Female Smoking Prevalence Research Articles

Cigarette smoking prevalence in US counties: 1996-2012

BackgroundCigarette smoking is a leading risk factor for morbidity and premature mortality in the United States, yet information about smoking prevalence and trends is not routinely available below the state level, impeding local-level action.MethodsWe used data on 4.7 million adults age 18 and older from the Behavioral Risk Factor Surveillance System (BRFSS) from 1996 to 2012. We derived cigarette smoking status from self-reported data in the BRFSS and applied validated small area estimation methods to generate estimates of current total cigarette smoking prevalence and current daily cigarette smoking prevalence for 3,127 counties and county equivalents annually from 1996 to 2012. We applied a novel method to correct for bias resulting from the exclusion of the wireless-only population in the BRFSS prior to 2011.ResultsTotal cigarette smoking prevalence varies dramatically between counties, even within states, ranging from 9.9% to 41.5% for males and from 5.8% to 40.8% for females in 2012. Counties in the South, particularly in Kentucky, Tennessee, and West Virginia, as well as those with large Native American populations, have the highest rates of total cigarette smoking, while counties in Utah and other Western states have the lowest. Overall, total cigarette smoking prevalence declined between 1996 and 2012 with a median decline across counties of 0.9% per year for males and 0.6% per year for females, and rates of decline for males and females in some counties exceeded 3% per year. Statistically significant declines were concentrated in a relatively small number of counties, however, and more counties saw statistically significant declines in male cigarette smoking prevalence (39.8% of counties) than in female cigarette smoking prevalence (16.2%). Rates of decline varied by income level: counties in the top quintile in terms of income experienced noticeably faster declines than those in the bottom quintile.ConclusionsCounty-level estimates of cigarette smoking prevalence provide a unique opportunity to assess where prevalence remains high and where progress has been slow. These estimates provide the data needed to better develop and implement strategies at a local and at a state level to further reduce the burden imposed by cigarette smoking.

Convergence of decreasing male and increasing female incidence rates in major tobacco-related cancers in Europe in 1988–2010

IntroductionSmoking prevalence has been declining in men all over Europe, while the trend varies in European regions among women. To study the impact of past smoking prevalence, we present a comprehensive overview of the most recent trends in incidence, during 1988–2010, in 26 countries, of four of the major cancers in the respiratory and upper gastro-intestinal tract associated with tobacco smoking. MethodsData from 47 population-based cancer registries for lung, laryngeal, oral cavity and pharyngeal, and oesophageal cancer cases were obtained from the newly developed data repository within the European Cancer Observatory (http://eco.iarc.fr/). Truncated age-standardised incidence rates (35–74years) by calendar year, average annual percentage change in incidence over 1998–2007 were calculated. Smoking prevalence in selected countries was extracted from the Organisation for Economic Co-operation and Development and the World Health Organization databases. ResultsThere remained great but changing variation in the incidence rates of tobacco-related cancers by European region. Generally, the high rates among men have been declining, while the lower rates among women are increasing, resulting in convergence of the rates. Female lung cancer rates were above male rates in Denmark, Iceland and Sweden (35–64years). In lung and laryngeal cancers, where smoking is the main risk factor, rates were highest in central and eastern Europe, southern Europe and the Baltic countries. Despite a lowering of female smoking prevalence, female incidence rates of lung, laryngeal and oral cavity cancers increased in most parts of Europe, but were stable in the Baltic countries. Mixed trends emerged in oesophageal cancer, probably explained by differing risk factors for the two main histological subtypes. ConclusionsThis data repository offers the opportunity to show the variety of incidence trends by sex among European countries. The diverse patterns of trends reflect varied exposure to risk factors. Given the heavy cancer burden attributed to tobacco and the fact that tobacco use is entirely preventable, tobacco control remains a top priority in Europe. Prevention efforts should be intensified in central and eastern Europe, southern Europe and the Baltic countries.

Abstract P187: Gender Equality and female-to-male Smoking Ratio: Trends in Spain Over the Last 50 Years (1960-2010)

INTRODUCTION Gender empowerment has been associated with higher gender smoking ratio (GSR) and proved to be a strong predictor of the GSR. Our aim is to study how changes in gender equality may be associated with female-to-male smoking ratio trends in Spain over the last 50 years. HYPOTHESIS We hypothesize that greater gender equality will increase female-to-male gender smoking ratio. METHODS Values of the United Nations Development Programme’s Gender Inequality Index (GII) were calculated in 5-year intervals from 1960-2010, using data from the National Institute of Statistics. The GII ranges from 0-1 (1 meaning highest inequality) and contemplates 3 dimensions: reproductive health (measured by maternal mortality ratio and adolescent fertility rate), empowerment (share of parliamentary seats and % of each gender with at least secondary education), and female and male labor force participation rates. Female and male smoking prevalence and female-to-male smoking ratio were measured by retrospective reconstruction of National Health Surveys conducted in 2001, 2003, 2006, 2009 (n=20.426, n=21.358, n=29.478, n=22.188), attending to smoking initiation and cessation dates and birth cohorts. In order to test the association between the GII and GSR over the 5 decades we performed Pearson’s correlation. FINDINGS The GII decreased from 0.65 to 0.09 in Spain in the last 50 years. Higher women’s empowerment (parliamentary representation: from 0% to 36%; attainment of secondary education: from 5% to 63%), higher women’s participation in the labor force (from 19% to 68%), and lower maternal mortality ratio (from 45.36 to 4.11 deaths/100.000 live births), can account for most of the reduction in the GII. The smoking prevalence reconstruction reproduced the model of the epidemic in developed countries. Women born after 1951 had a smoking prevalence pattern similar to men’s, as opposed to women born prior to this date. GSR increased from 0.05 to 0.66, indicating that smoking prevalence of both genders converged in time. A gradient of the GSR by level of education was observed and women with higher education had equal smoking prevalence compared to men since 1990. The relation between the GII and GSR over time resulted inversely proportional (r=-0.99) with decreases in gender inequality relating to higher female-to-male smoking ratio. CONCLUSIONS We found a strong negative correlation between gender inequality and female-to-male smoking ratio. Gender equality has significantly improved in Spain over the last 50 years and this process has been accompanied of differential smoking prevalence patterns by genders, which eventually result in analogous female and male smoking prevalence. Gender sensitive tobacco control measures specifically targeted to women are necessary to prevent female smoking prevalence from rising, especially in the context of social transitions involving women’s development.

The Brazil SimSmoke policy simulation model: the effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation.

Brazil has reduced its smoking rate by about 50% in the last 20 y. During that time period, strong tobacco control policies were implemented. This paper estimates the effect of these stricter policies on smoking prevalence and associated premature mortality, and the effect that additional policies may have. The model was developed using the SimSmoke tobacco control policy model. Using policy, population, and smoking data for Brazil, the model assesses the effect on premature deaths of cigarette taxes, smoke-free air laws, mass media campaigns, marketing restrictions, packaging requirements, cessation treatment programs, and youth access restrictions. We estimate the effect of past policies relative to a counterfactual of policies kept to 1989 levels, and the effect of stricter future policies. Male and female smoking prevalence in Brazil have fallen by about half since 1989, which represents a 46% (lower and upper bounds: 28%-66%) relative reduction compared to the 2010 prevalence under the counterfactual scenario of policies held to 1989 levels. Almost half of that 46% reduction is explained by price increases, 14% by smoke-free air laws, 14% by marketing restrictions, 8% by health warnings, 6% by mass media campaigns, and 10% by cessation treatment programs. As a result of the past policies, a total of almost 420,000 (260,000-715,000) deaths had been averted by 2010, increasing to almost 7 million (4.5 million-10.3 million) deaths projected by 2050. Comparing future implementation of a set of stricter policies to a scenario with 2010 policies held constant, smoking prevalence by 2050 could be reduced by another 39% (29%-54%), and 1.3 million (0.9 million-2.0 million) out of 9 million future premature deaths could be averted. Brazil provides one of the outstanding public health success stories in reducing deaths due to smoking, and serves as a model for other low and middle income nations. However, a set of stricter policies could further reduce smoking and save many additional lives. Please see later in the article for the Editors' Summary.

The Analysis of Tobacco Consumption in Croatia - Are We Successfully Facing the Epidemic?

Tobacco is the largest cause of morbidity and mortality. The aim of this study is to analyse several health and economically related indicators of tobacco consumption: smoking prevalence, standardized death rates (SDRs) from lung cancer and the proportion of GDP spent on tobacco in Croatia and other transitional countries--the Czech Republic, Slovakia, Poland, Hungary, Slovenia, Romania, and Bulgaria. The overall smoking prevalence in Croatia decreased by 5.2% during 1994-2005, more among females (-9.9%) than males (-0.3%). There is no significant difference in the smoking prevalence between Croatia (27.4%) and other countries. However, 33.8% of Croatian males smoked during 2002-2005, more than in Romania and the Czech Republic, and less than in Hungary and Poland. The prevalence of female smoking (21.7%) in Croatia is similar to the female smoking prevalence in Poland, the Czech Republic, and Hungary, but male smoking is predominant in all countries. The proportion of smokers among youth is above 20% and it is the highest in the Czech Republic (29.7%), followed by Hungary (26.7%), Slovenia (24.9%), Croatia (24.1%), and Poland (21.5%). The proportion of smokers among girls is higher than among boys in Slovenia, Hungary, the Czech Republic, and Croatia, contrary to Slovakia, Bulgaria, and Poland where boys smoke slightly more. There is no significant difference between the prevalence of smoking among girls in Croatia and Bulgaria, Poland, the Czech Republic, Hungary, Slovenia, and Slovakia. According to the SDR from lung cancer in males (70.3/100,000), Croatia is ranked high assuming the 3rd place, after Hungary (99.7) and Poland (72.0). With a SDR of 15.9/100,000 for females, Croatia is ranked slightly better--5th place. Tobacco consumption continues to be a major public health problem in transitional countries. Croatia conducted several campaigns and programmes in the past. However, results reveal that current anti-tobacco strategies are ineffective in reducing the smoking prevalence among men and youth. Men do not smoke less than a decade ago and, despite the observed decline among women, increasing trends are observed among teenage girls. Croatia should apply a comprehensive approach that would include raising awareness of health risks, restriction of smoking in public places, higher taxing, implementing stricter bans on advertising and promotion of tobacco as well as supporting smoking cessation. This last measure is believed to bring about some results in the medium term in targeted population groups, provided that it is supported by all health professionals. Otherwise, we may expect progress at the population level in the field of social stigmatization of smoking and wider intolerance to second-hand smoke. The full impact of smoking on the population health is yet to be seen and in the future it will undoubtedly remain one of the major contributors to the poor public health situation in Croatia.

Prevalence of Self-Reported Respiratory Symptoms, Asthma and Chronic Bronchitis in Slum Area of a Rapidly Developing Indian City

Background: Poverty is an important surrogate marker for obstructive airway diseases (OAD). Slum constitutes a habitat wherein various poverty related parameters are perpetually prevalent in the ambience. 1/6th of world population lives in slums yet there is no information regarding their health status in context to asthma and COPD. Aims: We investigated the prevalence of asthma and chronic-bronchitis symptoms and associated risk-factors in slum habitats of Pune city. Methodology: 7062 adult slum-dwellers living in 12 slums of Pune city were cross-sectionally interviewed by local healthcare workers with respiratory health questionnaire which was designed using respiratory symptoms of validated European Community Respiratory Health Survey (ECRHS II) questionnaire and International Union against Tuberculosis and Lung Disease (IUATLD) bronchial symptoms questionnaire. Results: The overall prevalence of selfreported asthma symptoms was 10% (18 - 40 years: 6.5%; >40 years: 13.5%). The overall prevalence of chronic bronchitis was 8.5% [18 - 40 years: 7% (males: 7%, females: 7%); >40 years: 10% (males: 10%, females: 10%)]. Increasing age (p = 0.00), female gender (p = 0.001), unemployment (0.00) current smoking (p = 0.00) and ex-smoking (p = 0.004) emerged as significant risk factor for asthma. While, ex-smoking (p = 0.004) and low-education status (p = 0.00) emerged as significant risk factors for chronic bronchitis. Conclusion: In slums reporting of asthma and chronic-bronchitis symptoms was much higher than what has been reported earlier from India. Asthma was commonly seen in females, old age, unemployed and ever-smokers. While chronic bronchitis was commonly seen in ex-smokers and illiterate subjects. Chronic bronchitis was equally distributed amongst male and females, despite 0% prevalence of smoking in females.

Women and the smoking epidemic: turning the tide

Women and the smoking epidemic: turning the tide

Prevalence and correlates of active and ever-smokers in metropolitan China

This study investigated the prevalence and demographic correlates of active and ever-smokers in Beijing and Shanghai. Using a multi-stage household probability sampling method, 5201 participants aged 18–70 underwent face-to-face interviews using the Composite International Diagnostic Interview. 67.1% and 55.5% of male and 7.1% and 5.5% of female respondents were ever-smokers and active smokers respectively. Quitting was less common by proportion among those no longer married or never-married, middle-aged or working adults. After adjusting for other sociodemographic factors, the oldest age-group (> 54 years) showed a significantly negative association with active smoking while those no longer married had significantly positive association with active smoking, among ever-smokers. Although the high prevalence of male smoking in Beijing and Shanghai was expected, the prevalence of female smoking was significantly higher than those found in previous surveys. This pattern of more female smoking not accompanied by an obvious decrease in male smoking defies the expectation of an orderly transition of smoking patterns and may foreshadow smoking patterns in other parts of China.

Gender, economics and culture: diversity and the international evolution of smoking prevalence

To examine whether the observed diversity between national patterns of smoking prevalence could require modification of the World Health Organization (WHO) linear model for an international 'smoking pandemic' (a worldwide epidemic) to address data from non-western countries. We conducted secondary research using current measures in three publicly available databases: Globalink, the International Labour Organization and the World Bank (all Internet-accessible). The measures we used are the separate percentage data for men and women on: smoking and employment and national income per capita (US$) and percentage growth per annum. Regression analysis showed that women smokers were more frequent in countries with higher national income, but women were less likely to smoke in countries of rapid growth. Men were less likely to smoke in countries with higher national income, but more likely to smoke in countries of rapid growth. Two principle components together explained 62% of all the variance in the international data. The largest factor was positively correlated with the percentage of employed females, the percentage of female smokers and national income per capita, but negatively correlated with the percentage of male smokers and percentage annual. growth. The effect of female employment was not continuous, but above a threshold of 51%, was associated with a higher prevalence of female smoking. The smaller, second factor was only weakly correlated with any smoking variables. In his 1994 model (subsequently adopted by the WHO) Lopez looked at historical trends in 'stages' of smoking prevalence. These have been associated with 'stages' of economic development. We extended this analysis to look at a dynamic change (% annual growth) and a social indicator (employment). Male and female smoking is affected differentially by economic change and by level of income. These are also strongly related to the percentage of women in employment. This has implications for workplace policies on smoking.

Recent trends of cancer in Europe: A combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s

Introduction We present a comprehensive overview of most recent European trends in population-based incidence of, mortality from and relative survival for patients with cancer since the mid 1990s. Methods Data on incidence, mortality and 5-year relative survival from the mid 1990s to early 2000 for the cancers of the oral cavity and pharynx, oesophagus, stomach, colorectum, pancreas, larynx, lung, skin melanoma, breast, cervix, corpus uteri, ovary, prostate, testis, kidney, bladder, and Hodgkin’s disease were obtained from cancer registries from 21 European countries. Estimated annual percentages change in incidence and mortality were calculated. Survival trends were analyzed by calculating the relative difference in 5-year relative survival between 1990–1994 and 2000–2002 using data from EUROCARE-3 and -4. Results Trends in incidence were generally favorable in the more prosperous countries from Northern and Western Europe, except for obesity related cancers. Whereas incidence of and mortality from tobacco-related cancers decreased for males in Northern, Western and Southern Europe, they increased for both sexes in Central Europe and for females nearly everywhere in Europe. Survival rates generally improved, mostly due to better access to specialized diagnostics, staging and treatment. Marked effects of organised or opportunistic screening became visible for breast, prostate and melanoma in the wealthier countries. Mortality trends were generally favourable, except for smoking related cancers. Conclusion Cancer prevention and management in Europe is moving in the right direction. Survival increased and mortality decreased through the combination of earlier detection, better access to care and improved treatment. Still, cancer prevention efforts have much to attain, especially in the domain of female smoking prevalence and the emerging obesity epidemic.

Should adjustment for covariates be used in prevalence estimations?

BackgroundAdjustment for covariates (also called auxiliary variables in survey sampling literature) is commonly applied in health surveys to reduce the variances of the prevalence estimators. In theory, adjusted prevalence estimators are more accurate when variance components are known. In practice, variance components needed to achieve the adjustment are unknown and their sample estimators are used instead. The uncertainty introduced by estimating variance components may overshadow the reduction in the variance of the prevalence estimators due to adjustment. We present empirical guidelines indicating when adjusted prevalence estimators should be considered, using gender adjusted and unadjusted smoking prevalence as an illustration.MethodsWe compare the accuracy of adjusted and unadjusted prevalence estimators via simulation. We simulate simple random samples from hypothetical populations with the proportion of males ranging from 30% to 70%, the smoking prevalence ranging from 15% to 35%, and the ratio of male to female smoking prevalence ranging from 1 to 4. The ranges of gender proportions and smoking prevalences reflect the conditions in 1999–2003 Behavioral Risk Factors Surveillance System (BRFSS) data for Massachusetts. From each population, 10,000 samples are selected and the ratios of the variance of the adjusted prevalence estimators to the variance of the unadjusted (crude) ones are computed and plotted against the proportion of males by population prevalence, as well as by population and sample sizes. The prevalence ratio thresholds, above which adjusted prevalence estimators have smaller variances, are determined graphically.ResultsIn many practical settings, gender adjustment results in less accuracy. Whether or not there is better accuracy with adjustment depends on sample sizes, gender proportions and ratios between male and female prevalences. In populations with equal number of males and females and smoking prevalence of 20%, the adjusted prevalence estimators are more accurate when the ratios of male to female prevalences are above 2.4, 1.8, 1.6, 1.4 and 1.3 for sample sizes of 25, 50, 100, 150 and 200, respectively.ConclusionAdjustment for covariates will not result in more accurate prevalence estimator when ratio of male to female prevalences is close to one, sample size is small and risk factor prevalence is low. For example, when reporting smoking prevalence based on simple random sampling, gender adjustment is recommended only when sample size is greater than 200.

Explaining the convergence of male and female smoking prevalence in Australia

To examine changes in age of tobacco experimentation and progression to daily smoking in men and women between birth cohorts that differ in exposure to public health programmes that aim to discourage smoking. Analysis of national cross-sectional household surveys of smoking patterns, conducted in Australia in 2001 and 2004. SETTING AND PARTICIPANTS Australian adults aged 22 years and over in 2001 and 2004 who responded to the National Drug Strategy Household Survey. Prevalence of tobacco experimentation and progression to daily smoking by age 21, estimated by sex and birth cohort. Odds of tobacco experimentation and progression to daily smoking by age 21 estimated by sex for each birth cohort, with corrections for the effects of 'forward telescoping' in recalling age of use. Sex differences in smoking prevalence are smaller in younger birth cohorts. Tobacco experimentation has increased among women, while progression to daily smoking has decreased among men. Sex differences in smoking experimentation and progression to daily smoking have decreased in younger birth cohorts. However, a significant proportion of younger males and females continue to experiment with tobacco and become daily smokers despite strong public health efforts to discourage smoking. More research is needed to determine why sex differences in smoking behaviour are not evident in younger birth cohorts.

Epidemiology Of Tobacco Smoking Among Adults Population In North-East Nigeria

This study is to determine the epidemiology of tobacco smoking in the adults' population of north-eastern Nigeria. We carried out a cross-sectional survey from June 2007 to July 2007 among 1793 adults in Yola, north-east Nigeria. An adapted WHO recommended interviewer questionnaire was used to collect information from subjects. Out of 1793 respondents, 37.9% had smoked tobacco in their lifetime, 31.9% were current smoker while 6.0% were former smoker of tobacco. The current male and female smoking prevalence was 45.3% and 18.4% respectively. The mean age for starting tobacco smoking was 18.6 ± 5.1years and the mean cigarette consumption was 10 ± 2 sticks per day. Peer pressure was major reason for using tobacco accounting for 26.4 %. The male gender, age group 40-49, alcohol use, Margi, Hausa and Fulani ethnic tribes have significant association with tobacco smoking. The prevalence of tobacco smoking among adults population in north-eastern Nigeria was high.

Is there a relationship between elderly suicide rates and smoking? A cross‐national study

An independent relationship between smoking cigarettes and completed suicides has been reported in several cohort and case-control studies of younger subjects, but this relationship has rarely been examined in the elderly. The relationship between the prevalence of smoking in males and females and suicide rates in males and females in the age-bands 65-74 years and 75 + years was examined using national-level aggregate data from the World Health Organisation and the United Nations Development Programme websites. In addition to univariate analysis, multivariate analysis were conducted to ascertain an independent relationship between the prevalence of smoking and elderly suicide rates. The main findings were: (i) on univariate analysis, the prevalence of smoking in males was positively correlated with suicide rates in males aged 65-74 years and males aged 75 + years, but this relationship was absent in females and (ii) on multivariate analysis there was no independent relationship between the prevalence of smoking in males and suicide rates in males in both the elderly age-bands. There is a case for examination of the relationship between smoking and elderly suicides in individual-level cohort or case-control studies because of the potential methodological difficulties in cross-national studies using national- level aggregate data, paucity of cohort or case-control studies at an individual-level in the elderly, and the observation of an independent relationship between smoking and completed suicides in individual-level cohort and case-control studies in younger age groups.

From Divergence to Convergence: The Sex Differential in Life Expectancy in Canada, 1971–2000*

Over the 20th century sex differences in life expectancy in the industrialized countries have widened in favour of women. Recently, a reversal in the long-term pattern of this differential has been noted in some countries. In Canada, between 1981 and 2000, this differential narrowed by almost two years. Greater than expected improvements in male death rates with respect to heart disease, lung cancer, accidents and violence (excluding suicide) explain a large part of this phenomenon. Change in male and female smoking prevalence correlates strongly with change in sex differences in mortality from heart disease and cancer. The reasons underlying men's greater mortality improvements in regard to accidents and violence are less clear and need further investigation.

Narrowing Sex Differential in Life Expectancy in Canada and Austria: Comparative Analysis

Throughout most of the 20 th century the sex gap in life expectancy in the industrialised countries widened in favour of women. By the early 1980s a reversal in the long-term pattern of this differential occurred in some countries, where it reached a maximum and thereafter has followed a declining trend. It is argued in this study that this development represents an emerging feature of the epidemiological profile of post-industrial societies. I look at Canada and Austria as two representative cases of this phenomenon over roughly three decades, between 1970 and 2001. Decomposition analysis shows that reduced sex differences in life expectancy in the 1980s and 1990s obtained mainly from the effects of reduced sex differences in mortality with respect to heart disease, and secondarily accidents and violence and lung cancer. Heart disease has played a larger role in Canada, whereas differential mortality from accidents and violence has been of greater importance in Austria. A further aspect of the investigation links sex differences in smoking prevalence to sex differences in life expectancy. A model is suggested that incorporates female labour force participation and a measure of gender role traditionalism in society as factors in female smoking prevalence. These variables are also postulated to correlate with change in the sex gap in life expectancy by a time lag of twenty years. It is found that sex differences in smoking prevalence in the past are related to sex difference in life expectancy in the present, and that female labour force participation and gender role traditionalism are also associated with the sex gap in expectation of life. The findings are interpreted in reference to epidemiological transition theory and the literature concerning change in the position of women and sex differences in mortality in high-income nations.

Changes in smoking prevalence in Russia, 1996–2004

Objectives: In Russia, smoking prevalence has historically been high in men and relatively low in women. Female smoking prevalence is predicted to rise but assessment of changes has been limited...

Smoking Prevalence, Smoking-Related Lung Diseases, and National Tobacco Control Legislation

To review statistics on smoking prevalence and to analyze whether the implementation of national tobacco control legislation had an association with the prevalence of smoking, and thereby, with the occurrence of smoking-related lung diseases. Smoking prevalence rates (from 1960 to 2000), lung cancer incidence rates (from 1980 to 2000), and respiratory disease mortality rates (from 1980 to 1998) were obtained from Finnish national surveys and registers. Regression models with 20-year lag times for disease occurrence were applied in the statistical analysis. Daily smoking prevalence among men decreased continuously from 58 to 28% in the period from 1960 to 2000. Between 1965 and 1971, male lung cancer incidence was still on the increase, but from 1971 it decreased from 80 to 32 per 100,000 men. The male respiratory disease mortality rate declined steeply during the study period. From 1960 to 1973, women's smoking prevalence increased from 12 to 20%. At the introduction of the tobacco control bill in 1975, the increase leveled off and female smoking prevalence slightly decreased, but then rose again after 1985 to remain at 20%. Lung cancer incidence among women increased throughout the study period, but the gradient of the curve lowered in the 1980s. National legislative actions were found to be associated with a change in smoking prevalence among women from a linear rise to a plateau. The results of the present study showed a very strong association between reduced smoking prevalence and the occurrence of lung cancer.

Emerging epidemic in a growing industry: cigarette smoking among female micro-electronics workers in Taiwan

Objective. To explore the emerging tobacco epidemic in female workers in the growing micro-electronics industry of Taiwan. Methods. Workers were surveyed regarding their smoking status, sociodemographics and work characteristics. In total, 1950 female employees in two large micro-electronics companies in Taiwan completed the survey. Results. Approximately 9.3% of the female employees were occasional or daily smokers at the time of the survey. The prevalence of smoking was higher in those aged 16–19 years (20.9%), those not married (12.9%), those with a high school education or less (11.7%), those employed by Company A (11.7%), shift workers (14.3%), and those who had been in their present employment for 1 year or less (13.6%). Results of multivariate adjusted logistic regression indicated that younger age, lower level of education, shorter periods of employment with the company and shift working were the important factors in determining cigarette smoking among the study participants. The odds ratio of being a daily smoker was similar to that of being a current smoker. Marital status was the only significant variable when comparing former smokers with current smokers. Conclusions. Smoking prevalence in female workers in the two micro-electronics companies studied was much higher than previous reports have suggested about female smoking prevalence in Taiwan and China. We suggest that smoking is no longer a ‘male problem’ in Taiwan. Future smoking cessation and prevention programmes should target young working women as well as men.

Time trends of lung cancer incidence by histologic types and smoking prevalence in Hong Kong 1983–2000

The gender difference in epidemiology of lung cancer has been postulated to be due to the higher susceptibility of women to risk factors especially tobacco smoking. Alternatively, such difference may also be explained by some unknown gender-specific etiological factors, which can have been masked if both the female and male prevalence of smoking are high. Hong Kong has a low female smoking prevalence rate and therefore the trend of the female incidence of lung cancer is particularly interesting because it can reflect the effects of the non-smoking related risk factors more clearly. The present study examined the trends of incidence rates for the major histologic types and smoking prevalence from 1983 to 2000 in Hong Kong with respect to gender. The prevalence of daily smokers decreased from 39.7% in 1982 to 22% in 2000 in males and from 5.6 to 3.5% in females. The time trends of the lung cancer incidence (overall or with respect to age and histology) were similar for both genders. The overall incidence decreased progressively throughout the study period, attributable to the decrease in squamous cell, small cell and large cell carcinoma. The decline occurred in all age groups but to a greater extent in the younger age groups. The incidence of adenocarcinoma increased until 1988–1990 and then stabilized. The initial increase was restricted to the older age groups. These temporal patterns suggested that the same etiological factors affected both genders to a different extent but manifested as similar changes in the direction of incidence over time. To confirm this hypothesis, further studies were needed to clarify the nature of these etiological factors for the non-smoking related lung cancer cases.