Age related changes in age of starting to smoke

Using the National Health Interview Survey to understand and address the impact of tobacco in the United States: past perspectives and future considerations

OBJECTIVE

The National Health Interview Survey (NHIS) is a continuous, nationwide, household interview survey of the civilian noninstitutionalized population of the United States. This annual survey is conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. Since 1965, the survey and its supplements have provided data on issues related to the use of cigarettes and other tobacco products. This paper describes the survey, provides an overview of peer-reviewed and government-issued research that uses tobacco-related data from the NHIS, and suggests additional areas for exploration and directions for future research.

DATA SOURCES

We performed literature searches using the PubMed database, selecting articles from 1966 to 2008. Study selection. Inclusion criteria were relevancy to tobacco research and primary use of NHIS data; 117 articles met these criteria. Data extraction and synthesis. Tobacco-related data from the NHIS have been used to analyze smoking prevalence and trends; attitudes, knowledge, and beliefs; initiation; cessation and advice to quit; health care practices; health consequences; secondhand smoke exposure; and use of smokeless tobacco. To date, use of these data has had broad application; however, great potential still exists for additional use.

CONCLUSION

NHIS data provide information that can be useful to both practitioners and researchers. It is important to explore new and creative ways to best use these data and to address the full range of salient tobacco-related topics. Doing so will better inform future tobacco control research and programs.

The evolution of educational inequalities in smoking: a changing relationship and a cross-over effect among German birth cohorts of 1921-70

AIMS

To investigate the evolution of the relationship between education and smoking behaviour (ever-smoking and age of initiation) among German birth cohorts of 1921-70.

PARTICIPANTS

A total of 5297 respondents to the German Federal Health Survey of 1998 were divided into 10-year sex-birth-education cohorts.

MEASUREMENTS

Self-reported smoking histories (ever-smoking and the age of starting smoking).

FINDINGS

There was an inversion of the educational gradient around the birth cohorts of 1931-40 for men and 1941-50 for women. For men, the educational cross-over in smoking was due to a stronger decrease of the ever-smoking prevalence of the highly educated compared to the least educated. In women it was due to a stronger increase in ever-smoking prevalence among the least educated compared to the highly educated. This educational cross-over effect was also be detected for the average age of starting smoking, and involved the same cohorts. Additionally, in the youngest birth cohorts the differences between the least and highest educated of each gender were greater than the differences between the genders.

CONCLUSIONS

The educational differences in smoking prevalence are stable in men but in women they are widening. Hence, socio-economic inequalities in health due to smoking will rise in women in the next decades, while they will stabilize in men.

Trends in cigarette smoking initiation and cessation among birth cohorts of 1926-1970 in Germany

This study examines temporal differences in cigarette smoking initiation and cessation among male and female birth cohorts of 1926-1970 born in Germany. Based on the German Federal Health Survey 1998 the sample is divided into a series of 5-year sex-birth cohorts, beginning with those born between 1926 and 1930 and extending to those born between 1966 and 1970. The final data file consists of a sample of 5110 people. Ever-smoking prevalence among men varies from 60 to 70% between the birth cohorts, while in women born 1926-1930 ever-smoking increases from 20 to about 50% in those born 1966-1970. A reduction of the median age at starting smoking also takes place between the cohorts. With 8.5 years this decrease is more incisive among women, compared with a drop of 2 years among men. Regarding cessation patterns the analysis shows a shift towards a shorter duration of smoking with succeeding birth cohorts, again this shift is more incisive in women. But even in the youngest cohort still more than 50% of ever-smokers smoke regularly for more than 25 years. In Germany tobacco-control activities are required in order to take antismoking actions that especially prevent youth from starting to smoke and that support smokers in quitting.

The controversial controversy of a passionate controversialist

Alvan Feinstein was among the pioneers who perceived the need to apply epidemiologic principles and methods to clinical medicine. In his attempt to convert his peers to his own views, he was very liberal in criticizing the work of others. Epidemiologists still recall his 1988 article in Science entitled "Scientific Standards in Epidemiologic Studies of the Menace of Daily Life," in which he criticized observational epidemiology for its lack of scientific rigor. In this context, Feinstein's work has also been the center of controversies. One in particular, related to the fact that he carried out research and consulted for industries, in particular the tobacco industry, has tainted the last years of Feinstein's career. My purpose in this article is to discuss Feinstein's relationship with the tobacco industry. It is not to judge the validity of his work. Against this background, a question of historic relevance, one that can be discussed on the basis of some evidence, is whether Feinstein, world-reknowned epidemiologist and editor of this journal from 1982 until his recent death, helped the tobacco industry to publish articles minimizing the deleterious effects of smoking in the Journal of Chronic Diseases and (since 1988) the Journal of Clinical Epidemiology. To address this question I have searched the articles related to the effects of tobacco that were published in the Journal since 1978. The tobacco industry has had the opportunity, via its consultants, to defend its own ideas in the "Variance and Dissent" section. Perhaps in hindsight Feinstein could be criticized for not having clearly indicated the sponsorship of the tobacco industry behind these publications, of which he was fully aware. However, this does not suffice to infer that he was the tobacco industry's "man." Feinstein's attitude in matters of publication appears balanced.

[The factors associated with tobacco use in a sample of schoolchildren at the primary and secondary levels]

The target of this study is to describe the prevalence and the associated factors to the smoking consumption in a sample of schoolchildren. During the academic year 1991-92 were administered 1,816 surveys among students of 13 and 18 years-old, whom corresponded to 7th and 8th EGB courses and all courses of BUP, COU and FP grades. The survey, include five Barcelona schools and one of Raimat (Lleida). The total rate of regular smokers was 28.6%, without differences between sex. The associated variables to smoking daily consumption in the bivariate analysis were to be more than 15 years old (OR = 3.5), to be student of FP grades (OR = 2.5), the low socioeconomic level (OR = 1.4), the influence of other smokers in the environment of the student (OR = 1.6), the advantageous attitudes the smoking consumption (OR = 37.0), a little level of physical activity (OR = 2.1), the alcohol associated consumption (OR = 15.1), and the greater responsibility of weekly own money (OR = 2.4). In the multivariate analysis stays the effect of all these variables, less for the socioeconomic level. In conclusion our results are consistent with previous studies and reinforce the necessity of approaching these factors in the preventive smoking programs in schoolchildren.

[Characteristics of tobacco smoking in schools in Andorra]

1600 schoolchildren aged 13 to 18 answered an anonimus, self administered questionnaire, in a cross sectional study to estimate the prevalence of cigarette smoking in the high grades schools in Andorra. 46.6% answered they did smoke cigarettes, either daily (11.2%) or occasionally (35.4%). Ten per cent of actual smokers did already smoke at age 10, and 50% at age 13. More girls (48.8%) than boys (44.4%) smoked (p less than 0.05) but boys smoked a greater number of cigarettes (p less than 0.001). Ninety five percent smoked Virginia tobacco, and little more than 50% used filter tipped cigarettes. Two thirds of smokers inhaled the smoke of cigarettes; this was more common among daily smokers. Again two thirds of smokers answered they would be prepared to quit smoking. 31% of those who had tried smoking said they believed they would smoke in the future, while only 5.6% of those that never smoked previously said so (p less than 0.001). Actual smokers answered they believed that they would not smoke in the future much less often than non smokers. Parents let boys smoke more than girls when the children started doing so, particularly before age thirteen and after age fifteen. These are the first available data about the community studied describing some features of its cigarette smoking habit. Their knowledge may well help to plan disease protection and health promotion developments addressed to youngsters in Andorra.

Determinants of teenage smoking, with special reference to non-standard family background

The prevalence of teenage smoking in a cohort of 12,058 subjects born in northern Finland in 1966 is discussed in terms of its social and family determinants, especially in "non-standard" families (with one or more of the parents absent for at least part of the child's upbringing). The prevalence of experimental or daily smoking was 67.4%, the rate being 65.5% in the standard, two-parent families and 75.5% in the non-standard families, the difference being statistically significant (p less than 0.001). The corresponding prevalence of daily smoking was 6.4%, but the rate was 5.1% in standard families and 12.1% in non-standard families (p less than 0.001). An elevated risk of smoking existed among adolescents who had experienced death of their father or divorce of their parents and among girls who had experienced death of their mother. Maternal smoking during pregnancy and maternal age under 20 years at the time of delivery increased the risk, while being the first-born child reduced it. Among family factors existing in 1980, paternal smoking increased the risk for both sexes, while more than three siblings, mother's unemployment or gainful employment (i.e. not a housewife) were associated with smoking by the boys as was urban living, and for the girls migration by the family to a town. The results suggest that juvenile smoking may be a kind of indicator of possible problems experienced by the parents and/or the adolescents themselves with respect to parenthood and family development.