Decennial trends of social differences in smoking habits in Italy: a 30-year update

A preliminary study: MUC5B promoter polymorphism and its association with IPF

Background

The (T) allele of MUC5B gene is strongly correlated with idiopathic pulmonary fibrosis (IPF) and interstitial lung diseases (ILD) related to autoimmune conditions in Caucasians, but no data is available regarding this polymorphism in the Egyptian patients.

Results

This study is an observational cross-sectional study; the percentage of the (T) allele of MUC5B gene promoter in normal Egyptian persons in this study was 20%. This polymorphism is strongly related with risk for development of UIP/IPF in Egyptian patients compared to the other 2 groups (P value < 0.001). The MUC5B polymorphism has no role for developing interstitial lung disease in autoimmune diseases.

Conclusions

This study showed the potential role of MUC5B promoter polymorphism in IPF patients. Further multicentric studies are essential to be conducted deploying larger cohorts and different ethnic populations for further evaluation of these polymorphisms correlation.

Occupational health check-ups and health-promoting programs and asthma

Background

The focus in occupational health check-ups is in work and health, but they offer also a possibility to assess health behavior and give guidance e.g. on weight control. We wanted to study whether having occupational health checks-up, receiving physicians’ advice to change health behavior or participation in health promotion programs had an effect on obesity in a five-year follow-up from 1998 to 2003 in asthmatic and non-asthmatic workers.

Methods

Altogether 23,220 individuals aged 20–54 years were picked up from a randomized Finnish population sample. Univariate and multivariate logistic regression analysis was used to calculate the risk for obesity in 2003. The variables used in the modelling were gender, age, smoking, asthma, depression, and physical workload.

Results

Both asthmatic and non-asthmatic workers gained weight during the follow-up. Of the asthmatics 48 and 47% of the non-asthmatics had occupational health-check-up in the last 5 years. Of the asthmatics 18 and 14% of the non-asthmatics had received physician’s advice to change their health behavior (p < 0.001). Associated factors for obesity (BMI > 30) in 2003 were gender (men OR 1.19), older age (OR 1.25), smoking (OR 1.07) or depression (OR 1.44).

Conclusions

Results show that having occupational health checks-up or receiving physicians’ advice to change health behavior or participation in health promotion programs did not stop gain of weight during a five-year follow-up. Asthmatic workers did not differ from non-asthmatics. Male gender, older age, smoking, and depression were associated with obesity but not the physical workload.

Educational inequalities in the prevalence and outcomes of diabetes in the Emilian Longitudinal Study

BACKGROUND AND AIM

Studies carried out in Italy in the last decades reported an effect modification in the association between socioeconomic position and diabetes outcomes, and the disease integrated care approach has been suggested as an explanatory factor. Whether this is true in Emilia-Romagna region in recent years is unknown and the aim of this study is to describe the role of educational level both on diabetes prevalence and health outcomes among the adult population with and without diabetes enrolled in the Emilian Longitudinal Study.

METHODS AND RESULTS

Inequalities in diabetes prevalence were evaluated through standardised estimates and prevalence ratios by educational level and inequalities in outcomes through standardised hospitalisation and mortality ratios and rate ratios by educational level. The lower the education the greater the diabetes prevalence; such differences were larger among women and younger age groups. Diabetes conferred a higher risk of hospitalisation and mortality; those outcomes also presented a social gradient with the less educated bearing the higher risk. However, educational differences were slightly stronger among the disease-free subjects, especially in the case of mortality. In both genders, inequalities tended to disappear with age.

CONCLUSION

This study confirms that diabetes increases the risk of unfavourable outcomes, but does not increase social inequalities in outcomes as might be expected. Similarly to what has been previously shown, it is likely that the protective effect of diabetes on the negative health effects of the low social position is attributable to the disease integrated care approach.

Passive Smoking Indicators in Italy: Does the Gross Domestic Product Matter?

Background: The aim of this study is to analyse the correlation between regional values of Gross Domestic Product (GDP) and passive smoking in Italy. Methods: The outcome measures were smoking ban respect in public places, workplaces and at home, derived from the PASSI surveillance for the period 2011–2017. The explanatory variable was GDP per capita. The statistical analysis was carried out using bivariate and linear regression analyses, taking into consideration two different periods, Years 2011–2014 and 2014–2017. Results: GDP is showed to be positively correlated with smoking ban respect in public places (r = 0.779 p < 0.001; r = 0.723 p < 0.001 in the two periods, respectively), as well as smoking ban respect in the workplace (r = 0.662 p = 0.001; r = 0.603 p = 0.004) and no smoking at home adherence (r = 0.424 p = 0.056; r = 0.362 p = 0.107). In multiple linear regression GDP is significantly associated to smoking ban respect in public places (adjusted β = 0.730 p < 0.001; β = 0.698 p < 0.001 in the two periods, respectively), smoking ban in workplaces (adjusted β = 0.525 p = 0.020; β = 0.570 p = 0.009) and no smoking at home (adjusted β = 0.332 p = 0.070; β = 0.362 p = 0.052). Conclusions: Smoking ban is more respected in Regions with higher GDP. For a better health promotion, systematic vigilance and sanctions should be maintained and strengthened, particularly in regions with low compliance with smoking bans.

Quit attempts and smoking cessation in Italian adults (25-64 years): factors associated with attempts and successes

Background

Over the past 50 years there was a substantial decrease in the prevalence of smoking in Italy. The objective of this work is to describe attempts to quit and cessation success in Italian smokers.

Methods

A surveillance on health-related behaviors (PASSI) was conducted in 2007-13 on a sample of 203 610 Italian adults 25-64 years of age. An analysis of smokers' characteristics and behaviors was performed, focusing on attempts to quit and quit success. Data from national surveys (ISTAT) from 1983 to 2013 (Italian adults, 25-64 years of age, 1983: 46 634; 1987: 40 915; 1990: 36 622; 2000: 77 531; 2005: 71 032; 2013: 64 205) were used to explore if a cessation trend in Italy exists.

Results

Smokers who quit in the previous year and were still abstinent when interviewed increased from 1990 to 2013. In the years 2011-13, 38% of people who had smoked in the last 12 months reported at least a quit attempt during the same period and 7% were still abstinent when interviewed. An association of successful recent quit attempts with higher educational level, absence of economic difficulties and younger age was found. In the years 2007-13, the great majority tried to stop unaided. Having received assistance from a cessation program did not increase the probability of enduring abstinence.

Conclusions

In Italy interventions to drive more smokers to quit should be focused in particular on disadvantaged groups. Initiatives have to be studied not only to incentive more smokers to try to quit, but also to maintain abstinence over time.

Social characteristics associated with disparities in smoking rates in Israel

BACKGROUND

Cigarette smoking is a major cause of health disparities. We aimed to determine social characteristics associated with smoking status and age at smoking initiation in the ethnically-diverse population of Israel.

METHODS

This is a cross-sectional survey, based on data collected during 2010 by the Israel Bureau of Statistics, in a representative nationwide sample of 7,524 adults (≥20 years). Information collected by personal interviews included a broad set of demographic and socio-economic characteristics and detailed information on smoking habits. Associations between social characteristics and smoking habits were tested in multivariable regression models.

RESULTS

Current smoking was more frequent among men than among women (30.9 % vs. 16.8 %; p < 0.0001). In multivariable regression analysis, the association of some social characteristics with smoking status differed by gender. Lower socioeconomic status (reflected by higher rate of unemployment, lower income, possession of fewer material assets, difficulty to meet living expenses) and lower educational level were significantly associated with current smoking among men but not among women. Family status other than being married was associated with higher likelihood of being a current smoker, while being traditional or observant was associated with a lower likelihood of ever smoking among both gender groups. Arab minority men and male immigrants from the former Soviet Union countries were more frequently current smokers than Israeli-born Jewish men [adjusted odds ratio (95 % confidence interval): 1.53 (1.22, 1.93) and 1.37 (1.01-1.87), respectively]. Compared to Israeli-born men, the age at smoking initiation was younger among male immigrants, and older among Arab minority men [adjusted hazard ratio (95 % confidence interval): 1.360 (1.165-1.586), and 0.849 (0.749-0.962), respectively]. While the prevalence of current smoking was lower in younger birth cohorts, the age at smoking initiation among ever-smokers declined as well.

CONCLUSIONS

Among several subgroups within the Israeli population the smoking uptake is high, e.g. Arab men, men who are less affluent, who have lower educational level, and male immigrants. These subgroups should be prioritized for intervention to reduce the burden of smoking. To be effective, gender, cultural background and socioeconomic characteristics should be considered in the design and implementation of culturally-congruent tobacco control and smoking prevention and cessation interventions.

Residential Proximity to Major Roadways and Lung Cancer Mortality. Italy, 1990-2010: An Observational Study

BACKGROUND

Air pollution from road traffic has been associated to an increased risk of lung cancer. Herein, we investigated the association between lung cancer mortality and residence near Italian highways or national major roads.

METHODS

Information on deaths for lung cancer registered from 1990 to 2010 and stratified by age, gender, and urban or rural municipality of residence at death were obtained from the National Institute of Statistics. Distance between the centroid of the municipality of residence and closest major roadways was considered as a proxy of pollution exposure. Relative Risks (RR) and 95% confidence intervals (CI) were computed using Poisson log-linear models adjusted for age, calendar period, deprivation index, North/South gradient, and urban/rural status.

RESULTS

A gradient in risk for lung cancer mortality was seen for residents within 50 meters (m) of national major roads. In particular, in rural municipalities a statistically significant increased risk for lung cancer death was observed in both sexes (RR = 1.27 for distance <25 m vs. 500-1999 m, 95% CI 1.17-1.42, in men; RR = 1.97, 95% CI 1.64-2.39, in women). In urban municipalities, weak risks of borderline significance were documented in both sexes (RR = 1.06, 95% CI 0.99-1.15 in men; and RR = 1.09, 95% CI 0.97-1.22 in women). No statistically significant association emerged between residence within 100 to 500 m from highways and RRs of death for lung cancer.

CONCLUSIONS

In Italy, residing near national major roads, in particular in rural municipalities, was related to elevated risks of death for lung cancer.

Reduction of risk of dying from tobacco-related diseases after quitting smoking in Italy

AIMS AND BACKGROUND

The aims of this paper are to compute the risks of dying of ischemic heart disease (IHD), lung cancer (LC), stroke, and chronic obstructive pulmonary disease (COPD) for Italian smokers by gender, age and daily number of cigarettes smoked, and to estimate the benefit of stopping smoking in terms of risk reduction.

METHODS

Life tables by sex and smoking status were computed for each smoking-related disease based on Italian smoking data, and risk charts with 10-year probabilities of death were computed for never, current and former smokers.

RESULTS

Men aged 45-49 years, current smokers, have a 8, 10, 3 and 1 in 1,000 chance of dying of IHD, LC, stroke and COPD, respectively, whereas women with the same characteristics have a 2, 6, 3 and 1 in 1,000 chance, respectively, for all smokers combined, i.e., independent of the smoking intensity. The risk reduction rates from quitting smoking are remarkable: a man who quits smoking at 45-49 years can reduce the risk of dying of IHD, LC, stroke and COPD in the next 10 years by 43%, 53%, 57% and 55%, respectively; a woman by 49%, 49%, 59% and 57%, respectively.

CONCLUSIONS

Estimates of risk reduction by quitting smoking are useful to provide a sounder scientific basis for public health messages and clinical advice.

Generation shifts in smoking over 20 years in two Dutch population-based cohorts aged 20-100 years

BACKGROUND

Younger and older generations may differ substantially in their lifetime smoking habits, which may result in generation-specific health challenges. We aimed to quantify generation shifts in smoking over a period of 25 years.

METHODS

We used the Doetinchem Cohort Study (baseline 1987-1991; 7768 individuals; 20-60 years; follow-up 1993-2012) and the Longitudinal Aging Study Amsterdam (baseline 1992-1993; 3017 individuals; 55-85 years; follow-up 1995-2009). Generation shifts were studied between 10-year generations (age range: 20-100 years). Generation shifts were examined graphically and by using logistic random effect models for men and women.

RESULTS

Among men, significant generation shifts in current smoking were found between two non-successive generations: for instance men in their 40s at baseline smoked much more than men in their 40s at follow-up (33.6% vs. 23.1%, p < 0.05). Among women, the most recently born generation showed a favourable significant generation shift in current smoking (-7.3%) and ever smoking (-10.1%). For all other generations, the prevalence of ever smoking among women was significantly higher in every more recently born generation, whereas no other generation shifts were observed for current smoking. The unfavourable generation shifts were mainly found among the lower educated.

CONCLUSIONS

The future burden of disease due to smoking is expected to be reduced among men, but not yet among women. Educational differences in smoking-related health problems are expected to increase.

Socioeconomic inequalities in smoking habits are still increasing in Italy

Background

Socioeconomic inequalities in smoking habits have stabilized in many Western countries. This study aimed at evaluating whether socioeconomic disparities in smoking habits are still enlarging in Italy and at comparing the impact of education and occupation.

Methods

In the frame of the GEIRD study (Gene Environment Interactions in Respiratory Diseases) 10,494 subjects, randomly selected from the general population aged 20–44 years in seven Italian centres, answered a screening questionnaire between 2007 and 2010 (response percentage = 57.2%). In four centres a repeated cross-sectional survey was performed: smoking prevalence recorded in GEIRD was compared with prevalence recorded between 1998 and 2000 in the Italian Study of Asthma in Young Adults (ISAYA).

Results

Current smoking was twice as prevalent in people with a primary/secondary school certificate (40-43%) compared with people with an academic degree (20%), and among unemployed and workmen (39%) compared with managers and clerks (20-22%). In multivariable analysis smoking habits were more affected by education level than by occupation. From the first to the second survey the prevalence of ever smokers markedly decreased among housewives, managers, businessmen and free-lancers, while ever smoking became even more common among unemployed (time-occupation interaction: p = 0.047). At variance, the increasing trend in smoking cessation was not modified by occupation.

Conclusion

Smoking prevalence has declined in Italy during the last decade among the higher socioeconomic classes, but not among the lower. This enlarging socioeconomic inequality mainly reflects a different trend in smoking initiation.

Mucin 5B promoter polymorphism is associated with susceptibility to interstitial lung diseases in Chinese males

The variation of G>T in the MUC5B promoter (rs35705950) has been associated with idiopathic pulmonary fibrosis (IPF) and familial interstitial pneumonia (FIP) in Caucasians, but no information is available regarding this variant in the Chinese population. We recruited 405 patients with interstitial lung diseases (ILD), including 165 IPF patients and 2043 healthy controls, for genotyping the MUC5B gene in the Chinese population. One hundred three patients with pneumonia and 360 patients with autoimmune diseases (ADs) were recruited as disease controls. Our results indicated that the prevalence of the minor allele (T) of the polymorphism rs35705950 in healthy Chinese subjects was approximately 0.66%, which was lower than that described in the Caucasian population. The frequencies of the T allele were 3.33% and 2.22% in IPF and ILD patients, respectively, and these values were significantly higher than those of healthy controls (P = 0.001, OR = 4.332 for IPF, and P = 0.002, OR = 2.855 for ILD). A stratified analysis showed that this variant in MUC5B associated with the risk for ILD mainly in older male Chinese subjects. No difference was observed between patients with pneumonia, AD patients, and healthy controls.

Life gain in Italian smokers who quit

This study aims to estimate the number of life years gained with quitting smoking in Italian smokers of both sexes, by number of cigarettes smoked per day (cig/day) and age at cessation. All-cause mortality tables by age, sex and smoking status were computed, based on Italian smoking data, and the survival curves of former and current smokers were compared. The more cig/day a man/woman smokes, and the younger his/her age of quitting smoking, the more years of life he/she gains with cessation. In fact, cessation at age 30, 40, 50, or 60 years gained, respectively, about 7, 7, 6, or 5, and 5, 5, 4, or 3 years of life, respectively, for men and women that smoked 10–19 cig/day. The gain in life years was higher for heavy smokers (9 years for >20 cig/day) and lower for light smokers (4 years for 1–9 cig/day). Consistently with prospective studies conducted worldwide, quitting smoking increases life expectancy regardless of age, gender and number of cig/day. The estimates of the number of years of life that could be gained by quitting smoking, when computed specifically for a single smoker, could be used by physicians and health professionals to promote a quit attempt.

Time trends of Italian former smokers 1980-2009 and 2010-2030 projections using a Bayesian age period cohort model

This study aimed to describe past time trends of the prevalence of former smokers in Italy and to estimate prevalence projections using a Bayesian approach. An age-period-cohort (APC) analysis has been carried out in order to investigate the effect of the age, period and birth cohort on the prevalence of former smokers during 1980–2009. A Bayesian APC model with an autoregressive structure for the age, period and cohort parameters has been used to estimate future trends. Results showed that awareness of harm from smoking occurred at younger ages with each advancing cohort, and that women were more likely to attempt to stop smoking during pregnancies and breastfeeding, whereas men attempted to quit only when smoking-related diseases became evident. Projections of future trend recorded a further increase in the number of former smokers in future decades, showing an estimate of the “end of smoking” around years 2060 and 2055 in men and women, respectively. The application of the APC analysis to study the prevalence of former smokers turned out to be a useful method for the evaluation of past smoking trends, reflecting the effects of tobacco control policies on time and generations, and to make projections of future trend.