Smoking in the UK– Between 1996 amd 2001 the Million Women Study started following more than one million women aged 50 to 65 years of age. In a report published in the Lancet, trial investigators, including renowned epidemiologist Richard Peto, found that 12-year mortality was significantly higher in women with a history of smoking compared to women who never smoked (rate ratio 2.76, CI 2.71-2.81). Smokers, the authors calculated, lose 10 years of life. The good news is that stopping smoking before the age of 40 reduces the excess mortality by 90%.
Smoking in Japan– The Life Span Study, published in BMJ, was started in 1950 and has followed more than 65,000 men and women in Hiroshima and Nagasaki, Japan. The results were consistent with the Million Women Study in the UK: the rate ratio for mortality was more than doubled for smokers compared to nonsmokers both for men (2.21, CI 1.97-2.48) and for women (2.61, CI 1.98-3.44). The investigators also reported that stopping smoking before age 35 eliminated almost all of the risk associated with smoking.
Smoke-free legislation meta-analysis– Smoking is not just a personal decision that has individual health effects. A new meta-analysis published in Circulation found that smoke-free legislation results in immediate reductions in hospital admissions or deaths for coronary events (RR .848, CI .816-.881), other heart disease (RR .610, CI .440-.847), cerebrovascular accidents (RR .840, CI .753-.936) and respiratory disease (RR .760, CI .682-.846). The authors, Crystal Tan and Stanton Glatz, also report that the biggest reductions in events were associated with the most stringent smoke-free laws.
Smoke-free legislation in Minnesota– Here’s one more study to lend support to the above meta-analysis. In a paper published in Archives of Internal Medicine Richard Hurt and colleagues analyzed data before and after the implementation of a smoke-free law in Olmsted County, Minnesota and found a significant 33% reduction in the incidence of MI from 150.8 to 100.7 per 100000 people and a trend in the reduction of sudden cardiac death by 17% from 109.1 to 92.0 per 100,000 people. In an accompanying commentary, Sara Kalkhoran and Pamela Ling write that as “the evidence base documenting the positive health outcomes” of smoke-free legislation grows, “we should prioritize the enforcement of smoke-free policies, eliminating loopholes in existing policies as well as encouraging expansion of smoke-free policies to include multiunit housing, motor vehicles, casinos, and outdoor locations. Exposure to SHS should not be a condition of employment, and all workers, including those of lower income and those in the service and hospitality industries, should have equal protection from SHS exposure.”
Here is the Lancet press release:
Study of a million women finds giving up smoking can extend life by ten years
The largest-ever study of the hazards of smoking and benefits of stopping for women in the UK has shown that female smokers lose at least ten years of lifespan, but that stopping before the age of 40, and preferably well before the age of 40, avoids more than 90% of the increased risk of dying caused by continuing to smoke, while stopping before the age of 30 avoids over 97% of it.
The research, based on results from the Million Women Study*, is published Online First in The Lancet today [Saturday, October 27] to mark the 100th anniversary of the birth of Sir Richard Doll, one of the first people to identify the link between lung cancer and smoking.
1·3 million women were recruited to the study between 1996 and 2001, at ages 50 to 65 years. Participants completed a questionnaire about lifestyle, medical and social factors and were resurveyed by post three years later. The NHS central register notified the researchers when any participant died, giving the cause of that death. Women were traced for an average of twelve years from the time they first joined; thus far, 66 000 study participants died.
Initially, 20% of the study participants were smokers, 28% were ex-smokers, and 52% had never smoked. Those who were still smokers at the 3-year resurvey were nearly three (2·97) times as likely as non-smokers to die over the next 9 years, even though some reduced their risk by stopping smoking during this period.
This threefold death rate ratio means that two-thirds of all deaths of smokers in their 50s, 60s, and 70s are caused by smoking, as most of the difference between smokers and non-smokers came from smoking-related diseases such as lung cancer, chronic lung disease, heart disease, or stroke. The risks among smokers increased steeply with the amount smoked, although even for those who were light smokers (1–9 cigarettes per day) at the start of the study, mortality rates were double those for non-smokers.
The key finding is that both the hazards of smoking and, correspondingly, the benefits of stopping are bigger than previous studies have suggested; smokers who stopped around age 30 avoided 97% of their excess risk of premature death, and although serious excess hazards remained for decades among those who smoked until age 40 before stopping, the excess hazards among those who continued smoking after age 40 were ten times bigger.
According to co-author Professor Sir Richard Peto, at the University of Oxford, UK, “If women smoke like men, they die like men – but, whether they are men or women, smokers who stop before reaching middle age will on average gain about an extra ten years of life.” He added, “Both in the UK and in the USA, women born around 1940 were the first generation in which many smoked substantial numbers of cigarettes throughout adult life. Hence, only in the 21st century could we observe directly the full effects of prolonged smoking, and of prolonged cessation, on premature mortality among women.”**
Writing in a linked Comment, Professor Rachel Huxley, at the University of Minnesota, USA, adds “That we had to wait until the 21st century to observe the full consequences in women of a habit that was already widespread in the mid-20th century, when tobacco smoking pervaded much of the developed world, might seem paradoxical. But this is because, in most of Europe and the USA, the popularity of smoking among young women reached its peak in the 1960s, decades later than for men. Hence, previous studies have underestimated the full eventual impact of smoking on mortality in women, simply because of the lengthy time lag between smoking uptake by young women and disease onset in middle and old age.”
NOTES TO EDITORS:
* The study was conducted by the authors for the Million Women Study Collaborators. The Million Women Study is funded by Cancer Research UK, the Medical Research Council, and the Health and Safety Executive.
** Quote direct from author and cannot be found in text of Article.
Here is the BMJ press release:
Smoking takes 10 years off life expectancy in Japan, not 4 as previously thought, experts warn
But much of the risk can be avoided if smoking is stopped, preferably well before age 35
Research: The impact of smoking on mortality and life expectancy in Japan
Smoking reduces life expectancy by ten years in Japan, but much of the risk can be avoided by giving up smoking, a paper published on bmj.com today shows.
Previous studies in Japan suggested smoking reduced life expectancy by only a few years compared with about ten years in Britain and the USA. This new report, from researchers in Oxford and Japan, investigates the impact of smoking on mortality in a large group of Japanese people who were living in Hiroshima or Nagasaki in 1950. The findings are, however, nothing to do with radiation exposure from the bombs.
The Life Span Study (LSS) was initiated in 1950 to investigate the effects of radiation, tracking over 100,000 people. However, most received minimal radiation exposure, and can therefore provide useful information about other risk factors. Surveys carried out later obtained smoking information for 68,000 men and women, who have now been followed for an average of 23 years to relate smoking habits to survival.
The younger a person was when they started smoking the higher the risk in later life. Older generations did not usually start to smoke until well into adult life, and usually smoked only a few cigarettes per day. In contrast, Japanese born more recently (1920-45) usually started to smoke in early adult life, much as smokers in Britain and the USA.
These differences in smoking habits are reflected in the mortality patterns. Smokers born before 1920 lost just a few years. In contrast, men born later (1920-45) who started to smoke before age 20 lost nearly a decade of life expectancy, and had more than double the death rate of lifelong non-smokers, suggesting that more than half of these smokers will eventually die from their habit. Results on the few women who had smoked since before age 20 were similar.
Previous studies of the effects of smoking in Japan had been mainly of individuals born in the first few decades of the twentieth century who probably didn’t start to smoke until well into adult life and smoked only a few cigarettes per day. This explains why the risks of smoking seemed low. Nowadays, however, young Japanese smokers tend to smoke more cigarettes per day and to start at a younger age, so their risks will be higher.
In addition to studying the risk of smoking, the researchers were able to examine the benefits of stopping. As elsewhere, those who stopped smoking before age 35 avoided almost all the excess risk among continuing smokers, and even those who stopped around age 40 avoided most of it.
The researchers conclude that the future health risks to young smokers are likely to be just as big in Japan as in other countries although much of the risk can be avoided by stopping.
Here is the press release from Circulation:
Smoke-free laws led quickly to fewer hospitalizationsStudy Highlights:
- Comprehensive smoke-free laws were associated with a rapid 15 percent decrease in hospitalizations for heart attacks, 16 percent for stroke and24 percent for asthma and other respiratory hospitalizations.
- The most comprehensive laws — those covering workplaces, restaurants and bars — resulted in more health benefits.DALLAS, Oct. 29, 2012 — Smoke-free legislation was associated with substantially fewer hospitalizations and deaths from heart and respiratory diseases, according to research in the American Heart Association journal Circulation.Researchers reviewed 45 studies covering 33 smoke-free laws at the local and state levels around the United States and from countries as varied as Uruguay, New Zealand andGermany and found:
- Comprehensive smoke-free laws were associated with a rapid 15 percent decrease in heart attack hospitalizations and 16 percent decrease in stroke hospitalizations.
- Smoke-free laws were also rapidly followed by a 24 percent decrease in hospitalizations for respiratory diseases, including asthma and chronic obstructive pulmonary disease.
- The most comprehensive laws — those covering workplaces, restaurants and bars — resulted in the highest health benefits.“The public, health professionals and policy makers need to understand that including exemptions and loopholes in legislation – such as exempting casinos – condemns more people to end up in emergency rooms,” said Stanton Glantz, Ph.D., senior study author and director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. “These unnecessary hospitalizations are the real cost of failing to enact comprehensive smoke-free legislation.”The findings support the American Heart Association’s position that smoke-free laws should be comprehensive and apply to all workplaces and public environments, including restaurants, bars and casinos. The analysis also is consistent with other studies that have found smoke-free laws were followed by significant decreases in acute heart attack and other cardiac-related hospital admissions.“Stronger legislation means immediate reductions in secondhand smoke-related health problems as a byproduct of reductions in secondhand smoke exposure and increases in smoking cessation that accompany these laws,” Glantz said. “Passage of these laws formalize and accelerate social change and the associated immediate health benefits.”Crystal E. Tan, M.S., a medical student at UCSF, is co-author of the study.Author disclosures are on the manuscript.The National Cancer Institute funded the study.Follow @HeartNews on Twitter for the latest heart and stroke news.For stroke science, follow the Stroke journal at @StrokeAHA_ASA .###
Here is the press release from Archives of Internal Medicine:
Decline in Incidence of Heart Attacks Appears Associated with Smoke-Free Workplace Laws
CHICAGO – A decline in the incidence of myocardial infarction (MI, heart attack) in one Minnesota county appears to be associated with the implementation of smoke-free workplace laws, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.
Exposure to secondhand smoke (SHS) is associated with coronary heart disease (CHD) in nonsmokers, and research suggests that the cardiovascular effects of SHS are nearly as large as those with active smoking, according to the study background. Elimination of smoking in public places, such as by smoke-free laws and policies, has the potential for reducing smoking and perhaps cardiovascular events.
Richard D. Hurt, M.D., and colleagues at the Mayo Clinic, Rochester, Minn., evaluated the incidence of MI and sudden cardiac death (SCD) in Olmsted County, Minn., during the 18-month period before and after implementation of smoke-free ordinances. In 2002, a smoke-free restaurant ordinance was implemented and, in 2007, all workplaces, including bars, became smoke free.
“We report a substantial decline in the incidence of MI from 18 months before the smoke-free restaurant law was implemented to 18 months after the comprehensive smoke-free workplace law was implemented five years later,” the authors comment.
When comparing the 18 months before implementation of the smoke-free restaurant ordinance with the 18 months after implementation of the smoke-free workplace law, the incidence of MI declined by 33 percent from about 150.8 to 100.7 per 100,000 population, and the incidence of SCD declined by 17 percent from 109.1 to 92 per 100,000 population.
“All people should avoid SHS exposure as much as possible, and those with CHD should have no exposure to SHS,” the authors conclude.
(Arch Intern Med. Published online October 29, 2012. doi:10.1001/2013.jamainternmed.46.)
Editor’s Note: This study was supported in part by a grant from ClearWay Minnesota, a grant from the National Heart, Lung and Blood Institute/National Institutes of Health and a grant from the National Institute on Aging/National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Extending the Health Benefits of Clean Indoor Air Policies
In an invited commentary, Sara Kalkhoran, M.D., and Pamela M. Ling, M.D., M.P.H., of the University of California, San Francisco, write: “The results of the study by Hurt et al highlight some of the potential benefits of 100 percent smoke-free policies in workplaces, restaurants and bars: significantly decreased incidence of myocardial infarction and a trend toward decreased sudden cardiac death.”
“Moving forward, we should prioritize the enforcement of smoke-free policies, eliminating loopholes in existing policies as well as encouraging expansion of smoke-free policies to include multiunit housing, motor vehicles, casinos and outdoor locations,” they continue.
“Exposure to SHS should not be a condition of employment, and all workers, including those of lower income and those in the service and hospitality industries, should have equal protection from SHS exposure,” they conclude.
(Arch Intern Med. Published online October 29, 2012. doi:10.1001/2013.jamainternmed.269. )
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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