Smoking in Italy, 1994

Mortality in the cohort of talc miners and millers from Val Chisone, Northern Italy: 74 years of follow-up

OBJECTIVE

To update the analysis of mortality of a cohort of talc miners and millers in Northern Italy.

METHODS

We analyzed overall mortality and mortality from specific causes of death during 1946-2020 of 1749 male workers in a talc mine where asbestos was not detected (1184 miners and 565 millers) employed during 1946-1995.

RESULTS

The overall standardized mortality ratio (SMR) was 1.21 (95 % confidence interval [CI] 1.14-1.28); no deaths were observed from pleural cancer. Mortality from lung cancer was not increased (SMR = 1.02 95 % CI 0.82-1.27), while mortality from pneumoconiosis was (SMR 9.55; 95 % CI 7.43-12.08), especially among miners (SMR 12.74; 95 % CI 9.79-16.31). There was a trend in risk of pneumoconiosis with increasing duration of employment in the overall cohort, and the SMR for 25+ years of employment was 15.12 (95 % CI 10.89-20.43).

CONCLUSIONS

This uniquely long-term follow up confirms the results of previous analyses, namely the lack of association between exposure to talc with no detectable level of asbestos and lung cancer and mesothelioma. Increased mortality from pneumoconiosis among miners is related to past exposure to silica.

Cancer Mortality in Italy, 1992

Background

Data and statistics are presented on cancer death certification in Italy, updating previous publications covering the period 1955-1991.

Methods

Data for 1992 subdivided into 30 cancer sites are presented in 8 tables, including age- and sex-specific absolute and percentage frequencies of cancer deaths, and crude, age-specific and age-standardized rates, at all ages and truncated for the 35-64 year age group. Male to female ratios have also been tabulated, and trends in age-standardized rates for major cancer sites plotted from 1955 to 1992.

Results

Age-adjusted death certification rates (on the world standard population) for all neoplasms declined from 193.4 in 1991 to 189.8/100,000 males in 1992, and from 100.1 to 99.5/100,000 females. The favorable trends were even more marked in middle and younger age, but not in children below age 15, whose overall age-standardized cancer mortality rates were higher in 1992 than in 1989. Lung cancer was by far the leading site of cancer mortality, with over 30,700 deaths. For the fourth subsequent year, its rates in males declined, to reach 57.0/100,000, but continued to rise in females, to reach 8.0/100,000. Rates for other major cancer sites (intestines, stomach, female breast, prostate, pancreas) were stable or moderately favorable, but some increase was apparent also in 1992 for non-Hodgkin's lymphoma death rates.

Conclusions

Italian cancer mortality rates in 1992 were moderately favorable, with the major exception of the persistent spread of the tobacco-related lung cancer epidemic in females.

Cancer Mortality in Italy, 1994, and an Overview of Trends from 1955 to 1994

Background

Data and statistics are presented on cancer death certification in Italy, updating previous publications covering the period 1955-1993.

Methods

Data for 1994 and the quinquennium 1990-94 subdivided into 30 cancer sites are presented in 8 tables, including age- and sex-specific absolute and percentage frequencies of cancer deaths, and crude, age-specific and age-standardized rates, at all ages and truncated for the 35-64 year age group. Trends in age-standardized rates for major cancer sites are plotted from 1955 to 1994.

Results

The age-standardized (world standard) death certification rates from all neoplasms steadily declined from the peak of 199.2/100,000 males in 1988 to 186.3 in 1994, and in females from 102.5 in 1989 to 98.6 in 1994. Ever larger was the decline in truncated rates, for males from the peak of 275.1/100,000 in 1983 to 223.2 (-19%) in 1994, and for females from 151.6/100,000 in 1987 to 136.4 (-10%). A major component of the favourable cancer mortality trends in males was lung cancer (accounting for 31,000 deaths in both sexes combined in 1994), whose overall age-standardized rates declined from 60.3 in 1987-89 to 54.6/100,000 males in 1994 (-9%), and from the peak of 96.7 in 1983 at ages 35 to 64 to 72.7 in 1994 (-25%). In contrast, female lung cancer rates have remained stable from 1992 onwards, but have increased from 7.2 to 7.7 at all ages and from 10.6 to 11.0 at age 35-64 between 1985-89 and 1990-94. These different trends in the two sexes reflect the patterns and trends in smoking among Italian males and females.

Conclusions

Cancer mortality trends in Italy over the period 1990-94 were relatively favourable, mainly reflecting the decline in lung cancer rates in males, together with the persistent declines in gastric cancer in both sexes and in cervix uteri for women. Continuous advancements were registered for neoplasms amenable to treatment, essentially testicular cancer, Hodgkin's disease and childhood leukaemias. The major unfavourable trends were observed for non Hodgkin's lymphomas, and require therefore further monitoring, besides a clearer understanding of their determinants. Italy maintains an intermediate level of cancer mortality on a European scale, suggesting that further progress is possible, mostly for tobacco-related neoplasms in males.

Italian General Practitioners and Smoking Cessation Strategies

Aims and Background

General practitioners (GPs) are in a key position to intervene with patients who smoke. The cornerstone of a smoking cessation strategy should be the routine provision of brief advice and follow-up in primary care. However, it seems GPs do not often take action against smoking, at least in Italy as shown by previous reports. The survey was planned, in the context of the “GPs Empowerment Project”, a collaborative project involving Denmark, France, Greece, Italy and Portugal, under the ENSP contract with the European Commission (Health & Consumer protection Directorate-General), to evaluate the general attitude, knowledge and behavior of GPs regarding smoking cessation methods.

Methods

A total of 729 family doctors, 409 in Northern and 320 in Southern Italy, were interviewed by phone in the period July-October 2000 regarding their personal smoking habits and their approach with patients on the topic. Prevalence rates were computed using the Epi INFO 6.0 software and were presented as the unadjusted percentage prevalence.

Results

The percentage of current smokers among GPs included in the survey was 28.3%, with a higher prevalence in the south (33.3%). Most of the GPs believe that it is their duty to give information about smoking cessation (96.8%) and consider giving information about smoking cessation to their patients an important intervention (98.5%), but only about 49% think their patients will accept their advice. Most GPs (87.3%) declared having discussed about tobacco use with their patients during the month preceding the interview, and 83.5% would like to be trained on smoking cessation strategies.

Conclusions

The results show that, in order to implement primary prevention in clinical practice in Italy, it appears essential to reduce the number of GPs who smoke and to improve GP training on smoking cessation procedures.

Smoking in Italy, 2002

Aims and background

To update estimates of smoking prevalence in Italy to the year 2002.

Methods

Population-based, face-to-face survey conducted by the DOXA (the Italian Branch of the Gallup International Association) in March-April 2002 on 3,238 individuals aged 15 or over, representative of the whole Italian population.

Results

Overall, 26.6% of Italian adults were current cigarette smokers (31.1% of men, 22.3% of women); 19.9% of men and 10.4% of women smoked 15 or more cigarettes per day. Ex-smokers were 15.2% (21.9% of men, 9.0% of women). There was no appreciable difference with reference to geographic area or education in men, but more educated women were more frequently smokers (28%). Compared to 2001, reported smoking prevalence declined by 3.7% in men and 1.3% in women, and the fall was evident in various age groups, including the youngest one (15–24 years). However, part of the fall is likely due to increased underreporting, since these survey figures are appreciably underestimated as compared to sale data. Among ex-smokers, 84% had stopped without support. Among smokers, 37% had tried at least once to stop. Using the Fagerström questionnaire, 69.5% of smokers were classified as low or very low dependent, whereas only 20.0% of smokers were classified as high or very high dependent. Women, younger and elderly, as well as more educated smokers of both sexes tended to be less dependent.

Conclusions

Self-reported smoking prevalence tends to decline in Italy, although the overall figure (26.6% of Italian adults) remains considerably higher than the USA and several Western European countries.

Cancer Mortality in Italy, 1993

Background

Data and statistics are presented on cancer death certification for 1993 in Italy, updating previous publications covering the period 1955–1992.

Methods

Data for 1993 subdivided into 30 cancer sites are presented in 8 tables, including age-and sex-specific absolute and percentage frequencies of cancer deaths, and crude, age-specific and age-standardized rates, at all ages and truncated for the 35–64 year age group.

Results

Age-adjusted death certification rates (on the world standard population) for all neoplasms declined from 189.8 in 1992 (and a peak of 199.2 in 1986) to 187.8/100, 000 males in 1993, and remained stable around 100, 000 females. The favorable trends were even larger in middle and younger age males, but not in children below age 15, whose overall age-standardized cancer mortality rates increased for the fourth subsequent year. Lung cancer was the leading site of cancer mortality, with over 30, 900 deaths. For the fifth subsequent year, its rates in males declined, to reach 56.0/100,000. The decline in lung cancer rates is now established in Italian males and is substantial in middle age, whereas the rise in female lung cancer rates seems to have leveled off over the last few years. Rates for other major cancer sites (intestines, stomach, female breast, prostate, pancreas, leukemias and lymphomas) were stable, but some decrease was apparent also in 1993 for Hodgkin's disease.

Conclusions

Italian cancer mortality rates in 1993 were moderately favorable in males, due to the leveling of the tobacco-related epidemic, whereas no appreciable change was registered in females. The persisting unfavorable trends in childhood cancer mortality should be investigated.

Smoking in Italy, 1995

Aims and background

Patterns and trends in smoking habits are a major determinant of subsequent incidence and mortality for lung cancer, and other tobacco related neoplasms on a population level.

Methods and study design

Smoking prevalence in Italy was analyzed using data from the 1995 National Multipurpose Survey, conducted by the National Institute of Statistics (ISTAT) and based on a sample of 50,585 subjects (24,497 men and 26,088 women), aged 15 years or over, identified in strata of geographic area and size of the municipality in order to be representative of the general Italian population. Data on smoking were obtained through a self-administered questionnaire.

Results

Overall, 25.3% of Italians aged 15 years or over (34.1% of males, 17.1% of females) described themselves as current smokers, 20.5% (28.0% of males, 13.5% of females) as ex-smokers, and 54.2% (37.9% of males, 69.4% of females) as never smokers. Heavy current smokers (≥15 cigarettes per day) were 15.6% of males and 3.9% of females. Compared to previous surveys, reported smoking prevalence increased, mostly in the youngest age groups (15 to 24 years) in both sexes. However, the increase could be partly or largely attributable to the different modality of data collection (interview in previous surveys, self-administered questionnaire in the present survey), which may have reduced underreporting.

Conclusions

The data of the 1995 National Household Survey confirmed previous patterns of smoking in Italy, i.e., a higher smoking prevalence in less educated, southern Italian males, and in more educated, northern Italian females. These figures reflect therefore the importance of the social and cultural correlates of smoking. Moreover, the stability in smoking prevalence over the last few years reflects the absence of any organized and structured intervention on a legislation and public health level on the smoking issue in Italy.

Educational inequalities in initiation, cessation, and prevalence of smoking among 3 Italian birth cohorts

OBJECTIVES

We examined socioeconomic inequalities in initiation and cessation rates of smoking and the resultant inequality in smoking prevalence among 3 consecutive Italian birth cohorts.

METHODS

We used data from the 1999-2000 Italian National Health Interview Survey, which included 28958 men and 29769 women who were born between 1940 and 1969. The association between smoking variables and level of education was assessed with logistic regression and life table analyses.

RESULTS

Inequalities in the lifetime prevalence of smoking increased across the 3 birth cohorts in Italy. At age 40, lower-educated persons in the youngest cohort reported on average 1 to 5 years of additional exposure to regular smoking compared with higher-educated persons. Inequalities in smoking prevalence increased among both men and women because of widening inequalities in initiation rates. Among women, growing inequalities in cessation rates also played a role.

CONCLUSIONS

The relative contribution of initiation and cessation to socioeconomic inequalities in smoking rates varied by both gender and birth cohort. For the youngest birth cohort, policies that address inequalities in smoking should focus on both initiation and cessation.

Are questions from the Italian National Health Survey adequate to measure prevalence of smoking among teens

OBJECTIVES

Studies on the prevalence of smoking among Italian adolescents have generated inconsistent estimates. Notably, the Italian National Health Survey (INHS) generates relatively lower estimates than estimates reported in other studies. The INHS asks adults and adolescents if they are smokers or nonsmokers. Research has shown that adolescent smoking is unstable compared to that of adults, and that adolescents may acquire their identity as smokers only after smoking becomes more established. We hypothesized that the INHS prevalence estimates of adolescent smoking could be improved by adding questions on smoking behavior.

METHODS

During the school year 1993-1994, 471 participants responded to a brief survey on smoking experiences. We compared the prevalence of smoking behavior with the prevalence of smoking identity of participants (mean age = 16.18) who attended five high schools in two Northern Italian cities, Padova and Bergamo.

RESULTS

Measures of smoking behavior generated higher prevalence estimates than did measures of identity, particularly among occasional smokers.

CONCLUSIONS

The INHS should add behavioral measures of smoking to maximize the accuracy of prevalence estimates.

Changing socioeconomic correlates for cancers of the upper digestive tract

BACKGROUND

Cancers of the upper digestive tract have long been associated with low socio-economic levels. It has however been suggested that in recent times the social gradient for these cancers is leveling off.

PATIENTS AND METHODS

Data from three case-control studies on oral, pharyngeal and oesophageal cancer conducted in Northern Italy during the periods 1984-1992 and 1992-1997 were combined and re-analyzed. Cases were subjects admitted to the major teaching and general hospitals in the areas under study with incident, histologically confirmed cancer of the oral cavity and pharynx (n = 1126) and oesophagus (n = 714). Controls were subjects admitted to the same hospitals for a wide spectrum of acute, non-neoplastic conditions, not related to smoking or alcohol consumption (n = 4642).

RESULTS

In the 1980s a significant association was observed with low education and social class level. The multivariate odds ratios for oral, pharyngeal and oesophageal cancers combined was 1.78 for the lowest versus the highest educational level, and 1.75 for the lowest versus the highest social class. No consistent pattern of risk was observed with any of the socio-economic indicators considered in the studies conducted in the 1990s.

CONCLUSIONS

The present study indicates that the socio-economic correlates of cancers of the upper digestive tract have changed over the last few years in Italy, with a disappearance of the social gradient.

Incidence of cancer in the course of chronic pancreatitis

OBJECTIVE

Chronic pancreatitis patients appear to present an increased incidence of pancreatic cancer. The aim of the study was to compare the incidence of cancer, whether pancreatic or extrapancreatic, in our chronic pancreatitis cases with that in the population of our region.

METHODS

We analyzed 715 cases of chronic pancreatitis with a median follow-up of 10 yr (7287 person-years); during this observation period they developed 61 neoplasms, 14 of which were pancreatic cancers. The cancer incidence rates were compared, after correction for age and gender, with those of a tumour registry.

RESULTS

We documented a significant increase in incidence of both extrapancreatic (Standardized Incidence Ratio [SIR], 1.5; 95% confidence interval [CI], 1.1-2.0; p <0.003) and pancreatic cancer (SIR, 18.5; 95% CI, 10-30; p <0.0001) in chronic pancreatitis patients. Even when excluding from the analysis the four cases of pancreatic cancer that occurred within 4 yr of clinical onset of chronic pancreatitis, the SIR is 13.3 (95% CI, 6.4-24.5; p <0.0001). If we exclude these early-onset cancers, there would appear to be no increased risk of pancreatic cancer in nonsmokers, whereas in smokers this risk increases 15.6-fold.

CONCLUSIONS

The risks of pancreatic and nonpancreatic cancers are increased in the course of chronic pancreatitis, the former being significantly higher than the latter. The very high incidence of pancreatic cancer in smokers probably suggests that, in addition to cigarette smoking, some other factor linked to chronic inflammation of the pancreas may be responsible for the increased risk.