Smoking trends in Italy from 1950 to 2000

Dietary habits, lifestyles, and overall adherence to 2018 WCRF/AICR cancer prevention recommendations among adult women in the EPIC-Florence cohort: Changes from adulthood to older age and differences across birth cohorts

OBJECTIVES, SETTING AND PARTICIPANTS

We aimed to examine changes in dietary habits, lifestyles (e.g., smoking, physical activity levels, and alcohol intake), anthropometry, other individual health-relevant characteristics, and overall adherence to 2018 WCRF/AICR cancer prevention recommendations, among women enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Florence cohort.

DESIGN AND MEASUREMENTS

We fitted age- and energy intake-adjusted generalized linear models to describe (a) changes occurring over a person's lifetime in the transition from adulthood to older age, and (b) differences between women aged 56-60 years belonging to two birth cohorts spaced apart by around 25 years (born in 1933-1941 vs. 1958-1964).

RESULTS

Dietary habits and overall adherence to cancer prevention recommendations improved among women (n = 3,309) followed from adulthood to older age (mean age 47.4 and 71.8 years, respectively), despite increases in the prevalence of adiposity and sedentary lifestyle. Women in the younger birth cohort (n = 163) showed significantly greater overall adherence to cancer prevention recommendations than in the older birth cohort (n = 355), but had more often a positive smoking history and an average larger waist circumference.

CONCLUSION

A trend toward better adherence to cancer prevention recommendations emerged when analyzing adult-to-older-age trajectories and differences across birth cohort, yet some critical issues were also identified. Continuous monitoring is essential to detect changing prevention needs and adapt public health policies and practices.

Trends of colorectal cancer incidence and mortality rates from 2003 to 2014 in Italy

OBJECTIVE

To evaluate the trends of colorectal cancer (CRC) incidence and mortality rates from 2003 to 2014 in Italy by age groups and regions.

METHODS

We used the data of 48 cancer registries from 17 Italian regions to estimate standardized incidence and mortality rates overall and by sex, age groups (<50, 50-69, 70+ years), and geographic area (northwest, northeast, center, south, and islands). Time trends were expressed as annual percent change in rates (APC) with 95% confidence intervals (95% CI).

RESULTS

Incidence rates decreased from 104.3 (2003) to 89.9 × 100,000 (2014) in men and from 64.3 to 58.4 × 100,000 in women. Among men, incidence decreased during 2007-2010 (APC -4.0, 95% CI -6.0 to -1.9) and 2010-2014 (APC -0.7, 95% CI -1.4 to 0.0), while in women it linearly decreased during the whole period (APC -1.1, 95% CI -1.4 to -0.8). Mortality rates showed a linear reduction both in men (APC -0.7, 95% CI -1.0 to -0.3) and women (APC -0.9, 95% CI -1.2 to -0.6) and decreased respectively from 41.1 to 39.2 × 100,000 and from 24.6 to 23.1 × 100,000. In the 50- to 69-year-old range (screening target age), incidence showed a prescreening increase, followed by a peak after screening started, and a decline thereafter. Incidence and mortality rates significantly decreased in all areas but in the south and islands, where incidence increased and mortality remained stable.

CONCLUSIONS

A renewed commitment by all regional health systems to invest in primary (i.e., lifestyle) and secondary (i.e., screening programs) prevention is of utmost importance.

Mortality rates for chronic lower respiratory diseases in Italy from 1979 to 2010: an age-period-cohort analysis

Chronic lower respiratory diseases (CLRDs) are a major cause of morbidity and mortality worldwide. The objectives of this study were to estimate the trends in CLRD mortality in Italy, and the specific contributions of age, time period and birth cohort in driving these trends. Population and cause-of-death data in Italy between 1979 and 2010 were collected from the World Health Organization website. Age-specific mortality rates for CLRDs, and effects for age, time period and birth cohort on mortality trends were estimated using age-period-cohort models. Chronic obstructive pulmonary disease (COPD) and chronic bronchitis represent nearly 98% of the deaths from CLRDs. Despite the overall number of deaths have been stable (in men) or increasing (in women), the age-standardised rates have been steadily decreasing from 1979 to 2010, passing from 104.3 to 55.4 per 100 000 person-years in men and from 32.2 to 19.6 per 100 000 person-years in women. The average relative annual decrease was -3.6% in men and -2.7% in women. Since the end of the 1990s, the decreasing trend of CLRD mortality has started to level off, in particular in women. The decrease in CLRD mortality rates has been more accentuated in more recent cohorts and in younger age groups. Both birth cohort and time period significantly affected the CLRD mortality rates, suggesting that changes in the spread of risk factors (smoking habits, early-life and occupational exposures) across different birth cohorts, as well as in advanced in healthcare and medical practice, may have played a major role in secular changes in COPD mortality rates in Italy.

SETIL: Italian multicentric epidemiological case-control study on risk factors for childhood leukaemia, non hodgkin lymphoma and neuroblastoma: study population and prevalence of risk factors in Italy

BACKGROUND

Aetiology of childhood leukaemia and childhood neoplasm is poorly understood. Information on the prevalence of risk factors in the childhood population is limited. SETIL is a population based case-control study on childhood leukaemia, conducted with two companion studies on non-Hodgkin Lymphoma (NHL) and neuroblastoma. The study relies on questionnaire interviews and 50 Hz magnetic field (ELF-MF) indoor measurements. This paper discusses the SETIL study design and includes descriptive information.

METHODS

The study was carried out in 14 Italian regions (78.3% of Italian population aged 0-10). It included leukaemia, NHL and neuroblastoma cases incident in 0-10 year olds in 1998-2001, registered by the Italian Association of Paediatric Haematology and Oncology (AIEOP) (accrual over 95% of estimated incidence). Two controls for each leukaemia case were randomly sampled from the Local Health Authorities rolls, matched by gender, birthdate and residence. The same controls were used in NHL and neuroblastoma studies. Parents were interviewed at home on: physical agents (ELF-MF and ionizing radiation), chemicals (smoking, solvents, traffic, insecticides), occupation, medical and personal history of children and parents, infectious diseases, immunizations and associated factors. Occupational exposure was collected using job specific modules. ELF-MF was measured in the main rooms (spot measurement) and close to child's bed (48 hours measurement).

RESULTS

The study included: 683 leukaemia cases (87% ALL, 13% AnLL), 97 NHL, 155 neuroblastomas, and 1044 controls.

CONCLUSIONS

SETIL represents a data source on exposure of Italian children to a broad array of potential carcinogenic factors.

Trends in inequalities in health, risk and preventive behaviour among the advanced-age population in Austria: 1983-2007

BACKGROUND

Although a number of previous research studies have focused on the long-term analysis of the health and health behaviour of the elderly, there is still a shortage of information in relation to the long-term trends regarding health or risk and preventive behaviour in the elderly population taking into account gender differences and differences in educational level.

METHODS

The database comprised subsamples of the Austrian Micro-Census, including individuals aged 65 years and older, for the years 1983, 1991, 1999, and subsamples of the ATHIS (Austrian Health Interview Survey) 2007. A trend analysis was conducted for four health-related variables with the year of the survey and education as predictors. The analysis was stratified by sex.

RESULTS

We found a general trend towards better self-rated health, better preventive and less risk behaviour among the elderly, while the body mass index has been increasing over the years. There are indeed gender differences regarding the trend in smoking behaviour. While the prevalence of male smoking has been steadily decreasing, female smoking prevalence has not changed. At all points in time, individuals with higher education had significantly better self-rated health than those with lower education but the association between education and preventive behaviour significantly decreased over the years.

CONCLUSION

We agree with previous research in concluding that preventive action and health promotion should aim in particular to support older women and men with lower education.

Biological and social predictors of smoking and perception of health

Világszerte jelentős figyelmet fordítottak a dohányzás biológiai (biológiai nem, életkor) és szociális (iskolai végzettség, foglalkoztatottság, lakóhely) jellemzőiben megmutatkozó egyenlőtlenségek vizsgálatára. Magyarországon ugyanakkor kevés elemzés történt ebben a témában. A dohányzással összefüggő morbiditási és mortalitási adatok hazai emelkedése ellenére a magyar lakosság egészségészlelése indokolatlanul optimista. Jelen tanulmányban a dohányzás biológiai és szociális prediktorjellemzőit a napi dohányzás prevalenciájával való összefüggésében, az általános egészség percepcióját pedig abban az összefüggésben vizsgáltuk, hogy a vizsgálati személyek milyennek tartották az egészségi állapotukat, és a vizsgálat időpontjában dohányoztak-e, valamint hány éves korukban kezdtek el dohányozni. A vizsgálati időszak 1990–2008 volt. A vizsgálat empirikus adatai 15, dohányzásra irányuló reprezentatív kutatás egyéni szintű adatbázisából származtak. A minta nagysága 30 352 személyt ölelt fel. GLIMMIX, GLM és logisztikus regressziós elemzést alkalmaztunk metaanalízis keretében. Az eredmények szerint a dohányzás prevalenciája a vizsgálati időszakban emelkedést mutatott. A nőknél lényegesen nagyobb volt a napi dohányzás prevalenciájának emelkedése, mint a férfiaknál. Az alacsony iskolai végzettség, a munkanélküliség és az egy lakásban élők magas száma megnövelte a napi dohányzás, a dohányzás ténye és korai kezdete pedig megnövelte a megkérdezettek saját egészségükről vallott rossz véleményének a valószínűségét. Az eredményekben megmutatkozó dohányzási tendenciák felhívják a figyelmet az eddigi hazai dohányzáspolitikák és prevenciós gyakorlat elégtelenségére, és azonnali szakmai, politikai intervenciót sürgetnek átfogó nemzeti stratégia keretében.

Explaining the unexpected success of the smoking ban in Italy: political strategy and transition to practice, 2000–2005

The approval (2003) and enforcement (2005) of a smoking ban in Italy have been viewed by many as an unexpectedly successful example of policy change. The present paper, by applying a processualist approach, concentrates on two policy cycles between 2000 and 2005. These had opposing outcomes: an incomplete decisional stage and an authoritative decision, enforced two years later. Through the analysis of the different phases of agenda setting, alternative specification and decision making, we have compared the quality of participation of policy entrepreneurs in the two cycles, their political strategies and, in these, the relevance of issue image. The case allows us to direct the attention of scholars and practitioners to an early phase of the policy implementation process – which we have named "transition to practice". This, managed with political strategy, might have strongly contributed to the final successful policy outcome.

Smoking in pregnancy and lactation: a review of risks and cessation strategies

BACKGROUND

Despite documented evidence of harm to fetus and infant, a substantial number of women continue to smoke during pregnancy and lactation.

OBJECTIVE

To examine the literature regarding smoking during pregnancy and breastfeeding to ascertain adverse effects as well as the efficacy of interventions to enable women to stop smoking in the perinatal period.

STUDY DESIGN

A comprehensive literature search was undertaken to identify all published studies reporting on smoking in pregnancy and lactation. MEDLINE, EMBASE, PUBMED, and Web of Science databases were searched for studies published in English from 1966 to 2008 that reported on smoking in pregnancy and breastfeeding, with information on adverse effects and on all forms of smoking cessation, including behavioral interventions, nicotine replacement therapy, and pharmacotherapy such as antidepressants.

RESULTS

There is evidence that smoking in pregnancy and lactation may cause many adverse affects in the perinatal period, childhood, and up to adulthood. These adverse effects include infertility, ectopic pregnancy, spontaneous abortion, placenta insufficiency, low birth weight, fetal growth restriction, preterm delivery, orofacial clefts, SIDS, craniosynostosis, clubfoot, childhood respiratory disease, attention deficit disorder, and some childhood cancers. A number of strategies have been developed to assist pregnant women in quitting smoking, including both behavioral interventions and pharmacological therapies, such as nicotine replacement and antidepressant therapy.

CONCLUSIONS

Behavioral interventions report only modest success rates. Nicotine replacement therapy and antidepressants appear to be safe to use in pregnancy, but do not achieve a substantially higher success rate for quitting.

Smoking trends and educational level in Italy in the age group 20-24, from 1950 to 2000

Smoking represents an important world research issue because of its diffusion among people and its effects on health. This study analyses, according to gender and educational level, the prevalence of smoking, in order to highlight the relationship between sociocultural status and smoking. Prevalence was calculated, with reference to Italian national data in 2000, by dividing a weighted population of 38,720,629 into 10 five-year birth cohorts. Results suggest that smoking is no longer perceived as being socially acceptable behavior. The prevalence declines for both sexes and educational levels, but in low educational levels the decline is slower. The study limitations are noted.

Trends in smoking in Sweden from 1968 to 2002: age, period, and cohort patterns

OBJECTIVE

Smoking is related to many later life health outcomes. We examined age, period, and cohort patterns in smoking between 1968 and 2002.

METHODS

A nationally representative panel study allowed repeated cross-sectional comparisons of ages 18-75 (5 waves n approximately 5000), and ages 77+ at later waves (2 waves n approximately 500). Cross-sectional 10-year age group differences in 5 waves, time-lag differences between waves for age groups, and within-cohort differences between waves for 10-year birth cohorts were evaluated using graphs and ordered logistic regressions.

RESULTS

Age-period-cohort models suggested that period and age effects dominated smoking patterns, showing decreases over time and age. The 1935-44 and 1945-54 cohorts, however, showed lesser period decline. Moreover, men showed a period reduction of smoking rates but no age related decrease, while women showed an age related decrease but no period effect. The genders' cohort patterns were similar, with higher smoking rates in the last waves for some cohorts, for men the 1945-54 cohort and women the 1935-44 cohort.

CONCLUSIONS

Cross-sectional studies of cohorts must be aware of age effects. Due to the coming of age of the 1940s' cohorts smoking may increase among women in the oldest age groups.

Socioeconomic differentials in premature mortality in Rome: changes from 1990 to 2001

Background

While socioeconomic inequalities in mortality have widened in many countries, evidence of social differentials is scarce in Southern Europe. We studied temporal changes in premature mortality across socioeconomic groups in Rome between 1990 and 2001.

Methods

We analysed all 126,511 death certificates of residents of Rome aged 0–74 years registered between 1990–2001. A 4-level census block index based on the 1991 census was used as an indicator of socioeconomic position (SEP). Using routine mortality data, standardised mortality rates (per 100,000 inhabitants) were calculated by SEP and gender for four time periods. Rate ratios were used to compare mortality by gender and age.

Results

Overall premature mortality decreased in both genders and in all socioeconomic groups; the change was greater in the highest socio-economic group. In both men and women, inequalities in mortality strengthened during the 1990s and appeared to stabilise at the end of the 20th century. However, for 60–74 year old women the gap continued to widen.

Conclusion

Socioeconomic inequalities in health in Rome are still present at the beginning of the 21^st century. Strategies to monitor the impact of SEP on mortality over time in different populations should be implemented to direct health policies.