to the pre-legislation period. No change in the level or trend of population smoking prevalence was seen in 13 of the 21 locations studied. The introduction of comprehensive smoke-free legislation has increased the rate at which smoking prevalence was declining in some locations, but in the majority of jurisdictions had no measureable impact on existing trends in smoking prevalence.

Schooling and smoking among the baby boomers – An evaluation of the impact of educational expansion in France

Post-war expansion of education in France transformed the distribution of schooling for the cohorts born between the 1940s and the 1970s. However, throughout this expansion the proportion with the highest levels of qualifications remained stable, providing a natural control group. We evaluate the impact of schooling on smoking, for the beneficiaries of the post-war expansion, by comparing changes in their outcomes across birth cohorts with changes within the control group. We uncover robust evidence that educational expansion contributed to a decline in smoking prevalence of 2.9 points of percentage for men and 3.2 points for women at the turn of the 21st century. Our results also suggest that the persistence of the schooling-smoking gradient is better explained by differences in the education-related opportunity costs of smoking than by differences in information about smoking dangers.

Women and the smoking epidemic: turning the tide

Women and the smoking epidemic: turning the tide

Is There Evidence of ‘Hardening’ Among Australian Smokers Between 1997 and 2007? Analyses of the Australian National Surveys of Mental Health and Well-Being

To use data from the 1997 and 2007 National Surveys of Mental Health and Well-Being (NSMHWB) to assess whether Australian smokers in 2007 have higher rates of mental distress and social disadvantage than smokers in 1997. We compared symptoms of mental distress and social disadvantage in Australian smokers in the 1997 and 2007 National Surveys of Mental Health and Well-Being (N = 10 373 in 1997 and N = 8135 in 2007). Both surveys used multistage probability samples of Australians living in private dwellings. Participants were classified into smokers and non-smokers (which included former and never smokers). We used the Kessler 10 (K10) symptom score to classify smokers into three levels of psychological distress (low, medium or high) and socioeconomic disadvantage was measured using an area-based index of relative disadvantage converted into quintiles. We used logistic regressions to: (i) examine associations between smoking status (smoker/non-smoker) and psychological distress and socioeconomic disadvantage in 1997 and 2007 surveys; and (ii) to test whether the prevalence of psychological distress and social disadvantage among smokers increased between 1997 and 2007. Psychological distress and social disadvantage were more common among smokers than non-smokers in both surveys but there was no evidence that the prevalence of psychological distress or social disadvantage was more common among smokers in 2007 than in 1997. We find no evidence that the declining smoking prevalence in Australia (over the last decade) has been accompanied by a 'hardening' of continuing smokers in terms of rates of mental disorders and socioeconomic disadvantage.