The diagnosis of a smoking-related disease is a prominent trigger for smoking cessation in a retrospective cohort study

doi:10.1016/j.jclinepi.2005.05.003

Journal of Clinical Epidemiology

Volume 59, Issue 1, January 2006, Pages 82-89

https://doi.org/10.1016/j.jclinepi.2005.05.003 Get rights and content

Abstract

Objective

We evaluated the impact of demographic factors, smoking patterns, and the occurrence of smoking-related diseases on smoking cessation, with a particular emphasis on the temporal relationship between diagnosis of smoking-related diseases and cessation.

Study Design and Setting

A cohort was assembled of participants of a general health screening examination aged 50–74 years. Lifetime smoking habits and medical history were obtained by a self-administered questionnaire. In a retrospective cohort study approach, predictors of cessation among ever-smokers (n = 4,575) were identified using the extended proportional hazards model.

Results

Male gender, late onset of smoking, and higher educational level were predictive of cessation. However, the by far strongest predictors of cessation were diagnoses of smoking-related diseases: relative cessation rates in the year of disease occurrence were 11.2 for myocardial infarction (95% confidence interval CI = 8.9–14.0), 7.2 for stroke (95% CI = 5.1–11.6), 2.5 for diabetes mellitus (95% CI = 1.6–4.0) and 4.8 for cancer (95% CI = 3.1–7.4) relative to years before diagnosis of the respective diseases.

Conclusion

Our results underline the key role of perceived detrimental effects of smoking for cessation. When smokers personally experience the health consequences of smoking, many permanently quit.

Introduction

The benefit of smoking cessation to health is beyond controversy; much of the damage caused by cigarette smoking can be averted if the detrimental habit is stopped [1], [2], [3], [4], [5]. Thus besides primary prevention of smoking, the promotion of smoking cessation is of outstanding public health importance.

The insights into circumstances and reasons that favor the decision of smokers to quit and their success in quitting are an important prerequisite for the development of efficient smoking cessation programs. In this context, the evaluation of the effect of a diagnosis of a smoking-related disease on smoking cessation is of particular interest. Smokers might be more willing to stop this detrimental habit, when they have already experienced its negative effect on their own health. In patients suffering severe diseases such as cancer or myocardial infarction, smoking cessation rates of 14% or even as high as 50% within the first year after diagnosis have been observed [6], [7]. However, the relevance of health status and smoking-related diseases for cessation rates in the general population is still unclear, epidemiologic studies on this topic have, to date, produced inconsistent results [8], [9], [10], [11], [12]. Some of these studies, however, have included very broad definitions of health status rather than the occurrence of major smoking-related diseases, and none have evaluated the temporal association between disease onset and cessation in detail. Thus, a possible major effect immediately after disease occurrence may have been underestimated or missed.

The aim of this large retrospective cohort study from Germany was to study the impact of demographic factors, smoking patterns, and the occurrence of smoking-related diseases on smoking cessation, with a particular emphasis on the temporal relationship between diagnosis of smoking-related diseases and smoking cessation.

Section snippets

Study design and population

This analysis was performed out using baseline data of the ESTHER study, a longitudinal study aimed at identifying new approaches to enhanced prevention, early detection, and therapy of chronic diseases in the elderly population [13]. From July 2000 to June 2002, an unselected cohort of 9,961 subjects aged 50–74 who visited their general practitioner (GP) for a general health screening examination was enrolled. In the German health care system, all persons aged 35 or older are entitled to such

Results

Of the 9,961 participants of the ESTHER-study, 1,654 (17%) reported current smoking and 3,131 (31%) were ex-smokers. Smoking status strongly differed by age and gender (Fig. 1). Overall, the proportion of never-smokers was much higher in women than in men, but the proportion of current smokers was almost equal. In women, the proportion of ever smoking was much lower among older than among younger cohorts. The proportion of current smokers strongly decreased with age among both men and women.

Discussion

To our knowledge, this is the first large-scale epidemiologic study addressing the impact of diagnoses of smoking-related diseases on smoking cessation in the general population in a time-dependent manner. Using this approach, our retrospective analysis in 4,575 current smokers and ex-smokers reveals an overwhelming impact of the occurrence of major smoking-related diseases on smoking cessation. In the year of diagnosis of myocardial infarction or stroke, the rate of cessation increased 7- to

Acknowledgments

This work was funded by the German Ministry of Education and Research (Bundesministerium für Bildung und Forschung BmBF) within the context of the Research Network on Addiction of Baden-Wurttemberg (project 01EB0113).

References (36)

T. Korhonen et al.
Evaluation of a national Quit and Win contest: determinants of successful quitting
Prev Med
(1997)
N.S. Godtfredsen et al.
Predictors of smoking reduction and cessation in a cohort of Danish moderate and heavy smokers
Prev Med
(2001)
C. Senore et al.
Predictors of smoking cessation following physicians' counseling
Prev Med
(1998)
E.H. Wagner et al.
Participation in a smoking cessation program: a population-based perspective
Am J Prev Med
(1990)
C. Senore et al.
Comparing participants and nonparticipants in a smoking cessation trial: selection factors associated with general practitioner recruitment activity
J Clin Epidemiol
(1999)
W.P. McWhorter et al.
Predictors of quitting smoking: the NHANES I follow up experience
J Clin Epidemiol
(1990)
G.E. Swan et al.
Differential rates of relapse in subgroups of male and female smokers
J Clin Epidemiol
(1993)
J.P. Leigh et al.
Instrumental variables technique: cigarette price provided better estimate of effects of smoking on SF-12
J Clin Epidemiol
(2004)
P.M. Lantz et al.
Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors
Soc Sci Med
(2001)
U.S. Department of Health and Human Services. The health benefits of smoking cessation. DHHS Publication (CDC) 90-8416....

R. Doll

Fifty years of research on tobacco

J Epidemiol Biostat

(2000)

K. Fagerstrom

The epidemiology of smoking: health consequences and benefits of cessation

Drugs

(2002)

R. Peto et al.

Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies

Br Med J

(2000)

D.H. Taylor et al.

Benefits of smoking cessation for longevity

Am J Public Health

(2002)

R.A. Schnoll et al.

Brief physician-initiated quit-smoking strategies for clinical oncology settings: a trial coordinated by the Eastern Cooperative Oncology Group

J Clin Oncol

(2003)

P. Quist-Paulsen et al.

Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease

BMJ

(2003)

M. Osler et al.

Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults

Tob Control

(1998)

K.M. Freund et al.

Predictors of smoking cessation: the Framingham Study

Am J Epidemiol

(1992)

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Original ArticleThe diagnosis of a smoking-related disease is a prominent trigger for smoking cessation in a retrospective cohort study

Abstract

Objective

Study Design and Setting

Results

Conclusion

Introduction

Section snippets

Study design and population

Results

Discussion

Acknowledgments

Prev Med

Prev Med

Prev Med

Am J Prev Med

J Clin Epidemiol

J Clin Epidemiol

J Clin Epidemiol

J Clin Epidemiol

Soc Sci Med

Fifty years of research on tobacco

J Epidemiol Biostat

The epidemiology of smoking: health consequences and benefits of cessation

Drugs

Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies

Br Med J

Benefits of smoking cessation for longevity

Am J Public Health

Brief physician-initiated quit-smoking strategies for clinical oncology settings: a trial coordinated by the Eastern Cooperative Oncology Group

J Clin Oncol

Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease

BMJ

Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults

Tob Control

Predictors of smoking cessation: the Framingham Study

Am J Epidemiol

Original Article
The diagnosis of a smoking-related disease is a prominent trigger for smoking cessation in a retrospective cohort study