Cigarette smoking and quitting behaviors among unemployed adults in the United States.

Little is known about factors associated with smoking among the unemployed. This study estimated the prevalence of smoking and examined sociodemographic factors associated with current, former, and successful quitting among unemployed adults aged 18-64. Cross-sectional data on 13,480 participants in the 1998-1999 and 2001-2002 Tobacco Use Supplements to the Current Population Surveys were analyzed. Multivariate logistic regression analyses were used to examine factors associated with study outcomes (current vs. never, former vs. current, successful quitter vs. other former smoker). Among the unemployed, 35% were current smokers and 13% were former smokers. Of the former smokers, 81% quit successfully for at least 12 months. Participants with family incomes of less than US$25,000 were more likely than those with incomes of $50,000 or more to currently smoke (OR=2.13, 95% CI=1.85-2.46). Service workers and blue-collar workers were less likely than white-collar workers to report former smoking. Participants unemployed for 6 months or more were twice as likely as those unemployed for less than 6 months to quit successfully (OR=2.05, 95% CI=1.07-3.95). Unemployed blue-collar workers had a greater odds ratio of successfully quitting than white-collar workers (OR=1.83, 95% CI=1.17-2.87). Smoking rates were high among the unemployed, and quitting behaviors varied by sociodemographic factors and length of unemployment. Studies are needed to examine the feasibility of cessation interventions for the unemployed.     

Cigarette smoking and smoking cessation among older adults: United States, 1965-94

OBJECTIVE: To characterise patterns of cigarette smoking and smoking cessation among older adults in the United States. DESIGN: Data from the National Health Interview Surveys (NHIS) 1965-94 were analysed. The NHIS is a cross-sectional survey using a representative national sample. SETTING: In most cases interviews were conducted in the home; telephone interviews were conducted when respondents could not be interviewed in person. PARTICIPANTS: Participants were from a representative sample of the American civilian, non-institutionalised population aged 18 and older. Sample sizes for the years analysed ranged from n = 19,738 to n = 138,988 overall, and n = 3806 to n = 12,491 for those aged 65 years and older. MAIN OUTCOME MEASURES: Using the NHIS data from 1965-94, trends in current smoking and the prevalence of smoking cessation by demographic characteristics among older adults (65 years and older) were assessed and compared with trends among younger adults. A logistic regression analysis was conducted to determine the demographic characteristics of former smokers compared with current smokers among those aged 65 and older. RESULTS: The prevalence of current smoking among 65 year olds and older declined from 1965 to 1994 (17.9% to 12.0%). Although smoking prevalence was lower among older adults than younger adults (aged 18- 64), the rate of decline in smoking was slower among older adults. Among older adults, the prevalence of cessation rose with increasing educational attainment, and was consistently higher for men than for women and for whites compared with blacks. After adjustment for demographic factors among older adults who had ever smoked, increasing age and educational attainment were strongly related to the likelihood of being a former smoker. Although there were no racial differences among women, older white (OR = 2.6) and Hispanic (OR = 3.67) men were significantly more likely to be former smokers than older black men. Also, the gender difference in smoking cessation was noted only for whites. CONCLUSIONS: Given the projected increase in the elderly population, the medical and economic consequences of smoking will become a greater burden in the next decades. Therefore, focusing attention on cessation among the elderly is an immediate and urgent priority for public health professionals and clinicians.


     

Declining mortality from smoking in the United States.

The proportion of Americans who smoke cigarettes has declined 50% since 1965. The effect on mortality of this considerable reduction has received little attention and is described in this study. U.S. national data were used to enumerate current, former, and never-smokers aged 35 years or older in 1987 and 2002. Mortality rate ratios were used to estimate smoking-attributable deaths among these groups, and corresponding age-adjusted smoking-attributable mortality rates (SAMRs) were calculated. There were 402,000 deaths attributable to smoking in 1987 and 322,000 in 2002. The SAMR for men aged 35 years or more was 556 deaths per 100,000 person-years in 1987, accounting for 24% of all male deaths. By 2002 the SAMR declined 41% to 329 and accounted for only 17% of deaths. The SAMR for women in 1987 was 175, accounting for 12% of deaths. By 2002 the SAMR among women had declined 30% to 122, representing 9% of deaths. The U.S. mortality rate attributable to smoking declined about 35% between 1987 and 2002. The impact of smoking on American society will diminish even further in the foreseeable future as smoking prevalence continues its decline among men and women.     

Chewing gum consumption in the United States among children,adolescents and adults

Data regarding chewing gum consumption habits and attitudes were collected for 963 children and adolescents (aged 6–14) and 3150 adolescents and adults (aged 13 years+) in the United States (U.S.) using a dedicated online food frequency questionnaire. A total of 79.6% of children/adolescents reported using chewing gum in the last 3 months, whereas 61.8% of adolescents/adults chewed gum in the previous 6 months. The mean and 90th percentile of consumption among children/adolescents aged 6–14 were 1.95 and 4.71 g day^?1, equivalent to 0.75 and 1.78 pieces per day, respectively. Stratification by gender and age brackets revealed that the consumption of chewing gum was more heavily reported in boys compared to girls. Among adolescents/adults aged 13 years and older, the mean and 90th percentile of consumption of chewing gum was estimated to be 2.98 and 7.67 g day^?1, or 1.05 and 3.00 pieces per day, respectively. Stratification by gender and by age brackets in this cohort did not reveal any marked patterns although it was noted that there was a decrease in the percent consuming with age (from 87.0 to 34.5%). The most commonly reported chew frequency among all ages was ‘two or three times a week’ (23.7 to 26.8%). The average and high-level estimates reported herein provide up-to-date estimates of chewing gum consumption in the U.S. Comparisons of the calculated intake values with those reported from the National Health and Nutrition Examination Survey dataset suggests that national nutrition surveys may result in an under-reporting of the percent consumers, but similar estimates for the daily intakes in g day^?1.     

Cigarette and waterpipe smoking among Lebanese adolescents, a cross-sectional study, 2003-2004.

Waterpipe or "argileh" is a form of smoking other than cigarettes that is currently spreading among people of all ages. The objective of the present study was to assess tobacco smoking practices (waterpipe and/or cigarette) among public and private adolescent school students in Beirut, Lebanon. A sample of 2,443 students selected from 10 private and 3 public schools with intermediate/secondary classes filled out a self-administered anonymous questionnaire that inquired about sociodemographic characteristics, and behavior about tobacco smoking. Binary analysis was performed as well as three regression models for the relationship between exclusive cigarettes smoking, exclusive waterpipe smoking and both cigarettes and waterpipe as the dependent variables and gender, type of school, and class as the independent variables. The current prevalence of cigarettes smoking was 11.4%, and that of waterpipe smoking was 29.6%. Gender was significantly associated with cigarettes (OR=3.2, 95% CI 1.8-5.6) but not waterpipe smoking. Public school students were, respectively, 3.2 (95% CI 1.8-5.6) and 1.7 (95% CI 1.4-2.1) times more likely to be exclusive cigarettes smokers, and exclusive waterpipe smokers. Class was not significantly associated with exclusive cigarette smoking; however, students attending secondary classes were 1.3 (95% CI 1.1-1.6) times more likely to be exclusive waterpipe smokers. The reasons behind the high prevalence of both types of smoking are presented and discussed. The present study calls for school-based prevention programs and other types of interventions such as tax increases, and age-restrictions on tobacco sales. More aggressive interventions to disseminate education and awareness among parents and students altogether are warranted.     

Patterns of smoking, risk factors for smoking, and smoking cessation among Vietnamese men in Massachusetts (United States)

OBJECTIVES—To measure the prevalence and patterns of, and risk factors for, smoking and other tobacco use among Vietnamese men in Massachusetts (United States).
METHODS—Data were obtained via a telephone interview of 774 Vietnamese men in 1994.
DESIGN—Cross-sectional survey administered via telephone in 1994.
SETTING—Massachusetts, United States.
SUBJECTS—Randomly selected Vietnamese men (n = 774).
MAIN OUTCOME MEASURES—Present and past use of tobacco products, knowledge and attitudes regarding tobacco, and risk factors for tobacco use. Results were compared with data from the Massachusetts general population.
RESULTS—Vietnamese men smoked at a rate 1.9 times that of the Massachusetts general men's rate (43% vs 24%). The smoking rate did not decrease with increasing length of residence in the United States. In a logistic regression, risk factors for current smoking were: age in the thirties; history of parental smoking; lower educational level; higher depression score; low level of exercise; lack of health insurance; and geographical origin from the south coast of Vietnam. Smoking cessation declined with increasing depression score. Most smokers (76%) had no plans to quit smoking.
CONCLUSIONS—Vietnamese men smoke at much higher rates than the general population, and are much less likely to be planning cessation. High rates of depression and sociocultural barriers to smoking cessation must be addressed in efforts to reduce tobacco use among this high-risk population.


Keywords: smoking cessation; tobacco use; Vietnamese     

The role of psychiatric disorders in the relationship between cigarette smoking and DSM-IV nicotine dependence among young adults.

This study set out to evaluate the association between cigarette smoking and nicotine dependence (Diagnostic and Statistical Manual of Mental Disorders [4th ed.]) (DSM-IV), and to determine whether psychiatric disorders may signal greater sensitivity to nicotine dependence at similar levels of smoking exposure. Drawing on the young adult sample (aged 18-25 years) from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), we conducted logistic regression analyses. Smokers with major depression, alcohol use disorders, or specific phobia had a higher risk of meeting DSM-IV criteria for nicotine dependence than did those without these disorders. When examining smoking quantity, we found that rates of nicotine dependence were similar for those with and without major depression among nondaily smokers, yet among daily smokers, rates of nicotine dependence were consistently higher among those with major depression than among those without. Alcohol dependence elevated the risk of nicotine dependence at low to moderate levels of use. However, no difference in risk for nicotine dependence was observed between alcohol-dependent and nondependent individuals smoking more than a pack a day. Increased risk of nicotine dependence among those with a specific phobia was consistent across the range of current smoking levels. These findings add to the growing literature documenting dependence in nondaily smokers and demonstrate that although chronic smoking is often a key feature in dependence, psychiatric disorders may signal greater sensitivity to nicotine dependence symptoms at substantially lower levels of smoking exposure.     

Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries

Objective: To determine those groups who are at increased risk of smoking related diseases, we assessed in which male and female generations smoking was more prevalent among lower educated groups than among the higher educated, in 11 European countries.

Design: Cross sectional analysis of data on smoking, covering the year 1998, from a social survey designed for all member states of the European Union.

Subjects: Higher and lower educated men and women aged 16 years and older from 11 member states of the European Union.

Outcome measures: Age standardised prevalence rates by education and prevalence odds ratios of current and ever daily smoking comparing lower educated groups with higher educated groups.

Results: A north–south gradient in educational inequalities in current and ever daily smoking was observed for women older than 24 years, showing larger inequalities in the northern countries. Such a gradient was not observed for men. A disadvantage for the lower educated in terms of smoking generally occurred later among women than among men. Indications of inequalities in smoking in the age group 16–24 years were observed for all countries, with the exception of women from Greece and Portugal.

Conclusions: Preventing and reducing smoking among lower educated subgroups should be a priority of policies aiming to reduce inequalities in health in Europe. If steps are not taken to control tobacco use among the lower educated groups specifically, inequalities in lung cancer and other smoking related diseases should be anticipated in all populations of the European Union, and both sexes.

     

Cigarette smoking weakens exercise habits in healthy men.

To investigate the longitudinal impact of smoking cessation and relapse on the exercise habits of apparently healthy Japanese men, 750 subjects presenting for a checkup at a metropolitan health center were surveyed annually for 7 years. Exercise was dichotomously classified as none or any. Subjects were grouped in two categories: 98 smokers who ceased smoking during the second year of the study, matched with 196 continuing smokers and 196 men who had never smoked; and 52 relapsed smokers (including 2 new smokers) who did not smoke at baseline or at Year 1 but smoked from Year 2 to final follow-up, matched with 104 continuing smokers and 104 never-smokers. Based on self-reported responses to questionnaires, exercise was consistently less prevalent among smokers who did not quit than among never-smokers throughout the study. Habitual exercise in subjects who had quit smoking increased during the follow-up (any exercise: 42.9% at baseline increased to 51% at final follow-up, p for longitudinal trend = .115). Habitual exercise in matched never-smokers did not change during the study and decreased significantly among persistent smokers (p = .025). Habitual exercise in relapsed smokers decreased during the follow-up (any exercise: 50.0% at baseline declined to 32.7% at final follow-up, p = .007), but habitual exercise in matched persistent smokers and never-smokers did not change. We conclude that smoking and sedentary lifestyle coexist continuously, that smoking cessation is associated with increased habitual exercise among healthy men, and that relapse is associated with reduced habitual exercise, suggesting that cigarette smoking weakens exercise habits.     

Getting young adults to quit smoking: a formative evaluation of the X-Pack Program.

The lack of promising smoking cessation interventions targeting young adults is a recognized public health problem. This study was designed to determine the feasibility of a young-adult-oriented program, the X-Pack Program, when administered to college student smokers, and to estimate its effect on smoking cessation. Participants (N = 83) were randomized after enrollment to receive either a moderately intensive, E-mail-based, young-adult intervention (the X-Pack group) or a less-intensive program aimed at a general adult audience (the Clearing the Air group). Participants were assessed at baseline and at 3 and 6 months after enrollment. Participants in the X-Pack group rated their treatment more favorably overall, were more engaged in program activities, and quit for more consecutive days at the 3- and 6-month follow-ups, compared with the Clearing the Air group. Differences in quit rates favored the X-Pack group at the two follow-ups, but the differences were not significant. These findings offer some support for the X-Pack Program when administered to college smokers.