Smoking cessation rates in the United States: a comparison of young adult and older smokers

Objectives. We compared smoking quit rates by age in a nationally representative sample to determine differences in cessation rates among younger and older adults.Methods. We used data on recent dependent smokers aged 18 to 64 years from the 2003 Tobacco Use Supplement to the Current Population Survey (n=31625).Results. Young adults (aged 18–24 years) were more likely than were older adults (aged 35–64 years) to report having seriously tried to quit (84% vs 66%, P<.01) and to have quit for 6 months or longer (8.5% vs 5.0%, P<.01). Among those who seriously tried to quit, a smoke-free home was associated with quitting for 6 months or longer (odds ratio [OR]=4.13; 95% confidence interval [CI]=3.25, 5.26). Compared with older smokers, young adults were more likely to have smoke-free homes (43% vs 30%, P<.01), were less likely to use pharmaceutical aids (9.8% vs 23.7%, P<.01), and smoked fewer cigarettes per day (13.2% vs 17.4%, P<.01).Conclusions. Young adults were more likely than were older adults to quit smoking successfully. This could be explained partly by young adults, more widespread interest in quitting, higher prevalence of smoke-free homes, and lower levels of dependence. High cessation rates among young adults may also reflect changing social norms.A key goal of tobacco control is to increase smoking cessation among young adults, because quitting at an early age increases the chances that a smoker will avoid the more serious health consequences of smoking.1 During the 1980s and 1990s, older smokers (50 years and older) were the most successful quitters,2^,3 and annual rates of successful quitting increased for all age groups.2 However, increases in cessation rates in the 1990s were greatest among young adults aged 20 to 34 years.2 Furthermore, among young adult smokers, but not older smokers, the increase in cessation rates was higher in states with higher cigarette prices and highest of all in California, which had a comprehensive statewide tobacco control program,2 suggesting that environmental factors may especially influence cessation rates among young adults. Projecting these national trends, we hypothesized that by 2003, young adults may have been the most successful quitters of any age group. Understanding recent changing influences on successful quitting could help increase the effectiveness of public health programs that aim to encourage cessation.Rates of successful quitting can differ between age groups because of differences in the proportion of smokers who try to quit, or because of differences in success rates among those who try. There is evidence that changes in the social norms surrounding smoking can lead to changes in the proportion of smokers who try to quit and that these norms can be influenced by tobacco-related news coverage4 and mass media advertising campaigns,5 both of which increased in the United States in the late 1990s with the Master Settlement Agreement and with the start of the American Legacy Foundation campaign.6 Young people (aged 0–29 years) may be particularly responsive to such influences,7 and throughout the 1990s, California’s tobacco control program used targeted media campaigns to specifically influence social norms about smoking.8Changes in social norms can also influence behavior associated with success in quitting. In particular, a decrease in levels of nicotine dependence among recent cohorts of smokers could partly explain higher rates of successful quitting among younger adults. Less-dependent smokers are more likely to successfully quit, presumably because of less-intense withdrawal symptoms.9^–11 Following the 1992 Environmental Protection Agency report classifying environmental tobacco smoke as a carcinogen,12 there was a rapid increase in social norms supporting restrictions on smoking,13 and increased restrictions on smoking at work and in public places have been associated with reduced levels of daily cigarette consumption.14^,15During the 1990s, an increasing proportion of smokers, particularly parents, banned smoking in the home.16 There is a strong association between smoke-free homes and successful quitting,17^,18 perhaps in part because a lapse, for example after a meal, is less likely. It is possible that recent birth cohorts who took up smoking under these restrictions at home and work may develop lower levels of dependence than previous cohorts,19 and they may themselves be more likely to live in a smoke-free home.During the 1990s, pharmaceutical aids became available to help overcome withdrawal symptoms, and these aids were associated with quitting success.20^,21 However, once these aids became easily available over the counter in 1996, their apparent effectiveness in population studies disappeared.22^,23 More in-depth analysis has suggested that effective use of pharmaceutical aids may be limited to smokers who are motivated to quit, such as those with a smoke-free home.24 Thus, differences in patterns of use of pharmaceutical aids between age groups may also contribute to recent differences in quitting success rates.We used a large nationally representative survey to compare US smoking cessation rates and associated tobacco-related behaviors between age groups. We compared attempted quitting rates across age groups each year as well as success rates among those who tried to quit smoking and explored whether there were important differences between age groups in prevalence of known correlates of cessation. We used multivariate logistic regression to establish whether differences in such correlates could account for differences in cessation rates, or whether younger smokers were quitting at higher rates than might be predicted by, for example, lower levels of addiction and a higher prevalence of smoke-free homes.     

Effect of type 2 diabetes and its duration on the risk of peripheral arterial disease among men

PURPOSE: To assess the relation between the duration of diabetes and the risk of peripheral arterial disease among men. METHODS: A total of 48,607 men in the Health Professionals Follow-up Study who returned a questionnaire in 1986 were followed for 12 years. Peripheral arterial disease (intermittent claudication or surgery for peripheral arterial diseases in the lower extremities) was ascertained by biennial questionnaire and confirmed by medical record review. Diabetes status and other cardiovascular risk factors were also ascertained by biennial questionnaire. RESULTS: During follow-up (534,588 person-years), we documented 387 cases of peripheral arterial disease. After adjusting for cardiovascular risk factors, the relative risk of developing peripheral arterial disease among men with diabetes compared with men without diabetes was 2.61 (95% confidence interval [CI]: 1.98 to 3.45). Compared with men without diabetes, the relative risk of peripheral arterial disease among men with diabetes increased with duration of disease, even after adjusting for cardiovascular risk factors: 1.39 (95% CI: 0.82 to 2.36) for 1 to 5 years of diabetes, 3.63 (95% CI: 2.23 to 5.88) for 6 to 10 years, 2.55 (95% CI: 1.50 to 4.32) for 11 to 25 years, and 4.53 (95% CI: 2.39 to 8.58) for >25 years of diabetes (P for trend < or =0.0001). CONCLUSION: These results indicate that duration of type 2 diabetes is associated strongly with the risk of developing peripheral arterial disease.     

Effects of a smoke-free law on hair nicotine and respiratory symptoms of restaurant and bar workers

OBJECTIVE: Bar and restaurant workers' exposure to secondhand smoke (SHS) was compared before and 3 and 6 months after implementation of a smoke-free ordinance. METHODS: Hair nicotine, self-reported exposure to SHS, and respiratory symptoms were assessed on 105 smoking and nonsmoking workers from randomly selected establishments in Lexington, Kentucky. Thirty-eight percent were current smokers with more than half smoking 10 or fewer cigarettes per day. Workers provided a hair sample at baseline and at the 3-month interview. RESULTS: There was a significant decline in hair nicotine 3 months postlaw when controlling for cigarettes smoked per day. Bar workers showed a significantly larger decline in hair nicotine compared with restaurant workers. The only significant decline in SHS exposure was in the workplace and other public places. Regardless of smoking status, respiratory symptoms declined significantly postlaw. CONCLUSIONS: Hospitality workers demonstrated significant declines in hair nicotine and respiratory symptoms after the law. Comprehensive smoke-free laws can provide the greatest protection to bar workers who are the most vulnerable to SHS exposure at work.     

Nicotine in hair of bar and restaurant workers

AIM: To measure the relation between workplace smoking policies and exposures to Environmental Tobacco Smoke (ETS) of workers in bars and restaurants. METHODS: 114 workers in Wellington and Auckland were questioned about sources of exposure to ETS and smoking habits, and details of the smoke-free policy in their work place were recorded. A hair sample was collected from each participant and tested for nicotine. RESULTS: Among non-smoking workers, hair nicotine levels varied strongly according to the smoke free policy at their place of work (Kruskall-Wallis, chi2 = 26.38, p < 0.0001). Those working in 100% smoke free restaurants had much lower levels than staff working in bars with no restrictions on smoking, and levels were intermediate for staff working in places with a partial smoking ban. These findings were not changed when adjustments were made for other sources of ETS exposure. Hair nicotine levels among nonsmokers working in places with no restriction on smoking were similar to hair nicotine levels of active smokers. CONCLUSION: The present New Zealand Smoke Free Environment Act does not protect workers in the hospitality industry from exposure to ETS. The findings from this study highlight the substantial levels of exposure of bar and restaurant staff from patrons' smoking.     

Measurement of nicotine in hair by reversed-phase high-performance liquid chromatography with electrochemical detection

We have developed an assay for nicotine in hair based on reversed-phase HPLC with electrochemical detection. The method uses a low-metal, high-purity silica reversed-phase column. We have investigated the washing, digestion and extraction procedures and discuss the important points in the HPLC method development. The assay is presented as an application in a population of exposed and non-exposed children. Analytical parameters are satisfactory with linearity, recoveries, limit of quantitation and precision all suitable for epidemiological studies involving environmental tobacco smoke exposure assessment.     

Snoring as a risk factor for type II diabetes mellitus: a prospective study

To examine the association between snoring and risk of developing type II diabetes mellitus, the authors analyzed data from the Nurses' Health Study cohort. This analysis included 69,852 US female nurses aged 40-65 years without diagnosed diabetes, cardiovascular disease, or cancer at baseline in 1986. Snoring patterns were ascertained by questionnaire. During 10 years of follow-up, 1,957 women were diagnosed with type II diabetes. In analyses adjusted for age and body mass index, snoring was associated with risk of diabetes (for occasional snoring vs. nonsnoring, relative risk (RR) = 1.48 (95% confidence interval (CI): 1.29, 1.70); for regular snoring vs. nonsnoring, RR = 2.25 (95% CI: 1.91, 2.66); p for trend < 0.0001). Further adjustment for other diabetes risk factors and sleeping-related covariates only slightly attenuated the risk (for occasional snoring, RR = 1.41 (95% CI: 1.22, 1.63); for regular snoring, RR = 2.03 (95% CI: 1.71, 2.40); p for trend < 0.0001). Analyses stratified by body mass index, smoking history, or parental history of diabetes showed a consistent association between snoring and diabetes within the categories of these variables. These results suggest that snoring is independently associated with elevated risk of type II diabetes.     

Measurement of tobacco smoke exposure: comparison of toenail nicotine biomarkers and self-reports.

BACKGROUND: Accurate measurement tools of exposure for use in large epidemiologic studies are lacking. Biomarkers of tobacco exposure provide additional advantages to self-reports and there is a need to further develop and validate them. The objective is to compare toenail nicotine levels, a novel biomarker of tobacco exposure, with self-reports of tobacco exposure from a large cohort study. METHODS: In this cross-sectional analysis, toenail samples were collected from 2,485 women participating in the Nurses' Health Study in 1982. Detailed self-reports of smoking habits and reported exposure to secondhand smoke (SHS) were collected from these women near the time of toenail collection. The toenail samples were analyzed by a high-performance liquid chromatography method for measuring nicotine. RESULTS: The 5 to 95 percentile range of toenail nicotine was from 0.06 to 4.06 ng/mg toenail and the median level was 0.21 ng/mg. There was a significant difference in toenail nicotine levels according to reported smoking status (the median level for nonsmokers with no SHS was 0.10 ng/mg, the median level for nonsmokers with SHS was 0.14 ng/mg, and the median level for active smokers was 1.77 ng/mg). However there was considerable overlap in nicotine levels according to reported smoking status. Toenail nicotine level was strongly associated with reported smoking level (Spearman r = 0.63), but there was no complete concordance, suggesting that the two methods are measuring different aspects of the same exposure. CONCLUSION: Our findings show that toenail nicotine levels capture the overall burden of tobacco smoke exposure and provide additional information on exposure not captured by reported history.