Trends In Smoking Habits Research Articles

Prevention or treatment of bronchial carcinoma: a literature review

Bronchial carcinoma is the second most commonly diagnosed cancer, and is currently the number one cause of cancer death in the UK. Smoking is the major risk factor for the development of bronchial carcinoma and trends in smoking habits are reflected in incidence rates. Poor survival is due in part, to late development of symptoms, and a tendency for the presence of metastatic spread at presentation. This study aims to evaluate the efficacy of current treatments and whether or not prevention strategies should play a more prominent role in the future.

Trends in mortality and mean age at death from lung cancer in Austria (1975–2007)

Objective: To investigate trends in mortality and mean age at death from lung cancer (MADLC) compared to mean age at death from all causes (MAD) over the period 1975 - 2007 in Austria. Results are assessed with respect to secular trends in smoking habits. Methods: MAD and MADLC were computed by year and gender as the expected value of a fitted Weibull distribution. Age-period-cohort effects on lung cancer death rates were estimated by hierarchical Poisson models. Results: In females MADLC was on average about 2 years higher than in males and tended to decrease since the mid 1980s, while after the mid 1990s MADLC in males increased such that the difference between men and women shrank to about half a year in 2007. Females dying from lung cancer lost about 6 years of life during the late 1970s but more than 10 years after 2000, while males lost 2 years in the 1970s and 5 years after 2000. Males demonstrated a decreasing risk with increasing year of birth, with the exception of cohorts born during or immediately after the World Wars that showed peak relative risks (RR). Females did not show pronounced birth cohort effect except for a peak RR for cohorts born during and after World War II. Conclusions: MADLC provides additional information about secular trends in addition to incidence data. The declining trend of MADLC in females and in males up to the mid 1990s points to a change of smoking habits with an earlier onset of smoking in both genders. The subsequent increase in males during the last decade may be attributed to an increasing proportion of quitters because smoking cessation delays onset of lung cancer.

Time trends in smoking habits among Italian young adults

In most developed countries the prevalence of smoking habits is decreasing in men, while in women the prevalence seems to decline in Northern Europe but to increase in the Mediterranean area. The present research aims at assessing time trends in smoking habits in Italy. In the frame of the Italian Study on Asthma in Young Adults (ISAYA) a random sample of the Italian population aged 20-45 years was administered a mailed questionnaire in 9 Italian centers between 1998 and 2000. Cumulative response was 72.7% (18873/25969). Kaplan-Meier survival curves and log-rank test were used to compare probability of remaining a life-time non-smoker across birth cohorts (1953-58, 1959-63, 1964-68, 1969-73, 1974-78). Probability to quit smoking was also evaluated among ever-smokers. Probability to persist as a non-smoker significantly increased across subsequent generations in both sexes. At the age of 20 years this probability amounted to 41.7% (95% CI 39.4-44.0%) in men and 52.7% (50.4-54.9%) in women born between 1953 and 1958, and it increased to 57% (54.8-59.1%) in men and 68.7% (66.6-70.7%) in women born in 1969-73, but no further decline in smoking habits was observed in the next birth cohort (1974-78). Also the probability to quit smoking significantly increased from the 1953-58 birth cohort to the 1969-73 one. Smoking has declined among Italian young adults of both genders. Further efforts are necessary to promote active anti-smoking campaign, especially among adolescents, which are at higher risk of starting to smoke.

Die Veränderung des Rauchverhaltens in Deutschland von 1985 bis 2002

Due to the great impact of smoking on health this study investigates secular trends in smoking habits in Germany between 1985 and 2002. Special emphasis is on social characteristics which are related to the pattern of the smoking habits in the general population. Data sources are four national health surveys, conducted between 1985 and 1998, and three waves of the 'Bertelsmann-Health-Monitor' in 2002 and 2003. Included from these representative cross-sectional surveys are only persons aged 25-69 years. The total number of study participants are 13,079 males and 13,732 females. Independent variables included are schooling, occupational status, household equivalent income, occupational status, family status, community size and a social risk indicator. The analysis shows convergence in the secular trend in smoking behaviour between males and females, with decreasing rates for males and increasing rates for females. Overall, no noteworthy success of preventive measures to reduce smoking in Germany can be seen. The marked social polarisation of smoking which already existed in 1985 continued. In comparison to other European countries there is a great need for enhancing activities regarding prevention of smoking by adults in Germany.

Trends in cigarette smoking in the German centers of the European Prospective Investigation into Cancer and Nutrition (EPIC): the influence of the educational level

Background Several studies in Germany and other European countries have already shown smoking prevalence to be related to education. This study was aimed to investigate time trends in smoking habits in the German cohorts Heidelberg and Potsdam of the European Prospective Investigation into Cancer and Nutrition (EPIC) according to sex, birth cohort, and level of education. Methods Within EPIC, 25,546 and 27,548 participants were recruited in Heidelberg and Potsdam, respectively. Data on smoking were collected by means of a computer-guided interview during the baseline examination between 1994 and 1998. For each birth cohort smoking prevalence and mean number of cigarettes smoked per day at different ages were calculated. Odds ratios and 95% confidence interval for associations between smoking prevalence and educational level were computed by using logistic regression. Results Smoking prevalence was higher among men than among women, with a smaller difference in younger birth cohorts. Between 1950 and 1960, smoking prevalence among women in the Heidelberg cohort rose sharply (from 12.8% to 51.8% in the least educated group). This strong increase was delayed by 10 years in the Potsdam cohort. Men and women in Heidelberg smoked more cigarettes per day than their counterparts in Potsdam, but in both study centers less educated subjects smoked more than subjects with a higher education. Conclusions Smoking patterns in the Potsdam and Heidelberg cohorts are quite similar with respect to prevalence and years of lifetime smoking. Since an increasing difference between smoking prevalence of less and high educated individuals is observable, programs on smoking cessation should especially concentrate on persons of lower educational level.

Why Are Lung Cancer Rate Trends So Different in the United States and United Kingdom?

Over the period 1951-1995, lung cancer rates in men aged 35-74 yr more than doubled in the United States but declined slightly in the United Kingdom. In women, rates rose about sevenfold in the United States but only about threefold in the United Kingdom. To investigate whether these very different trends in lung cancer risk could be explained by smoking habits, trends in smoking were compared in the two countries and a multistage model was used to predict lung cancer rates from detailed data on age of starting and stopping smoking, amount smoked per smoker, and sales-weighted average tar levels. In both countries, there was a similar switch to filter cigarettes, reduction in tar levels and the average age of starting to smoke, and decline in prevalence of smoking in women aged under 50 yr and in men. Although some differences were evident, most notably in older women where prevalence of smoking and consumption per adult has increased more in the United States, these trends do not appear to explain the markedly different trends in lung cancer, evident in both sexes and all age groups. The multistage analyses confirmed these tentative conclusions-the differing trends in smoking in the two countries could not explain the markedly differing trends in lung cancer. Lung cancer trends in the United Kingdom were found to be clearly more favorable than expected on the basis of smoking trends, while trends in the United States were less favorable. In sensitivity analyses, these conclusions were found not to be materially dependent on the precise methods used, including whether tar reduction was or was not assumed to be beneficial. The explanation for these findings must lie in changes over time, differing in the two countries, in aspects of smoking not considered in these analyses and/or in exposure to other risk factors. Evidence relating to a number of possible such smoking variables (including type of tobacco, curing, use of pesticides and additives, and butt length) or other risk factors (including air pollution, radon, asbestos, obesity, and marijuana) is discussed, but no clear explanation of the findings is offered. Further research is urgently needed to investigate the causes of these apparently anomalous trends in lung cancer and in smoking habits. Criticism is also presented of the views recently expressed by the authors of NCI Monograph 13 that tar reduction has been ineffective in lowering lung cancer risk and that trends in lung cancer in the United States fit in well with trends in smoking habits.

Decennial trends of social differentials in smoking habits in Italy.

To present social trends of smoking habits in Italy during the period 1980-1994. Data from five national health surveys (1980, 1983, 1986-1987, 1990-1991, 1994) were analyzed in order to calculate smoking prevalences. Education attained was used as social class indicator. SDPs (prevalence rate standardized on the 1981 Italian population) and PRs (prevalence ratios primary school/degree). Confidence intervals and p-values were calculated as indicators of statistical significance. Among men SDP decreased from 59.5% in 1980 to 37.3% in 1994 and PRs for social classes varied from 1.21 in 1980 to 1.47 in 1994. Corresponding results for women were 17.9% to 20.0% and 0.36 to 0.73. Lower-educated men smoke more than those in higher social categories, and data collected during 1980-1994 in Italy show a tendency to increase such differentials. Among women this pattern was the opposite in 1980, with a tendency to reduce differences over time. Therefore, for both genders data show a progressive disadvantage for the low-educated categories. The greater compliance of better-educated groups with anti-smoking interventions must be taken into account, and should suggest "unequal" interventions that can be more effective among disadvantaged social groups.

Smoking in Italy, 1995.

Patterns and trends in smoking habits are a major determinant of subsequent incidence and mortality for lung cancer, and other tobacco related neoplasms on a population level. Smoking prevalence in Italy was analyzed using data from the 1995 National Multipurpose Survey, conducted by the National Institute of Statistics (ISTAT) and based on a sample of 50,585 subjects (24,497 men and 26,088 women), aged 15 years or over, identified in strata of geographic area and size of the municipality in order to be representative of the general italian population. Data on smoking were obtained through a self-administered questionnaire. Overall, 25.3% of Italians aged 15 years or over (34.1% of males, 17.1% of females) described themselves as current smokers, 20.5% (28.0% of males, 13.5% of females) as ex-smokers, and 54.2% (37.9% of males, 69.4% of females) as never smokers. Heavy current smokers (> or = 15 cigarettes per day) were 15.6% of males and 3.9% of females. Compared to previous surveys, reported smoking prevalence increased, mostly in the youngest age groups (15 to 24 years) in both sexes. However, the increase could be partly or largely attributable to the different modality of data collection (interview in previous surveys, self-administered questionnaire in the present survey), which may have reduced underreporting. The data of the 1995 National Household Survey confirmed previous patterns of smoking in Italy, i.e., a higher smoking prevalence in less educated, southern Italian males, and in more educated, northern Italian females. These figures reflect therefore the importance of the social and cultural correlates of smoking. Moreover, the stability in smoking prevalence over the last few years reflects the absence of any organized and structured intervention on a legislation and public health level on the smoking issue in Italy.

Trends in cigarette smoking habits in The Netherlands in relation to age, gender and educational level 1987-1991

The objective of the study was to obtain information on recent trends in smoking habits in socioeconomic subgroups (gender, age and educational level) in The Netherlands. The data were analysed from the Monitoring Project on Cardiovascular Disease Risk Factors yearly cross-sectional surveys that were performed between 1987 and 1991. Each year a random sample of men and women aged 20–59 years in three towns in The Netherlands was invited to participate in the study. The overall response rate was 50% for men and 57% for women. A total of over 36,000 subjects participated in the study. The age-standardized prevalence of current, former and never smoking was the outcome measure. Data on smoking habits were collected by means of a self-administered questionnaire. The age-standardized smoking prevalence between 1987 and 1991 fell from 41.4 to 38.9% in men (−0.5 percentage points per year and 95% Cl: −1.0 to −0.02) and from 42.0 to 38.2% in women (−0.8 percentage points per year and 95% Cl: −1.3 to −0.3). The prevalence of current smoking decreased in men with low education and in women with low and intermediate/high education. In the 1961–1970 birth cohort of men with intermediate/high education a relatively large increase of 2.8 percentage points (95% Cl: 1.0–4.5) per year was observed. The decrease In smoking prevalence observed between 1987 and 1991 was small compared to the period before 1987. Differences in the magnitude and direction of trends were observed between birth cohorts and educational levels. The results of the study emphasize the need for an approach that is targeted toward specific sociodemographic subgroups.

Smoking and Coronary Artery Disease

This article discusses the specific effects of smoking on the heart and coronary arteries and demonstrates how these effects increase the risk for cardiovascular morbidity and mortality. The conflicting results of various studies concerning the association of smoking and coronary heart disease in older persons are reviewed, and possible explanations for the discrepancy are given. Recent trends in smoking habits in the United States and the effects of these changing trends on cardiovascular mortality are presented. Finally, data are presented that demonstrate the effects of physician-directed cessation programs and the health benefits of smoking cessation in elderly and younger persons.

Trends of smoking habits in northern Italy (1986-1990). The WHO MONICA Project in Area Brianza, Italy. MONICA Area Brianza Research Group.

The trends of age-gender specific prevalence of self-reported smoking habits are presented, observed in two population surveys, performed in 1986-87 and 1989-90 in Area Biranza, a northern Italian industrialized district where a WHO MONICA Centre is located. Methods were internationally standardized to obtain comparable data on two independent random samples, each composed of 1,600 subjects, age-sex stratified and extracted from the 25-64 year old residents. A closed question interview was administered to identify smoking condition (smoker, past-smoker, occasional smoker, never smoker), number of cigarettes consumed per day and attained educational level, categorized in compulsory school and post-compulsory school. Serum thiocyanate was measured as a validation index, using a cutpoint of > 100 mumol l-1 to detect false negatives. Trends in smoking prevalence are analyzed taking into account influences of education in the presence of an anti-smoking policy that was started in Italy toward the end of the eighties. Self-reported data, confirmed by serum thiocyanate, show a consistent decline of smokers among males (from 48 to 41%), more evident in younger age groups. In females, smoking prevalence is stable (23-24%), although thiocyanate levels in the whole samples indicate a slight but significant tendency to decrease. Education demonstrates positive influences against smoking, particularly in younger male classes. In females a crossover effect is observable: in the second survey youngest group, education results protective against smoking; the contrary is true in the older groups. Our data, detailing what was initially recognized in previous Italian surveys, may be useful to specify the directions of future preventive actions.

Assessing the risks of Rn exposure: the influence of cigarette smoking.

The principal hazard associated with exposure to Rn progeny is lung cancer. However, most lung cancer is caused by smoking, which raises a dual problem of deriving Rn-progeny cancer risk estimates from miner populations who, in large part, are smokers and applying these estimates to the general population whose lung cancer risk, in large part, is determined by smoking habits. We examine current risk estimates for Rn-progeny-induced lung cancer using a cohort life table methodology. Estimates of lifetime probability of dying of lung cancer, average loss in life expectancy due to premature lung cancer death, and loss in life expectancy per premature lung cancer death are calculated for the general population for 1969 and 1978, nonsmokers, and smokers. These calculations demonstrate that such risk estimates are affected by smoking, and by trends in smoking habits, in several ways. Major smoking-related factors in this interaction are the proportion of smokers in the mining population used to derive lung cancer risk estimates, the proportion of smokers in the "general" population, and the assumed interaction (additive or multiplicative) between lung cancer risk, Rn-progeny exposure, and smoking history. At this time the data are not sufficient to recommend one particular modeling approach. However, our evaluation demonstrates that broad statements about Rn-progeny lung cancer risk such as "x cancers/10(6) person working level month," while informative, are incomplete without further specification. Any risk assessment must clearly state the population assumed to be at risk and the risk model assumed to be operating. Finally, the caveats appropriate to these assumptions should also be enunciated.

FAMILIAL TRENDS IN LOW BIRTH WEIGHT

The reproductive performance of sisters and sisters-in-law of 185 women who had delivered “light-for-dates” and “premature expulsion” low birth weight infants was studied. Percentile birth weights were compared taking into account length of gestation, fetal sex, and the height, weight, parity, and smoking habits of the mother. Sisters of women who had delivered light-for-dates babies had lighter babies than the general population, their sisters-in-law, or the sisters of women in the premature expulsion group. These other groups, however, had the expected distribution of percentile birth weights. Data on familial trends in smoking habits and unknown gestation are also presented. The results are consistent with the theory that the mother9s own intrauterine experience affects her reproductive performance but could also be explained by shared family learning experience of as yet unidentified microsocial factors related to pregnancy performance.

Familial trends in low birth weight.

The reproductive performance of sisters and sisters-in-law of 185 women who had delivered "light-for-dates" and "premature expulsion" low birth weight infants was studied. Percentile birth weights were compared taking into account length of gestation, fetal sex, and the height, weight, parity, and smoking habits of the mother. Sisters of women who had delivered light-for-dates babies had lighter babies than the general population, their sisters-in-law, or the sisters of women in the premature expulsion group. These other groups, however, had the expected distribution of percentile birth weights. Data on familial trends in smoking habits and unknown gestation are also presented. The results are consistent with the theory that the mother's own intrauterine experience affects her reproductive performance but could also be explained by shared family learning experience of as yet unidentified microsocial factors related to pregnancy performance.

CRITICAL APPRAISAL OF THE ROYAL COLLEGE OF PHYSICIANS' REPORT ON SMOKING AND HEALTH

The claims in the Royal College of Physicians' report Smoking and HealthNow are examined with reference to certain secular changes in mortality for British doctors as compared with those for the general population. The data as presented are found to exhibit geographical and populational restrictions, age restrictions, and unexpected changes in classification of diseases; they also omit a crucial time period and assume certain unverified trends in smoking habits. The statements and claims of the Royal College of Physicians are not supported by the re-examination of certain data included in the report, and by an analysis of pertinent data that were omitted. The appraisal of the full data illustrates the hazards of drawing firm conclusions from secular changes in death-rates, and raises doubts that the Royal College of Physicians' report contains the " strongest evidence there is of the value of giving up cigarettes ".