Smoking cessation and receipt of cessation advice from health professionals among older smokers in Taiwan

ObjectivesTo examine the prevalence and correlates of smoking cessation and receiving professional cessation advice among older smokers in Taiwan.MethodsCross-sectional data from the 2008–2010 and 2012 Taiwan Adult Smoking Behavior Survey was used to form a sample of 4081 recent active smokers aged 50 +, comprising current smokers and former smokers who quit smoking within the past 12 months. We examined three outcome variables: quit attempt in the past 12 months, successful cessation for at least 3 months, and receipt of health professional cessation advice. Multivariate logistic regressions were used to identify significant correlates.ResultsDuring the study period, the annual quit attempt rate was 41.4%, annual successful cessation rate was 4.7%, and prevalence of receiving cession advice among smokers who visited health professionals within the past 12 months was 72.3%. After controlling for other covariates, quit attempts were significantly higher in 2009 and positively associated with higher education, poorer health status, smoke-free homes, and receipt of cessation advice. Successful cessation was significantly higher in 2009, positively associated with older age, higher income, and smoke-free homes, and negatively associated with receiving cessation advice. Receipt of cessation advice was significantly lower in 2010 and 2012, positively associated with male gender, older age, and poorer health status, and negatively associated with higher education.ConclusionsOur results suggest that targeting lower educated and lower income subgroups, adopting effective strategies to increase voluntary smoke-free home rules, and improving professional cessation advice will have great potential to further reduce smoking prevalence in older smokers.     

Predictors of attempted quitting and cessation among young adult smokers

BACKGROUND: This study compared young adult nonsmokers (n = 1216), light smokers (n = 406), and regular smokers (n = 360) on demographic, psychosocial, and behavioral characteristics, as well as identified predictors of attempted quitting and 6-month cessation among regular smokers. METHOD: Participants were recruited from middle schools in 1985 (age 13) and assessed repeatedly through 2001 (age 29). Mail surveys were used to obtain information on smoking status and hypothesized predictors of cessation at age 23, and quit attempts and cessation occurring between ages 23-39 among regular smokers. Logistic regression analysis was used to identify predictors of quit attempts and 6-month cessation. RESULTS: Among initial smokers, 76% attempted to quit and 26% quit for 6 months or longer between ages 23-29. Higher rates of substance use, illegal activity, poor mental health, and victimization were found among regular smokers than nonsmokers and lighter smokers at age 23. However, multivariate analyses indicated that these problems were less relevant to quitting than social transitions and interpersonal factors, demographics (e.g., race/ethnicity), and health status. CONCLUSIONS: Different risk and protective factors are relevant to understanding why smokers attempt to quit versus why they are able to quit for 6 months or longer. We discuss implications of these findings for cessation interventions and programs for young adults.     

Smoking cessation and mortality trends among two United States populations.

The long-term impact of smoking cessation on mortality is assessed among two U.S. populations: a large cohort of U.S. veterans aged 55-64 at entry and followed from 1954 through 1979 and the NHANES I Epidemiologic Followup Study (NHEFS) cohort of a national sample of U.S. adults aged 55-74 at entry and followed from 1971 through 1992. Direct and indirect survey data indicate that 50-70% of those who were current cigarette smokers at entry had quit smoking during the 19- to 26-year follow-up periods. The impact of smoking cessation on mortality among the cigarette smokers as a whole has been assessed by determining the time trend of the relative risk (RR) of death and 95% confidence interval (CI) for the cigarette smokers compared with never-smokers over the entire follow-up period in both cohorts. The total death rates for the 1954/57 U.S. veteran smokers as a whole (63,159 males) have converged only slightly toward those of never-smokers, from RR = 1.65 (1.58-1.72) during 1954-1959 to RR = 1.61 (1.58-1.63) during 1954-1979. The lung cancer death rates for 1954/57 smokers as a whole have not converged toward those of never-smokers, with RR = 10.89 (7.70-15.41) during 1954-1959 and RR = 11.10 (9.78-12.61) during 1954-1979. The total death rates for the 1971-1975 NHEFS smokers as a whole (694 males and 1116 females) have not converged toward those of never-smokers. For males, RR = 1.92 (1.46-2.52) during 1971-1982 and RR = 1.96 (1.63-2.36) during 1971-1992; for females, RR = 1.79 (1.31-2.46) during 1971-1982 and RR = 1.79 (1.47-2.17) during 1971-1992. The lung cancer death rates have diverged, based on small numbers of deaths. For males, RR = 15.76 (2.06-120.61) during 1971-1982 and RR = 22.20 (5.31-92.92) during 1971-1992; for females, RR = 2.92 (0.57-15.06) during 1971-1982 and RR = 4.74 (1.94-11.59) during 1971-1992. These trends are contrary to the substantial convergence predicted by the death rate trends among U.S. veterans who were former smokers at the beginning of follow-up. While these results confirm that those former smokers who survive for at least 5 years experience death rates that converge toward those of never-smokers, they also indicate that a cohort of cigarette smokers that undergoes substantial cessation experiences a death rate that does not converge toward the death rate of never-smokers. The fact that there has been no convergence for lung cancer is quite surprising, as this is the disease most strongly linked to smoking and smoking cessation and less likely to be influenced by other lifestyle factors. Further investigation is needed for a complete understanding of the impact of smoking cessation.     

Public policy and smoking cessation among young adults in the United States

In the wake of significant budget shortfalls, numerous states have increased cigarette excise taxes to boost revenues. This study examines whether or not increasing the price of cigarettes, which will occur as a consequence of cigarette excise tax increases, and implementing stronger restrictions on smoking in private worksites and other public places have an impact on smoking cessation decisions of young adults, thereby influencing public health in the United States (US). This paper employs longitudinal data on young adults from the Monitoring the Future Surveys matched with information on site-specific prices and measures of clean indoor air restrictions. A Cox regression is employed to estimate the smoking cessation equations. The estimates clearly indicate that increasing the price of cigarettes increases the number of young adults who quit smoking. The average price elasticity of cessation is 0.35. In addition, stronger restrictions on smoking in private worksites and public places other than restaurants increase the probability of young adult smoking cessation. Given the well-documented benefits of smoking cessation, a significant increase in cigarette excises taxes may be one of the most effective means to reduce premature death and disease in the United States.     

Quit attempts and quit rates among menthol and nonmenthol smokers in the United States

Objectives. We compared quit attempts and quit rates among menthol and nonmenthol cigarette smokers in the United States.Methods. We used data from the 2003 and 2006–2007 waves of the large, nationally representative Tobacco Use Supplement to the Current Population Survey with control for state-level tobacco control spending, prices, and smoke-free air laws. We estimated mean prevalence, quit rates, and multivariate logistic regression equations by using self-respondent weights for menthol and nonmenthol smokers.Results. In 2003 and 2007, 70% of smokers smoked nonmenthol cigarettes, 26% smoked menthol cigarettes, and 4% had no preference. Quit attempts were 4.3% higher in 2003 and 8.8% higher in 2007 among menthol than nonmenthol smokers. The likelihood of quitting was 3.5% lower for quitting in the past year and 6% lower for quitting in the past 5 years in menthol compared with nonmenthol smokers. Quit success in the past 5 years was further eroded among menthol-smoking Blacks and young adults.Conclusions. Menthol smokers are more likely to make quit attempts, but are less successful at staying quit. The creation of menthol preference through marketing may reduce quit success.On June 22, 2009, the Family Smoking Prevention and Tobacco Control Act was signed into law, granting the US Food and Drug Administration (FDA) the authority to regulate tobacco products by establishing the Center for Tobacco Products (CTP). As one of the first activities of the CTP, the FDA will review evidence on the impact of menthol in cigarettes on the public health to determine whether to recommend removal of mentholated cigarettes from the US market. Regarding the process of making decisions for a proposed ban on menthol in cigarettes, the act specifies that scientific evidence be considered with a broad population-based standard rather than a narrow individual standard. Specifically, the CTP must consider (1) the risks and benefits to the population as a whole, including users and nonusers of tobacco products, (2) the increased or decreased likelihood that existing users of tobacco products will stop using such products, and (3) the increased or decreased likelihood that those who do not use tobacco products will start using such products.¹In 2008, more than one third (33.9%) of past-month smokers aged 12 years and older reported smoking menthol cigarettes²; this rate equates to more than 10 million menthol smokers in the United States.³ The prevalence of menthol cigarette use is highest among Black smokers (82.6%) and young smokers (44.8%)²—2 groups that have been the target of menthol cigarette marketing by the tobacco industry.^4–6 Studies of youths indicate that menthol flavoring affects smoking initiation, with higher proportions of recent initiates smoking mentholated cigarettes compared with those who have been smoking more than 1 year,^2,7 and that middle-school smokers are more likely to smoke menthol cigarettes than are high-school smokers.⁷Recent research also suggests that smoking menthol cigarettes negatively influences smoking cessation among adults. One randomized controlled study showed no difference in 7-day point prevalence abstinence between menthol and nonmenthol smokers at 6 months,⁸ but 2 other studies^9,10 reported reduced cessation among menthol smokers, though results were not consistent across all follow-up time points. Of 5 population studies examining differences in smoking cessation by menthol cigarette use,^11–15 the 2 more recent studies reported significantly lower quit rates among menthol smokers compared with nonmenthol smokers at follow-up.^13,15 Gandhi et al.¹⁵ and Gundersen et al.¹³ also highlighted reduced cessation among Black and Latino menthol smokers. Few studies have explored the impact of menthol cigarette use on smoking cessation in large population-based studies. We used a large, recent national- and state-representative data set to examine quit rates among menthol and nonmenthol cigarette smokers. Unlike previous population studies, we explicitly considered the role of quit attempts and also controlled for the state tobacco control policies.     

天津市戒烟门诊158名就诊吸烟者戒烟状况调查

目的 了解天津市戒烟门诊就诊吸烟者的人群特点、吸烟情况、戒烟情况,为更有效的开展戒烟门诊服务提供科学依据。方法 调查前来三家戒烟门诊就诊的158名吸烟者,并于一个月后进行随访。结果 就诊吸烟者中50%(79/158)是通过医生推荐或转诊至戒烟门诊,47.5%(75/158)决定戒烟的原因是自身患病,59.5%(94/158)的人尝试过戒烟;就诊吸烟者的平均烟龄为19.5年,平均每日吸烟量为16.3支;一个月随访的应答率为86.7%(137/158),一个月随访的时点戒烟率为43.1%(59/137),未戒烟者的一个月时点减烟率为56.4%(44/78);27.0%(37/137)的人认为医生或药物对其戒烟帮助最大。结论 天津市戒烟门诊能提高吸烟者的戒烟率,但目前就诊人数较少,还应继续加大戒烟门诊的宣传力度。     

Smoking and cancer in the United States

Based on the mortality experience of over one million Americans who have been followed in a prospective epidemiologic study since 1959, it is estimated that from 25 to 35% of cancer mortality in the U.S. male population and 5 to 10% in the female population are mainly due to smoking of tobacco products and cigarettes. These estimates are remarkably close to those derived from other U.S. studies and similar studies in the United Kingdom and Japan. While it is clear that several factors contribute to the causation of smoking-related cancer mortality, it is unlikely that the excess in deaths would occur in the absence of tobacco usage. The contribution of smoking is hence considered as the preponderant risk, and one that could be controlled by combined actions of individuals' responses to education, legislation, and modification of cigarettes toward less hazardous characteristics.     

Long-term trends in adolescent and young adult smoking in the United States: metapatterns and implications

Objectives. We sought to describe long-term adolescent and young adult smoking trends and patterns.Methods. We analyzed adolescent data from Monitoring the Future, 1976 to 2005, and young adult (aged 18–24 years) data from the National Health Interview Survey, 1974 to 2005, overall and in subpopulations to identify trends in current cigarette smoking prevalence.Results. Five metapatterns emerged: we found (1) a large increase and subsequent decrease in overall smoking over the past 15 years, (2) a steep decline in smoking among Blacks through the early 1990s, (3) a gender gap reversal among older adolescents and young adults who smoked over the past 15 years, (4) similar trends in smoking for most subgroups since the early 1990s, and (5) a large decline in smoking among young adults with less than a high school education.Conclusions. Long-term patterns for adolescent and young adult cigarette smoking were decidedly nonlinear, and we found evidence of a cohort effect among young adults. Continued strong efforts and a long-term societal commitment to tobacco use prevention are needed, given the unprecedented declines in smoking among most subpopulations since the mid- to late 1990s.Cigarette smoking has long been recognized as having high mortality, morbidity, and economic costs.1^–6 Because of the addictive nature of nicotine,3^,7 preventing cigarette smoking is an especially important societal goal.4^,8 Most regular smokers smoke their first cigarette by age 18 years,9^–11 although there is some evidence that the age of initiation may be increasing.9^,11 Because smoking initiation rarely occurs at later ages, the critical time for prevention occurs in adolescence and early adulthood.4^,9^–13After a sharp increase in adolescent and young adult smoking that began during the late 1980s, there was a rapid and unprecedented decline in prevalence, especially among adolescents, beginning in the mid-to late 1990s.9^,14^,15 Most surveys suggest that adolescent prevalence has slowed or leveled off over the past few years.11^,14^,15Examining long-term trend data among adolescents and young adults can serve several purposes. Long-term trend data can help assess the effectiveness of past and existing prevention activities, assess the need for future prevention efforts, and predict the future burden of tobacco-related health effects.16 Building on previous national trend studies,3^,12^–26 we used smoothing techniques and regression analyses to comprehensively describe overall and subgroup-specific long-term cigarette smoking trends and to identify meta-patterns among adolescents and young adults in the United States.     

Smoking cessation and relapse among pregnant African-American smokers in Washington, DC

Smoking is the single most preventable cause of perinatal morbidity. This study examines smoking behaviors during pregnancy in a high risk population of African Americans. The study also examines risk factors associated with smoking behaviors and cessation in response to a cognitive behavioral therapy (CBT) intervention. This study is a secondary analysis of data from a randomized controlled trial addressing multiple risks during pregnancy. Five hundred African-American Washington, DC residents who reported smoking in the 6 months preceding pregnancy were randomized to a CBT intervention. Psycho-social and behavioral data were collected. Self-reported smoking and salivary cotinine levels were measured prenatally and postpartum to assess changes in smoking behavior. Comparisons were made between active smokers and those abstaining at baseline and follow-up in pregnancy and postpartum. Sixty percent of participants reported quitting spontaneously during pregnancy. In regression models, smoking at baseline was associated with older age,   

Smoking cessation in indigenous populations of Australia, New Zealand, Canada, and the United States: elements of effective interventions

Indigenous people throughout the world suffer a higher burden of disease than their non-indigenous counterparts contributing to disproportionate rates of disability. A significant proportion of this disability can be attributed to the adverse effects of smoking. In this paper, we aimed to identify and discuss the key elements of individual-level smoking cessation interventions in indigenous people worldwide. An integrative review of published peer-reviewed literature was conducted. Literature on smoking cessation interventions in indigenous people was identified via search of electronic databases. Documents were selected for review if they were published in a peer-reviewed journal, written in English, published from 1990-2010, and documented an individual-level intervention to assist indigenous people to quit smoking. Studies that met inclusion criteria were limited to Australia, New Zealand, Canada, and the USA, despite seeking representation from other indigenous populations. Few interventions tailored for indigenous populations were identified and the level of detail included in evaluation reports was variable. Features associated with successful interventions were integrated, flexible, community-based approaches that addressed known barriers and facilitators to quitting smoking. More tailored and targeted approaches to smoking cessation interventions for indigenous populations are required. The complexity of achieving smoking cessation is underscored as is the need to collaboratively develop interventions that are acceptable and appropriate to local populations.     

A comparison of injury death rates in China and the United States, 1986.

BACKGROUND: The importance of injury as a public health problem is not well recognized in many developing countries. Data have recently become available on injury mortality in China. METHOD: We compared Chinese injury data based on a 100 million population segment for 1986 with data for the United States. RESULTS: The age-adjusted death rate from all injuries for China exceeds the rate for the US (69.0 vs 61.3 per 100,000). The US has higher death rates from motor vehicle crashes, fires, and homicide; China has greater mortality from drowning, poisoning, falls, and suicide. Especially noteworthy in China are the high drowning rates among young children and the elderly and the high suicide rates in rural areas among young adults and the elderly. CONCLUSION: Injury is an important public health problem in China, exceeding in many respects the problem in the United States. It is urgent for China to place high priority on injury research and prevention.     

Life expectancies of cigarette smokers and nonsmokers in the United States

This research employs the National Health Interview and the National Mortality Followback Surveys to calculate life expectancies by age and sex for white nonsmokers, former smokers, and current smokers in the United States in 1986. In general, life expectancies are higher for never smokers than for former smokers, and higher for former smokers than for current smokers. Heavy smokers have lower life expectancies than persons with all other smoking statuses; indeed, compared to never smokers, heavy smokers at age 25 can expect at least a 25% shorter life. Gender differences in life expectancies were found to persist even with the elimination of smoking. Differences in life expectancy by sex thus appear to be due, in part, to cigarette smoking, but also to occupational, environmental, and sociodemographic factors.