Smoking reduction at midlife and lifetime mortality risk in men: a prospective cohort study

Changes in smoking use and subsequent lung cancer risk in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study

BACKGROUND

Reducing cigarettes per day may lower the risk of lung cancer compared with continuing to smoke at the same intensity. Other changes in smoking behaviors, such as increasing cigarette consumption or quitting for a period and relapsing, may also affect lung cancer risk.

METHODS

We examined changes in smoking status and cigarettes per day among 24 613 Finnish male smokers aged 50-69 years who participated in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Longitudinal data on smoking were collected during study follow-up visits 3 times a year (approximately every 4 months) between 1985 and 1993. Incident lung cancer patients through 2012 were identified by the Finnish Cancer Registry. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.

RESULTS

Compared with smoking 20 cigarettes per day continuously across the intervention period, reducing an average of 5 cigarettes per day per year while smoking was associated with a 20% lower risk of lung cancer (95% CI = 0.71 to 0.90). A substantially lower risk of lung cancer was also observed when participants smoked at 50% (RR = 0.72, 95% CI = 0.57 to 0.90) and 10% (RR = 0.55, 95% CI = 0.36 to 0.83) of study visits, relative to smoked at 100% of study visits.

CONCLUSIONS

Smokers may lower their risk of lung cancer by reducing smoking intensity (cigarettes per day while smoking) and the time they smoke. However, quitting smoking completely is the most effective way for smokers to reduce their risk of lung cancer.

Smoking cessation, but not reduction, reduces cardiovascular disease incidence

AIMS

The aim of this study was to assess the association of smoking cessation and reduction with risk of cardiovascular disease (CVD).

METHODS AND RESULTS

A total of 897 975 current smokers aged ≥40 years who had undergone two consecutive national health examinations (in 2009 and 2011) were included. Participants were classified as quitters (20.6%), reducers I (≥50% reduction, 7.3%), reducers II (20-50% reduction, 11.6%), sustainers (45.7%), and increasers (≥20% increase, 14.5%). During 5 575 556 person-years (PY) of follow-up, 17 748 stroke (3.2/1000 PY) and 11 271 myocardial infarction (MI) (2.0/1000 PY) events were identified. Quitters had significantly decreased risk of stroke [adjusted hazard ratio (aHR) 0.77 95% confidence interval (CI) 0.74-0.81; absolute risk reduction (ARR) -0.37, 95% CI -0.43 to -0.31] and MI (aHR 0.74, 95% CI 0.70-0.78; ARR -0.27, 95% CI -0.31 to -0.22) compared to sustainers after adjustment for demographic factors, comorbidities, and smoking status. The risk of stroke and MI incidence in reducers I (aHR 1.02, 95% CI 0.97-1.08 and aHR 0.99, 95% CI 0.92-1.06, respectively) and reducers II (aHR 1.00, 95% CI 0.95-1.05 and aHR 0.97, 95% CI 0.92-1.04, respectively) was not significantly different from the risk in sustainers. Further analysis with a subgroup who underwent a third examination (in 2013) showed that those who quit at the second examination but had starting smoking again by the third examination had 42-69% increased risk of CVD compared to sustained quitters.

CONCLUSIONS

Smoking cessation, but not reduction, was associated with reduced CVD risk. Our study emphasizes the importance of sustained quitting in terms of CVD risk reduction.

Smoking Behavior in Patients With Early-Stage NSCLC: A Report From ECOG-ACRIN 1505 Trial

INTRODUCTION

Smoking cessation has been reported to benefit patients even after a diagnosis of lung cancer. We studied the smoking behavior of patients who participated in a phase 3 trial of adjuvant therapy following resection of stages IB-IIIA NSCLC.

METHODS

The ECOG-ACRIN 1505 was conducted to determine whether the addition of bevacizumab to adjuvant chemotherapy would improve overall survival (OS) for patients with early-stage NSCLC. Studying the association between smoking status and OS was a secondary end point. Patients completed a questionnaire on their smoking habits at baseline, 3, 6, 9, and 12 months.

RESULTS

A total of 1501 patients were enrolled, and 99.8%, 95%, 94%, 93%, and 93% responded to the questionnaire at baseline, 3, 6, 9, and 12 months, respectively. A total of 90% reported a current or previous history of cigarette smoking. In addition, 60% of nonsmokers at enrollment reported smoking after diagnosis (before randomization); however, 1% of them reported smoking at 12 months. Furthermore, 94% of the respondents smoked none/fewer cigarettes daily at 12 months. The incidence of grades 3-5 toxicity on treatment was 68%, 76%, and 72% in never, former, and current smokers, respectively (p = 0.05). The disease-free survival for never-smokers relative to current and former smokers was (hazard ratio [HR] 0.93, p = 0.64 and HR 1.05, p = 0.72), and OS was (adjusted HR for death 0.54, p = 0.005 and adjusted HR for death 0.68, p = 0.03), respectively.

CONCLUSIONS

This is the first comprehensive, prospective report of smoking habits in patients with NSCLC patients from a phase III early-stage trial. There was a high rate of smoking reduction and cessation following study entry. The disease-free survival did not differ significantly between smokers and never smokers, though there were less grade 3-5 toxicities and more favorable OS in never-smokers.

Association of smoking reduction and mortality: protocol for a systematic review and meta-analysis of longitudinal observational studies

INTRODUCTION

Strong evidence shows that smoking cessation decreases mortality. Much less is known regarding the association between reduction in cigarettes per day (CPD) and mortality. The primary aim of this systematic review is to compare the mortality risk between smokers achieving a sustained reduction of CPD and smokers maintaining their smoking rate. The secondary aims are to compare the mortality risk between smokers achieving complete, sustained smoking cessation and (1) smokers maintaining their smoking rate and (2) smokers who achieved a sustained reduction in smoking rate.

METHODS AND ANALYSIS

MEDLINE, Web of Sciences and Embase will be searched using a prespecified search strategy, up to 23 November 2020, and will be limited to studies published in English and in French. Longitudinal observational studies using individual data including smokers with at least two distant CPD assessments and a follow-up period of systematic mortality data recording will be included. The main outcome will be the all-cause mortality. The secondary outcome will be specific mortality. The Newcastle-Ottawa Scale will be used to assess the risk of bias of individual studies. Outcomes will be analysed using HRs. All other outcomes' effect size reported in included studies will be converted in HRs using validated methods.

ETHICS AND DISSEMINATION

We intend to publish the results of our review in a peer-reviewed journal and to present the findings at national and international meetings and conferences.

PROSPERO REGISTRATION NUMBER

CRD42019138354.

Childhood self-control forecasts the pace of midlife aging and preparedness for old age

The ability to control one's own emotions, thoughts, and behaviors in early life predicts a range of positive outcomes in later life, including longevity. Does it also predict how well people age? We studied the association between self-control and midlife aging in a population-representative cohort of children followed from birth to age 45 y, the Dunedin Study. We measured children's self-control across their first decade of life using a multi-occasion/multi-informant strategy. We measured their pace of aging and aging preparedness in midlife using measures derived from biological and physiological assessments, structural brain-imaging scans, observer ratings, self-reports, informant reports, and administrative records. As adults, children with better self-control aged more slowly in their bodies and showed fewer signs of aging in their brains. By midlife, these children were also better equipped to manage a range of later-life health, financial, and social demands. Associations with children's self-control could be separated from their social class origins and intelligence, indicating that self-control might be an active ingredient in healthy aging. Children also shifted naturally in their level of self-control across adult life, suggesting the possibility that self-control may be a malleable target for intervention. Furthermore, individuals' self-control in adulthood was associated with their aging outcomes after accounting for their self-control in childhood, indicating that midlife might offer another window of opportunity to promote healthy aging.

Do Daily Compensatory Health Beliefs Predict Intention to Quit and Smoking Behavior? A Daily Diary Study during Smoking Cessation

Compensatory health beliefs (CHBs) are a means to cope with motivational conflicts between intended health goals and the temptation for an unhealthy behavior. As CHBs can fluctuate on a daily basis, this study examined how daily CHBs are associated with daily intention to quit smoking and daily number of cigarettes smoked before and after a quit date at the between- and within-person level. The study comprised a prospective longitudinal design and investigated 83 women and 83 men for 32 consecutive days during an ongoing joint self-set quit attempt. Daily CHBs varied from day to day and between individuals. At the between-person level, higher women’s mean CHBs were associated with lower intention (b = −0.23, p = 0.04) and at the 10% level with more cigarettes smoked after the quit date (rate ratio (RR) = 1.92, p = 0.07). At the within-person level, women’s higher than usual CHBs were unrelated to intention to quit, but were related to less smoking before (RR = 0.96, p = 0.03) and at the 10% level after the quit date (RR = 0.91, p = 0.09). A marginally positive association between daily CHBs and smoking at the within-person level emerged for men. The negative effect of daily CHBs at the between-person level on smoking seems to unfold after the quit attempt and for women only.

Cigarette Smoking Reduction and Health Risks: A Systematic Review and Meta-analysis

Introduction

Studies have shown the health benefits of cigarette smoking cessation. However, the literature remains unclear about the relationship between smoking reduction and health risks. This comprehensive review and meta-analysis updates previous reviews with the newest estimates.

Aims and Methods

We conducted a systematic review and meta-analysis evaluating the association between smoking reduction and some health risks in observational studies. We defined the following smoking categories: heavy smokers smoked ≥15–20 cigarettes per day (CPD), moderate smokers smoked 10–19 CPD, and light smokers smoked <10 CPD. The relative risks (RRs) and 95% confidence intervals (CIs) were estimated using random-effect models.

Results

We identified 19 studies including four case–control and 15 cohort studies. Compared with continuing heavy smokers, we found decreased lung cancer risk for those who reduced CPD by more than 50% (RR = 0.72, 95% CI: 0.52, 0.91), from heavy to moderate (RR = 0.66, 95% CI: 0.46, 0.85), and from heavy to light (RR = 0.60, 95% CI: 0.49, 0.72). We also found lower risk of cardiovascular disease (CVD) for those who reduced from heavy to light smoking (RR = 0.78, 95% CI: 0.67, 0.89) but not those who reduced by more than 50% and reduced smoking from heavy to moderate. We did not find any significant difference in all-cause mortality, all-cancer risks, and smoking-/tobacco-related cancer risk among those who reduced.

Conclusions

Substantial smoking reduction may decrease lung cancer risk but results on CVD (coronary heart disease and stroke combined) risk were mixed. The relationships between smoking reduction and other endpoints examined were not significant.

Implications

This meta-analysis helps clarify our understanding of various smoking reduction levels on some health risks. While smoking reduction may decrease risks of lung cancer, the relationships between smoking reduction and other endpoints, including all-cause mortality and cardiovascular disease, remain unclear. Although smoking reduction may decrease lung cancer risks, the magnitude of lung cancer risk remain high. Among smokers, complete cessation remains the most effective approach for cancer and CVD prevention.

The impact of lifestyle behaviours, physical activity and smoking on morbidity and mortality in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is associated with pain, disability and increased risk of developing comorbidities and premature mortality. While these poor outcomes have improved in line with advances in the treatment of RA, they still persist to some degree today. Physical activity and smoking are two areas of patients' lives where changes may have a substantial impact on the poor outcomes associated with RA. Physical activity in RA has been well studied, with many randomised trials indicating the benefits of physical activity on pain and disability. A number of observational studies have assessed the impact of smoking on RA, also indicating the benefits of quitting smoking on RA-related outcomes, but with less consistent findings, potentially due to epidemiological challenges (e.g. collider bias, recall bias). There are also a number of barriers preventing patients making these positive lifestyle changes, such as lack of time and motivation, lack of knowledge and advice, as well as disease-specific barriers, such as pain and fatigue.

The effect of smoking intensity on all-cause and cause-specific mortality-a Mendelian randomization analysis

BACKGROUND

Smoking is an important cause of mortality and recent studies have suggested that even low-intensity smoking might be associated with increased mortality. Still, smoking is associated with lower socio-economic status as well as other potential risk factors, and disease onset might motivate smoking cessation, thus residual confounding and reverse causality might bias results. We aimed to assess the evidence of a causal relationship between smoking intensity and cause-specific as well as all-cause-mortality using Mendelian randomization analyses.

METHODS

We included 56 019 participants from the Norwegian HUNT2 Study and 337 103 participants from UK Biobank, linked to national registry data on causes of death. We estimated associations of self-reported smoking as well as the genetic variant rs1051730 as an instrument for smoking intensity with all-cause and cause-specific mortality. We subsequently meta-analysed the results from the two cohorts.

RESULTS

Each effect allele of the rs1051730 was associated with a 9% increased hazard of all-cause mortality [95% confidence interval (CI) 6-11] among ever smokers. Effect alleles were also associated with death by neoplasms [hazard ratio (HR) 1.11, 95% CI 1.06-1.15], circulatory diseases (HR 1.06, 95% CI 1.01-1.11) and respiratory diseases (HR 1.15, 95% CI 1.05-1.26) among ever smokers. The association was stronger among ever than never smokers for all-cause mortality (p < 0.001), neoplasms (p = 0.001) and respiratory diseases (p = 0.038).

CONCLUSIONS

Our results indicate a causal effect of smoking intensity on all-cause mortality and death by neoplasms and respiratory diseases. There was weaker evidence of a causal effect of smoking intensity on death by circulatory diseases.

Concurrent Daily and Non-Daily Use of Heated Tobacco Products with Combustible Cigarettes: Findings from the 2018 ITC Japan Survey

Use of heated tobacco products (HTPs) among current smokers is becoming increasingly popular in Japan. This study aims to compare characteristics and tobacco-related behaviors among concurrent users of HTPs and combustible cigarettes (n = 644) with exclusive smokers (n = 3194) or exclusive HTP users (n = 164). The secondary aim was to explore heterogeneity within concurrent use subgroups. Data were from Wave 1 of the ITC Japan Survey, a nationally representative web survey conducted from February to March 2018. Concurrent cigarette-HTP users were younger and wealthier than exclusive smokers. However, there were no difference in the frequency of smoking, number of cigarettes per day, and smoking cessation behaviors between the two groups, suggesting that HTPs reinforce nicotine dependence. Compared to exclusive HTP users, concurrent cigarette-HTP users reported higher frequency of non-daily HTP use, and lower number of tobacco-containing inserts per day. Almost all concurrent cigarette-HTP users smoked every day (93.9%); 48.4% both smoked and used HTPs daily (dual daily users, n = 396), while 45.5% were daily smokers and non-daily HTP users (predominant smokers, n = 213). Concurrent user subgroups differed from each other on age, tobacco use behaviors, and quit intention. Alongside heterogeneity between concurrent and exclusive product users, differences across concurrent use subgroups highlight the importance of considering frequency of use in characterizing poly-tobacco users.

Cigarette Affordability and Cigarette Consumption among Adult and Elderly Chinese Smokers: Evidence from A Longitudinal Study

China is in the midst of an epidemic of non-communicable diseases (NCDs), which has increasingly accounted for a growing share of disease burden, due in part to China's ongoing rapid socioeconomic changes and population aging. Smoking, the second leading health risk factors associated with NCDs in China, disproportionately affects the old population more than their younger counterparts. Using survey data from the China Health and Retirement Longitudinal Study (CHARLS), this study evaluated the impact of changes in cigarette affordability on smoking behavior among middle-aged and elderly (age 45 and older) smokers. Self-reported cigarette price and disposable income were used to calculate cigarette affordability. Cigarette consumption was measured using the number of cigarettes smoked per day reported by the survey respondents. The correlation between cigarette affordability and cigarette consumption was estimated using generalized estimating equations adjusting for demographics, socioeconomic status, geolocations, and cigarette price tiers, as well as year fixed effects. The estimated overall conditional cigarette affordability elasticity of demand was -0.165, implying a 10% decrease in cigarette affordability would result in a reduction in cigarette consumption by 1.65%. The cigarette affordability responsiveness differs by demographics, socioeconomic status, geolocations, and cigarette price tiers. This study provides evidence that tax/price policies that reduce cigarette affordability could lead to a decrease in cigarette consumption among middle-aged and elderly smokers in China. Smoke-free laws, as well as minimum price regulations, may be needed to compliment excise tax policy to target specific smoking subgroups whose cigarette consumption is less sensitive to changes in cigarette affordability.

Dose-response effect of smoking status on quality-adjusted life years among U.S. adults aged 65 years and older

Background

To estimate the impact of smoking on quality-adjusted life years (QALY) for US adults aged 65 years and older.

Methods

Using the 2003-08 National Health and Nutrition Examination Survey Linked Mortality File, we estimated the mean QALY throughout the remaining lifetime by participants' smoking status as well as smoking intensity and time since cessation.

Results

Never, former and current smokers had a mean QALY of 16.1, 12.7 and 7.3 years, respectively. Among current smokers, those who started smoking before age 18 had fewer QALYs than those who started at or after age 18 (6.0 and 8.5 years, respectively) and those smoking ≥20 cigarettes per day had fewer QALYs than those smoking <20 cigarettes per day (6.6 and 8.1 years, respectively). QALYs also declined with a longer duration of smoking and a shorter time since cessation. The potential gains if a person quit smoking would be 5.4 QALYs, and the gains would increase with a longer time since quitting as well as quitting at a younger age.

Conclusions

This study demonstrated the dose-response effect of smoking status on QALY. The results indicate the health benefits of tobacco cessation at any age and sizeable losses for former or current smokers.

Pilot study of a mobile smoking cessation intervention for low-income smokers with serious mental illness

Introduction

People with serious mental illness (SMI) have high rates of smoking and need better access to cessation treatment. Mobile behavioral interventions for cessation have been effective for the general population, but are not usable by many with SMI due to cognitive impairments or severe symptoms. We developed a tailored mobile cessation treatment intervention with features to reduce cognitive load.

Method

We enrolled 20 smokers with SMI and showed them how to use the program on a device of their choice. They were assessed at 8 weeks for intervention use, usability, satisfaction, smoking characteristics, and biologically verified abstinence.

Results

Participants accessed an average of 23.6 intervention sessions (SD = 17.05; range 1–48; median = 17.5) for an average total of 231.64 minutes (SD = 227.13; range 4.89–955.21; median = 158.18). For 87% of the sessions, average satisfaction scores were 3 or greater on a scale of 1–4. Regarding smoking, 25% of participants had reduced their smoking and 10% had biologically verified abstinence from smoking at 8 weeks.

Conclusion

Home and community use of this mobile cessation intervention was feasible among smokers with SMI. Further research is needed to evaluate such scalable approaches to increase access to behavioral treatment for this group.

Association Between Reductions of Number of Cigarettes Smoked per Day and Mortality Among Older Adults in the United States

Many smokers do not quit but instead reduce the number of cigarettes they smoke per day (CPD) over their lifetime. Yet the associations of such changes in CPD with health risks are unclear. We examined the association of changes in CPD with subsequent death in the period 2004-2011 among 253,947 participants of the National Institutes of Health-AARP Diet and Health Study. Using a questionnaire assessing responders' history of smoking cigarettes, we identified cigarette smokers who quit, decreased, maintained, or increased their CPD between ages 25-29 and 50-59 years. Hazard ratios and 95% confidence intervals were obtained from multivariable adjusted Cox proportional hazards regression models. Relative to never smokers, smokers who maintained a consistent CPD had 2.93 times (95% confidence interval (CI): 2.82, 3.05) higher all-cause mortality risk, and participants who increased their CPD had still higher risk (hazard ratio (HR) = 3.37, 95% CI: 3.23, 3.52). Death risk was lower among participants who decreased their CPD (HR = 2.38, 95% CI: 2.25, 2.52) or quit smoking (for quitting between ages 30 and 39 years, HR = 1.32, 95% CI: 1.25, 1.39). Similar patterns were observed for smoking-related causes of death, with particularly strong associations for lung cancer and respiratory disease. Reductions in CPD over the lifetime meaningfully decreased death risk; however, cessation provided a larger benefit than even large declines in CPD.

Factors associated with changing cigarette consumption patterns among low-intensity smokers: Longitudinal findings across four waves (2008-2012) of ITC Mexico Survey

Background

Light and intermittent smoking has become increasingly prevalent as smokers shift to lower consumption in response to tobacco control policies. We examined changes in cigarette consumption patterns over a four-year period and determined which factors were associated with smoking transitions.

Methods

We used data from a cohort of smokers from the 2008–2012 ITC Mexico Survey administrations to investigate transitions from non-daily (ND; n = 669), daily light (DL; ≤5 cigarettes per day (cpd); n = 643), and daily heavy (DH; >5 cpd; n = 761) smoking patterns. To identify which factors (i.e., sociodemographic measures, perceived addiction, quit behavior, social norms) were associated with smoking transitions, we stratified on smoking status at time t (ND, DL, DH) and used multinomial (ND, DL) and binomial (DH) logistic regression to examine transitions (quitting/reducing or increasing versus same level for ND and DL, quitting/reducing versus same level for DH).

Results

ND smokers were more likely to quit at follow-up than DL or DH smokers. DH smokers who reduced their consumption to ND were more likely to quit eventually compared to those who continued as DH. Smokers who perceived themselves as addicted had lower odds of quitting/reducing smoking consumption at follow-up compared to smokers who did not, regardless of smoking status at the prior survey. Quit attempts and quit intentions were also associated with quitting/reducing consumption.

Conclusions

Reducing consumption may eventually lead to cessation, even for heavier smokers. The findings that perceived addiction and quit behavior were important predictors of changing consumption for all groups may offer insights into potential interventions.

•

Smoking transitions were evaluated in a cohort of Mexican smokers.

•

The cohort consisted mostly of understudied light and intermittent smokers (LITS).

•

Reductions in smoking intensity were found to facilitate smoking cessation.

•

Greater perceived addiction inhibited cessation for smokers at all levels of intensity.

•

LITS patterns warrant attention as number of low-intensity smokers worldwide grows.

Recommendations for the Appropriate Structure, Communication, and Investigation of Tobacco Harm Reduction Claims. An Official American Thoracic Society Policy Statement

RATIONALE

The tobacco harm reduction literature is replete with vague language, far-reaching claims, and unwarranted certainty. The American Thoracic Society has increasingly recognized the need for a framework for reliably making such claims. Evidence-based standards improving the scientific value and transparency of harm reduction claims are expected to improve their trustworthiness, clarity, and consistency.

METHODS

Experts from relevant American Thoracic Society committees identified key topic areas for discussion. Literature search strategy included English language articles across Medline, Google Scholar, and the Cochrane Collaborative databases, with expanded search terms including tobacco, addiction, smoking, cigarettes, nicotine, and harm reduction. Workgroup members synthesized their evidentiary summaries into a list of candidate topics suitable for inclusion in the final report. Breakout groups developed detailed content maps of each topic area, including points to be considered for suggested recommendations. Successive draft recommendations were modified using an iterative consensus process until unanimous approval was achieved. Patient representatives ensured the document's relevance to the lay public.

RESULTS

Fifteen recommendations were identified, organized into four framework elements dealing with: estimating harm reduction among individuals, making claims on the basis of population impact, appropriately careful use of language, and ethical considerations in harm reduction.

DISCUSSION

This statement clarifies important principles guiding valid direct and inferential harm reduction claims. Ideals for effective communication with the lay public and attention to unique ethical concerns are also delineated. The authors call for formal systems of grading harm reduction evidence and regulatory assurances of longitudinal surveillance systems to document the impact of harm reduction policies.

Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial

INTRODUCTION

Adults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation.

METHODS

The sample includes male, AD smokers (N = 129) with 1-32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up.

RESULTS

Overall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82-0.90), motivation to quit (IRRs = 0.65-0.85), and intrinsic reasons for quitting (IRRs = 0.96-0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05-1.07), impulsivity (IRRs = 1.01-1.03), weight-control expectancies (IRRs = 1.10-1.15), and childhood sexual abuse (IRRs = 1.03-1.07) predicted more cigarettes/day.

CONCLUSIONS

Smokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.

[Is reduction of tobacco consumption associated with reduced risk of cardiovascular and pulmonary mortality and morbidity?]

INTRODUCTION

Smokers without an intention to completely quit smoking often try to reduce their daily tobacco consumption. However, smoking reduction is not associated with reduced risk of all-cause mortality. The aim of this systematic literature review of data was to expose relations between reduction of daily tobacco consumption and a potential decrease in the risks of cardiovascular and pulmonary mortality and morbidity.

METHOD

Medline, on the period 1980-2018 with the following keywords: "smoking reduction", "harm reduction", "mortality", "morbidity", "cardiovascular disease^*", myocardial infarction", "coronar^*", "stroke", "lung cancer", "COPD", "chronic obstructive pulmonary disease", "asthma", "pulmonary disease^*" and "respiratory disease" limits "title/abstract"; the selected languages were English or French. Among 158 articles, 32 abstracts have given use to a dual reading to select 19 studies.

RESULTS

Reduction of daily tobacco consumption by at least 50% is not associated with (1) reduced risk of cardiovascular mortality and morbidity and (2) reduced risk of lung cancer mortality. Results of studies on the risk of lung cancer morbidity are conflicting. Smoking reduction by at least 50% has no or little effect on the incidence of chronic obstructive pulmonary disease (COPD) and FEV1 decline. In asthmatic patients, smoking reduction is associated with small improvement for night use of short acting beta2-agonists, doses of inhaled corticosteroids and bronchial hyper-reactivity.

CONCLUSION

Smoking cessation is the only effective strategy to reduce the harm caused by tobacco smoking. This finding should lead clinicians to offer support to smokers in order to assist them to completely quit smoking.

Evaluation of the cognitive behavioral smoking reduction program "Smoke_less": a randomized controlled trial

The vast majority of smokers are unable or unwilling to quit, but many are open to reducing smoking. No treatment options exist for these smokers besides medication-based therapies. Thus, this study investigated the efficacy of a cognitive behavioral therapy (CBT) smoking reduction program, Smoke_less. A sample of 155 outpatient smokers aged 18-70 years was recruited at the Tobacco Dependence Outpatient Clinic of the Medical Center of the University of Munich, Germany, and randomly assigned to the experimental group (Smoke_less: four weekly CBT group sessions and two telephone calls over 5 weeks, n = 51), active comparator group (one 15-minute counseling session, n = 49), or waiting control group (no intervention during the study, n = 55). The primary endpoint was a ≥50% smoking reduction in the intention-to-treat group 1 week and 6 months after the intervention. We evaluated also abstinence rates at follow-up. Significantly more participants in the Smoke_less group had reduced smoking ≥50% compared to the waiting group at 1 week [OR 7.59 (2.59-22.19)] and 6 months [OR 5.00 (1.68-14.84)] and compared to the active comparison group at 1 week [OR 8.58 (2.67-27.31)] but not at 6 months [OR 1.73 (0.71-4.20)]. We found no significant effects on abstinence rates. The CBT smoking reduction program Smoke_less is effective for smoking reduction but is superior to brief counseling only in the short term. Further research is required to improve its efficacy in long-term smoking reduction to provide a valid, non-medication-based alternative to smokers unable or unwilling to quit.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT02337400.

Population Modeling of Modified Risk Tobacco Products Accounting for Smoking Reduction and Gradual Transitions of Relative Risk

Introduction

As suggested by the Food and Drug Administration (FDA) Modified Risk Tobacco Product (MRTP) Applications Draft Guidance, we developed a statistical model based on public data to explore the effect on population mortality of an MRTP resulting in reduced conventional cigarette smoking. Many cigarette smokers who try an MRTP persist as dual users while smoking fewer conventional cigarettes per day (CPD). Lower-CPD smokers have lower mortality risk based on large cohort studies. However, with little data on the effect of smoking reduction on mortality, predictive modeling is needed.

Methods

We generalize prior assumptions of gradual, exponential decay of Excess Risk (ER) of death, relative to never-smokers, after quitting or reducing CPD. The same age-dependent slopes are applied to all transitions, including initiation to conventional cigarettes and to a second product (MRTP). A Monte Carlo simulation model generates random individual product use histories, including CPD, to project cumulative deaths through 2060 in a population with versus without the MRTP. Transitions are modeled to and from dual use, which affects CPD and cigarette quit rates, and to MRTP use only.

Results

Results in a hypothetical scenario showed high sensitivity of long-run mortality to CPD reduction levels and moderate sensitivity to ER transition rates.

Conclusions

Models to project population effects of an MRTP should account for possible mortality effects of reduced smoking among dual users. In addition, studies should follow dual-user CPD histories and quit rates over long time periods to clarify long-term usage patterns and thereby improve health impact projections.

Implications

We simulated mortality effects of a hypothetical MRTP accounting for cigarette smoking reduction by smokers who add MRTP use. Data on relative mortality risk versus CPD suggest that this reduction may have a substantial effect on mortality rates, unaccounted for in other models. This effect is weighed with additional hypothetical effects in an example.

Smoking Status and Incidence of Cancer After Myocardial Infarction: A Follow-Up Study of over 20 Years

OBJECTIVES

We evaluated long-term incidence of cancer after myocardial infarction among current, former, and never smokers, and assessed whether reducing cigarette consumption is associated with decreased cancer risk.

METHODS

Consecutive patients aged ≤65 years discharged from 8 hospitals in central Israel after first myocardial infarction in 1992-1993 were followed for cancer and death. Extensive data including smoking habits were obtained at the index hospitalization and 4 time points during follow-up. Survival methods were applied to assess the hazard ratios (HRs) for cancer associated with smoking categories.

RESULTS

Included in the study were 1486 cancer-free participants (mean age, 54 years; 81% men), among whom 787 were current smokers at baseline (average daily cigarette consumption = 29). Smokers were younger than nonsmokers and more likely to be male and of lower socioeconomic status. Over a median follow-up of 21.4 years, 273 (18.4%) patients developed cancer. Baseline smoking was associated with a ∼40% excess adjusted risk of cancer; ∼25% after accounting for death as a competing event. Considering changes in smoking during follow-up, the excess risk was confined to persistent smokers (adjusted HR 1.75; 95% confidence interval [CI], 1.22-2.50), whereas post- (HR 1.14; 95% CI, 0.80-1.62) and pre-myocardial infarction quitters (HR 1.02; 95% CI, 0.71-1.47) were comparable with never smokers. Among persistent smokers, each reduction of 10 cigarettes relative to pre-myocardial infarction consumption was associated with a ∼10% reduced adjusted risk.

CONCLUSION

Among young survivors of first myocardial infarction followed-up longitudinally, smoking cessation is associated with lower risk of cancer. Reducing consumption among smokers may also be beneficial.

Long-term exposure to traffic-related air pollution and cancer among survivors of myocardial infarction: A 20-year follow-up study

BACKGROUND

Previous studies suggested a carcinogenic effect of exposure to traffic-related air pollution. Recently, higher rates of cancer incidence were observed among myocardial infarction survivors compared with the general population. We examined the association between chronic exposure to nitrogen oxides, a proxy measure for traffic-related air pollution, and cancer incidence and mortality in a cohort of myocardial infarction patients.

METHODS

Patients aged ≤65 years admitted to hospital in central Israel with a first myocardial infarction in 1992-1993 were followed to 2013 for cancer incidence and cause-specific mortality. Data on sociodemographic and cancer risk factors were obtained, including time-varying information on smoking. Using land use regression models, annual averages of nitrogen oxides during follow-up were estimated individually according to home addresses. Cox proportional hazards models were constructed to study the relationships with cancer outcomes.

RESULTS

During a mean follow-up of 16 (SD 7) years, 262 incident cancers and 105 cancer deaths were identified among 1393 cancer-free patients at baseline (mean age 54 years; 81% men). In adjusted models, a 10 ppb increase in mean nitrogen oxide exposure was associated with a hazard ratio (HR) of 1.06 (95% confidence interval (CI) 0.96-1.18) for cancer incidence and HR of 1.08 (95% CI 0.93-1.26) for cancer mortality. The association with lung, bladder, kidney or prostate cancer (previously linked to air pollution) was stronger (HR 1.16; 95% CI 1.00-1.33).

CONCLUSIONS

Chronic exposure to traffic-related air pollution may constitute an environmental risk factor for cancer post-myocardial infarction. Variation in the strength of association between specific cancers needs to be explored further.

Gender differences in self-reported withdrawal symptoms and reducing or quitting smoking three years later: A prospective, longitudinal examination of U.S. adults

BACKGROUND

Little is known about gender differences in withdrawal symptoms among smokers in the community. This study used longitudinal epidemiologic data to examine gender differences in current smokers' report of withdrawal symptoms during past quit attempts and the relationship between withdrawal symptoms and the odds of reducing or quitting smoking three years later.

METHODS

Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 1, 2001-2001, n=43,093; Wave 2, 2004-2005, n=34,653). Analyses were conducted on respondents who reported current daily cigarette smoking at Wave 1 (n=6911). Withdrawal symptoms during past quit attempts were assessed at Wave 1. Current smoking status was assessed at Wave 2.

RESULTS

Wave 1 current smoking women, compared to men, were more likely to endorse any withdrawal symptoms, withdrawal-related discomfort, and withdrawal-related relapse (ps<0.0001). Women endorsed a greater number of withdrawal symptoms than men (M=2.37, SE=0.05 versus M=1.78, SE=0.04; p<0.0001). The odds of reducing and quitting smoking were significantly lower for respondents who reported any Wave 1 withdrawal symptoms, withdrawal-related discomfort, and withdrawal-related relapse. These relationships did not differ for women versus men. Among men, the odds of reducing smoking at Wave 2 decreased significantly with each cumulative withdrawal symptom compared to women (β interaction=0.87; p=0.01).

CONCLUSIONS

Women were more likely to report withdrawal while the relationship between withdrawal symptoms and decreased likelihood of reducing smoking was stronger in men. Identifying gender differences in withdrawal can help develop strategies to help reduce withdrawal for both men and women.

Cigarette Taxes and Older Adult Smoking: Evidence from the Health and Retirement Study

In this study, we use the Health and Retirement Study to test whether older adult smokers, defined as those 50 years and older, respond to cigarette tax increases. Our preferred specifications show that older adult smokers respond modestly to tax increases: a $1.00 (131.6%) tax increase leads to a 3.8-5.2% reduction in cigarettes smoked per day (implied tax elasticity = -0.03 to -0.04). We identify heterogeneity in tax elasticity across demographic groups as defined by sex, race/ethnicity, education, and marital status and by smoking intensity and level of addictive stock. These findings have implications for public health policy implementation in an aging population.

Relapse-Prevention Booklets as an Adjunct to a Tobacco Quitline: A Randomized Controlled Effectiveness Trial

INTRODUCTION

Relapse prevention (RP) remains a major challenge to smoking cessation. Previous research found that a set of self-help RP booklets significantly reduced smoking relapse. This study tested the effectiveness of RP booklets when added to the existing services of a telephone quitline.

METHODS

Quitline callers (N = 3458) were enrolled after their 2-week quitline follow-up call and randomized to one of three interventions: (1) Usual Care: standard intervention provided by the quitline, including brief counseling and nicotine replacement therapy; (2) Repeated Mailings (RM): eight Forever Free RP booklets sent to participants over 12 months; and (3) Massed Mailings: all eight Forever Free RP booklets sent upon enrollment. Follow-ups were conducted at 6-month intervals, through 24 months. The primary outcome measure was 7-day-point-prevalence-abstinence.

RESULTS

Overall abstinence rates were 61.0% at baseline, and 41.9%, 42.7%, 44.0%, and 45.9% at the 6-, 12-, 18- and 24-month follow-ups, respectively. Although RM produced higher abstinence rates, the differences did not reach significance for the full sample. Post-hoc analyses of at-risk subgroups revealed that among participants with high nicotine dependence (n = 1593), the addition of RM materials increased the abstinence rate at 12 months (42.2% vs. 35.2%; OR = 1.38; 95% CI = 1.03% to 1.85%; P = .031) and 24 months (45% vs. 38.8%; OR = 1.31; 95% CI = 1.01% to 1.73%; P = .046).

CONCLUSIONS

Sending self-help RP materials to all quitline callers appears to provide little benefit to deterring relapse. However, selectively sending RP booklets to callers explicitly seeking assistance for RP and those identified as highly dependent on nicotine might still prove to be worthwhile.

Behavioural Risk Factors in Mid-Life Associated with Successful Ageing, Disability, Dementia and Frailty in Later Life: A Rapid Systematic Review

BACKGROUND

Smoking, alcohol consumption, poor diet and low levels of physical activity significantly contribute to the burden of illness in developed countries. Whilst the links between specific and multiple risk behaviours and individual chronic conditions are well documented, the impact of these behaviours in mid-life across a range of later life outcomes has yet to be comprehensively assessed. This review aimed to provide an overview of behavioural risk factors in mid-life that are associated with successful ageing and the primary prevention or delay of disability, dementia, frailty and non-communicable chronic conditions.

METHODS

A literature search was conducted to identify cohort studies published in English since 2000 up to Dec 2014. Multivariate analyses and a minimum follow-up of five years were required for inclusion. Two reviewers screened titles, abstracts and papers independently. Studies were assessed for quality. Evidence was synthesised by mid-life behavioural risk for a range of late life outcomes.

FINDINGS

This search located 10,338 individual references, of which 164 are included in this review. Follow-up data ranged from five years to 36 years. Outcomes include dementia, frailty, disability and cardiovascular disease. There is consistent evidence of beneficial associations between mid-life physical activity, healthy ageing and disease outcomes. Across all populations studied there is consistent evidence that mid-life smoking has a detrimental effect on health. Evidence specific to alcohol consumption was mixed. Limited, but supportive, evidence was available relating specifically to mid-life diet, leisure and social activities or health inequalities.

CONCLUSIONS

There is consistent evidence of associations between mid-life behaviours and a range of late life outcomes. The promotion of physical activity, healthy diet and smoking cessation in all mid-life populations should be encouraged for successful ageing and the prevention of disability and chronic disease.

Characterizing use patterns and perceptions of relative harm in dual users of electronic and tobacco cigarettes

Awareness and use of electronic cigarettes (e-cigarettes) is increasing. Questions regarding positive (e.g., smoking reduction/cessation) and negative (e.g., delay of cessation) potential public health consequences of e-cigarettes may be informed by studying dual users of e-cigarettes and tobacco cigarettes. A cross-sectional online survey assessed demographics, product use patterns, and beliefs about relative product benefits and harms among dual users (n = 350) in the United States using the website Amazon Mechanical Turk. Compared to tobacco cigarettes, e-cigarettes were used less often and were associated with lower dependence. Participants reported a 30% reduction in self-reported tobacco cigarette smoking since beginning to use e-cigarettes. Reported primary reasons for e-cigarette use were harm reduction and smoking cessation. E-cigarette use was reported as more likely in settings with smoking restrictions and when others' health could be adversely affected. Conversely, participants reported having used tobacco cigarettes more often than e-cigarettes in hedonic situations (e.g., after eating, drinking coffee or alcohol, or having sex), outdoors, or when stressed. Participants were twice as likely to report wanting to quit tobacco cigarettes compared to e-cigarettes in the next year and intended to quit tobacco cigarettes sooner. Tobacco cigarettes were described as more harmful and addictive, but also as more enjoyable than e-cigarettes. Participants provided evidence consistent with both positive and negative public health consequences of e-cigarettes, highlighting the need for experimental research, including laboratory studies and clinical trials. Policies should consider potential public health benefits of e-cigarettes, in addition to potential harms.

Does reduced smoking if you can't stop make any difference?

BACKGROUND

Promoting and supporting smoking reduction in smokers with no immediate intention of stopping smoking is controversial given existing fears that this will deter cessation and that reduction itself may not improve health outcomes.

DISCUSSION

Evidence shows that smokers who reduce the number of daily cigarettes smoked are more likely to attempt and actually achieve smoking cessation. Further, clinical trials have shown that nicotine replacement therapy benefits both reduction and cessation. Worldwide data suggests that 'non-medical' nicotine is more attractive to people who smoke, with electronic cigarettes now being widely used. Nevertheless, only one small trial has examined the use of electronic cigarettes to promote reduction, with direct evidence remaining inconclusive. It has been suggested that long-term reduced smoking may directly benefit health, although the benefits are small compared with cessation.

SUMMARY

The combined data imply that smoking reduction is a promising intervention, particularly when supported by clean nicotine; however, the benefits are only observed when it leads to permanent cessation.

[Contributions of auriculotherapy in smoking cessation: a pilot study]

OBJECTIVE

To evaluate the contribution of auriculotherapy in smoking cessation.

METHOD

Double-blind randomized controlled trial, conducted with 30 smokers allocated into two groups: Experimental Group (21 participants received 10 sessions of auriculotherapy at specific points for smoking) and Control Group (nine participants received auriculotherapy in points that have no effect on the focus of research).

RESULTS

Auriculotherapy contributed in reducing the number of cigarettes smoked in 61.9% of participants (p=0.002), in reducing the difficult to abstain from smoking in places where it is forbidden by 38% (p=0.050) and in not smoking when ill 23.8% (p=0.025).

CONCLUSION

Given the efficacy only in terms of reducing the number of cigarettes smoked and other parameters, we suggest that future studies consider the use of auriculotherapy combined with other treatment methods, in order to achieve better results in cessation/abstinence.

A randomized clinical trial of self-help intervention for smoking cessation: research design, interventions, and baseline data

Tobacco smoking is the leading preventable cause of mortality and morbidity. Although behavioral counseling combined with pharmacotherapy is the most effective approach to aiding smoking cessation, intensive treatments are rarely chosen by smokers, citing inconvenience. In contrast, minimal self-help interventions have the potential for greater reach, with demonstrated efficacy for relapse prevention, but not for smoking cessation. This paper summarizes the design and methods used for a randomized controlled trial to assess the efficacy of a minimal self-help smoking cessation intervention that consists of a set of booklets delivered across time. Baseline participant recruitment data are also presented. Daily smokers were recruited nationally via multimedia advertisements and randomized to one of three conditions. The Usual Care (UC) group received a standard smoking-cessation booklet. The Standard Repeated Mailings (SRM) group received 8 booklets mailed over a 12-month period. The Intensive Repeated Mailings (IRM) group received 10 booklets and additional supplemental materials mailed monthly over 18months. A total of 2641 smokers were screened, 2349 were randomized, and 1874 provided data for analyses. Primary outcomes will be self-reported abstinence at 6-month intervals up to 30months. If the self-help booklets are efficacious, this minimal, low cost intervention can be widely disseminated and, hence, has the potential for significant public health impact with respect to reduction in smoking-related illness and mortality.

Changes in smoking behavior and subsequent mortality risk during a 35-year follow-up of a cohort in Xi'an, China

Prospective evidence of the associations of smoking cessation with chronic obstructive pulmonary disease (COPD) and other causes of death in Asia is scarce. Previous studies, which were mostly based on baseline smoking behavior only, were subject to sick-quitter bias and misclassification resulting from changes in smoking behavior during follow-up. We followed up a cohort for 18 years (1976-1994) to assess changes in smoking behavior and then for an additional 17 years (1994-2011) to examine the relationships of continuing to smoke and new quitting with mortality risk in 1,494 Chinese people (961 men, 533 women). Of the baseline current smokers, 38.7% quit between 1976 and 1994. From 1994 to 2011, a total of 488 persons (359 men, 129 women) died. Ever smokers had increased risks of lung cancer, coronary heart disease, thrombotic stroke, and COPD, with dose-response relationships. For all tobacco-related mortality, the relative risk for new quitters compared with continuing smokers was 0.68 (95% confidence interval: 0.46, 0.99) for those who had quit 2-7 years previously and 0.56 (95% confidence interval: 0.37, 0.85) for those who had quit 8 years or more previously. The corresponding relative risks were 0.69 and 0.45 for lung cancer, 0.78 and 0.51 for coronary heart disease, 0.76 and 0.84 for thrombotic stroke, and 0.89 and 0.61 for COPD, respectively. Smoking increased tobacco-related deaths, and particularly deaths from COPD, in China, whereas quitting at middle age (at approximately 50 years of age) substantially reduced the risks of death from these causes. The benefits of smoking cessation were underestimated in previous studies that did not use repeated measures.

Increased mortality in schizophrenia due to cardiovascular disease - a non-systematic review of epidemiology, possible causes, and interventions

BACKGROUND

Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed.

METHODS

Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors' experience from clinical work and research in the field.

RESULTS

In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population.

DISCUSSION

The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.

Smoking and physical inactivity patterns during midlife as predictors of all-cause mortality and disability: A 39-year prospective study

This study estimated the long-term mortality hazards and disability risks associated with various combinations of smoking and physical inactivity measured over time in a sample of middle-aged adults. Data came from a national sample of Swedish adults, originally interviewed in 1968 and followed until 2007 (N=1,682). Smoking and physical activity status were measured at baseline and 13 years later (1981). Different patterns of change and stability in smoking and physical inactivity over this 13 year period were used as predictors of mortality through 2007. Also, associations between different patterns of these health behaviors and the odds of disability (measured in 2004) were estimated among survivors (n=925). Results suggest that mortality rates were elevated among persistent (HR=1.7; 95% CI=1.5, 2.0) and new smokers (HR=2.5; 95% CI=1.6, 4.1), but not among discontinued smokers. However, mortality rates remained elevated among discontinued smokers who were also persistently inactive (HR=1.9; 95% CI=1.3, 2.6). Additional findings suggest that persistent physical inactivity during midlife was associated with increased odds of late-life disability (OR=1.8; 95% CI=1.1, 2.7), but that smoking had no clear additive or multiplicative effects on disability. As such, these findings indicate that while persistent smoking during midlife primarily impacts subsequent mortality, persistent physical inactivity during midlife appears to counteract the survival benefits of smoking cessation, while also imposing a long-term risk on late life disability among those who do survive to old age.

An exploratory analysis of the impact of a university campus smoking ban on staff and student smoking habits in Japan

Background

Smoking bans in public places have been shown to have an impact on smoking habits, however the potential influence of a university smoking ban on faculty and staff smoking habits remains elusive.

Methods

This cross sectional study was implemented in Nayoro City, Japan in 2011, among the faculty and students of the Nayoro City University. Five years after the declaration of a total ban on smoking on a university campus, the smoking characteristics of all students, teachers and office workers, and the policy’s impact on smokers were investigated. The survey was conducted through an anonymous, self-administered, multiple-choice questionnaire. Information was gathered on the characteristics and smoking characteristics of respondents, and the smokers attitudes toward smoking.

Results

The recovery rate was 62.1%. Among respondents, smoking prevalence was 17.9% in teachers and office workers, and 4.0% in students. Among all smokers, 46.4% did not abstain from smoking while at the university and they indicated their smoking areas were “on the streets next to the campus”: 16 and “outdoors on campus”: 3, respectively. As for smokers, 29.6% of them reduced the number of cigarettes smoked per day as a result of the smoking ban. None of the ex-smokers replied that their principal motivation for quitting smoking was the smoking ban.

Conclusions

The ban on smoking served a motivator for smokers to reduce in smoking, but not serve as an effective motivator to quit smoking.

Does smoking reduction in midlife reduce mortality risk? Results of 2 long-term prospective cohort studies of men and women in Scotland

A long-term cohort study of working men in Israel found that smokers who reduced their cigarette consumption had lower subsequent mortality rates than those who did not. We conducted comparable analyses in 2 populations of smokers in Scotland. The Collaborative Study included 1,524 men and women aged 40-65 years in a working population who were screened twice, in 1970-1973 and 1977. The Renfrew/Paisley Study included 3,730 men and women aged 45-64 years in a general population who were screened twice, in 1972-1976 and 1977-1979. Both groups were followed up through 2010. Subjects were categorized by smoking intensity at each screening as smoking 0, 1-10, 11-20, or ≥21 cigarettes per day. At the second screening, subjects were categorized as having increased, maintained, or reduced their smoking intensity or as having quit smoking between the first and second screenings. There was no evidence of lower mortality in all reducers compared with maintainers. Multivariate adjusted hazard ratios of mortality were 0.91 (95% confidence interval (CI): 0.75, 1.10) in the Collaborative Study and 1.08 (95% CI: 0.97, 1.20) in the Renfrew/Paisley Study. There was clear evidence of lower mortality among quitters in both the Collaborative Study (hazard ratio = 0.66, 95% CI: 0.56, 0.78) and the Renfrew/Paisley Study (hazard ratio = 0.75, 95% CI: 0.67, 0.84). In the Collaborative Study only, we observed lower mortality similar to that of quitters among heavy smokers (≥21 cigarettes/day) who reduced their smoking intensity. These inconclusive results support the view that reducing cigarette consumption should not be promoted as a means of reducing mortality, although it may have a valuable role as a step toward smoking cessation.

Smoking trajectories from midlife to old age and the development of non-life-threatening health problems: a 34-year prospective cohort study

OBJECTIVE

To examine how trajectories of smoking observed over a 34-year period, were associated with the progression of mobility impairment, musculoskeletal pain, and symptoms of psychological distress from midlife to old age.

METHOD

The Swedish Level of Living Survey (LNU) and the Swedish Panel Study of the Oldest Old (SWEOLD) were merged to create a nationally representative longitudinal sample of Swedish adults (aged 30-50 at baseline; n=1060), with four observation periods, from 1968 through 2002. Five discrete smoking trajectory groups were treated as predictors of variation in health trajectories using multilevel regression.

RESULTS

At baseline, there were no differences in mobility impairment between smoking trajectory groups. Over time all smokers, particularly persistent and former heavy smokers, exhibited faster increases in mobility problems compared with persistent non-smokers. Additionally, all smoking groups reported more pain symptoms than the non-smokers, at baseline and over time, but most of these differences did not reach statistical significance. Persistent heavy smokers reported elevated levels of psychological distress at baseline and over time.

CONCLUSION

Smokers, and even some former smokers, who survive into old age appear to be at increased risk for non-life-threatening conditions that can diminish quality of life and increase demands for services.

Transitions in smoking status over time in a population-based panel study of smokers

INTRODUCTION

Few studies have examined the transitions of smokers in the general population through multiple periods of daily, occasional smoking, or abstinence over time. Transitions from daily to occasional smoking are particularly of interest as these may be steps toward cessation.

METHODS

The Ontario Tobacco Survey panel study followed 4,355 baseline smokers, semiannually for up to 3 years. Probabilities of all possible changes in smoking status more than 6 months were estimated using 13,000 repeated measures observations generated from sets of 3 consecutive interviews (n = 9,932 daily smokers, 1,245 occasion smokers, and 1,823 abstinent for at least 30 days, at Time 1).

RESULTS

For initial daily smokers, an estimated 83% remained daily smokers more than 2 follow-ups. The majority of those who had been abstinent for 30 days at 1 interview, were also former smokers at the following interview. In contrast, occasional smoking status was unstable and future smoking status was dependent upon smoking history and subjective dependence. Among daily smokers who became occasional smokers 6 months later, an estimated 20% became a former smoker, at the next interview, but 50% returned to daily smoking. Daily, turned occasional smokers who rebounded back to daily smoking were more likely to describe themselves as addicted at Time 1. Continuing occasional smokers were somewhat less likely to intend to quit, or have tried, despite considering themselves less addicted.

CONCLUSIONS

Reducing to occasional smoking can be a stepping stone toward cessation but entails a greater risk of return to daily smoking, compared with complete abstinence.

Weight concerns among Finnish ever-smokers: a population-based study

INTRODUCTION

Concern over weight gain after smoking cessation has been hypothesized to discourage quit attempts and consequently reduce smoking cessation rates. The aim of this study was to examine the association between smoking status and weight concerns among a population-based sample of Finnish ever-smokers.

METHODS

Data were collected in conjunction with the National FINRISK 2007 Study from a population-based sample of 25- to 74-yearold Finns. These analyses were based on a subsample of 1,614 ever-smokers. Participants were divided into 4 groups (daily smokers, occasional smokers, recent quitters, and former smokers) based on the self-reported smoking status. Weight concerns were analyzed as a sum score including 6 items (range 0-24). Regression analyses were used to examine the association between smoking status and weight concerns, while adjusting for multiple confounders.

RESULTS

Smoking status was significantly associated with weight concerns, current daily smokers reporting the highest levels of weight concerns. After adjusting for potential confounders (age, gender, body mass index, socioeconomic status, and health behavior), the weight concerns of daily smokers remained significantly higher in comparison with all other groups. Although women were more concerned about their weight than men, no gender-specific associations were found between weight concerns and smoking status.

CONCLUSIONS

Current daily smokers are more concerned about their weight than recent quitters, as well as former and occasional smokers. Weight concerns should be taken into account in tobacco dependence treatment.