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OBJECTIVES: To estimate the risk of dying from all causes and from specified smoking-related diseases in people who were ex-smokers at two consecutive examinations, compared with never smokers and with people who were ex-smokers at the first examination but who had resumed smoking at the following examination. DESIGN: A prospective cohort study. SETTING: Three counties in Norway. PARTICIPANTS: A total of 23 560 men and 25 122 women, aged 20–49, screened for cardiovascular disease risk factors in the mid 1970s, rescreened after 3–13 years and followed throughout 2005 participated in this study. OUTCOMES: Absolute mortality and relative risks adjusted for confounding variables, of dying from all causes, cardiovascular disease, ischaemic heart disease, stroke, lung cancer and other smoking-related cancer. RESULTS: With sustained never smokers as reference, the sustained ex-smokers had adjusted relative risk (95% CI), of dying from any cause, for men 0.97 (0.80 to 1.18), for women 0.98 (0.65 to 1.48). Corresponding risk for ex-smokers who resumed smoking was for men 1.59 (1.32 to 1.91), for women 1.40 (1.08 to 1.81). For the specified smoking-related diseases, the risk in sustained ex-smokers was not significantly different from the risk in sustained never-smokers, except for lung cancer in men. For ex-smokers who resumed smoking, the corresponding risk was on the whole significantly higher. CONCLUSIONS: A more valid and favourable picture of ex-smokers’ risk will be obtained if exposure is being based upon people with two consecutive examinations, years apart. The study confirms clearly the large health benefit of quitting smoking for good. [ABSTRACT FROM AUTHOR]

Background: Although several epidemiological studies have examined the mortality among users of spit tobacco, none have compared mortality of former cigarette smokers who substitute spit tobacco for cigarette smoking ("switchers") and smokers who quit using tobacco entirely. Methods: A cohort of 116 395 men were identified as switchers (n=4443) or cigarette smokers who quit using tobacco entirely (n= 111 952) when enrolled in the ongoing US American Cancer Society Cancer Prevention Study II. From 1982 to 31 December 2002, 44 374 of these men died. The mortality hazard ratios (HR) of tobacco-related diseases, including lung cancer, coronary heart disease, stroke and chronic obstructive pulmonary disease, were estimated using Cox proportional hazards regression modelling adjusted for age and other demographic variables, as well as variables associated with smoking history, including number of years smoked, number of cigarettes smoked and age at quitting. Results: After 20 years of follow-up, switchers had a higher rate of death from any cause (HR 1.08, 95% confidence interval (CI) 1.01 to 1.15), lung cancer (HR 1.46, 95% CI 1.24 to 1.73}, coronary heart disease (HR 1.13, 95% CI 1.00 to 1.29) and stroke (HR 1.24, 95% CI 1.01 to 1.53) than those who quit using tobacco entirely. Conclusion: The risks of dying from major tobacco-related diseases were higher among former cigarette smokers who switched to spit tobacco after they stopped smoking than among those who quit using tobacco entirely. [ABSTRACT FROM AUTHOR]

Aims: Little is known about the extent to which quit attempts are planned ahead or initiated immediately following a sudden decision to quit. This is important because if most smokers quit abruptly, rather than plan ahead, this could impact heavily upon recommendations to health care professionals on the kind of smoking cessation advice they deliver to patients. This paper aims to address this gap in knowledge by examining detailed smoking histories taken from smoking and ex-smoking patients. Design: Face-to-face in depth semi-structured interviews. Participants: 146 smoking and ex-smoking patients within a family medicine practice were recruited by means of screening 700 consecutive patients (14 years of age and older) and inviting eligible patients to participate. To be eligible, patients had to have smoked a minimum of five cigarettes per day for at least six months in their lives and made at least one serious quit attempt that lasted at least 24 hours. There were no refusals. Ex-smokers (n = 67) were defined as those who had not smoked for six months. The remainder were classified as smokers (n = 79). Measurements: Participants were asked to describe, in their own words, their most recent quit attempt and whether they had planned the quit attempt in advance, what were the triggers, and how long they abstained. A quit attempt was defined as planned if smokers set a quit date at some future time point. An unplanned quit attempt was defined as a sudden decision not to smoke any more cigarettes including those that might be remaining in the current pack. Information was also collected on methods used to quit and reasons for quilting. Results: A majority (51.6%) of quit attempts were reported as being unplanned. The figure was higher for ex-smokers than for smokers (67.1 % v 36.7%, p « 0.001). Most quit attempts were unaided (64%) and made for reasons of health (64%). Conclusions: The finding that so many quit attempts are unprepared suggests that models of smoking cessation should place greater emphasis on the dynamic nature of motivation to quit. This is an area that requires further investigation. [ABSTRACT FROM AUTHOR]

Objective: To estimate the number of deaths that could be prevented in the UK by implementing population strategies to reduce smoking prevalence. Design: A prospective analysis of future mortality using recent national smoking prevalence data and relative risks of mortality in current smokers, ex-smokers, and never-smokers. Population: Smokers in the UK. Interventions: Population measures of proven effectiveness assumed to reduce smoking prevalence by 1 percentage point per year for 10 years, or alternatively by 13% over 19 years (1 percentage point per annum for seven years, 0.5 percentage point per annum for 12 years) as considered to be achievable in a recent report to the UK Chancellor of the Exchequer. Main outcome measure: Estimated deaths from smoking prevented in the 35-75 year age group. Results: Reducing the prevalence of smoking by 1 percentage point each year for 10 years would prevent 69 049 deaths at ages between 35 and 74 years during that period. The model of reduction by 13% over 19 years would prevent 54 308 and 194 493 deaths in 10 and 19 years, respectively. Continued prevalence reductions at the current rate of 0.4 percentage points each year will prevent 23 192 deaths over 10 years. Conclusions: Full implementation of simple population measures to encourage smoking cessation could prevent substantial numbers of deaths in the UK. [ABSTRACT FROM AUTHOR]

Objective: This study examined the impact of smoking, quitting, and time since quit on absences from work. Methods: Data from the nationally representative Tobacco Use Supplements of the 1992/93, 1995/96, and 1998/99 Current Population Surveys were used. The study included full time workers aged between 18-64 years, yielding a sample size of 383 778 workers. A binary indicator of absence due to sickness in the lost week was analysed as a function of smoking status including time since quit for former smokers. Extensive demographic variables were included as controls in all models. Results: In initial comparisons between current and former smokers, smoking increased absences, but quitting did not reduce them. However, when length of time since quit was examined, it was discovered that those who quit within the last year, and especially the last three months, had a much greater probability of absences than did current smokers. As the time since quitting increased, absences returned to a rate somewhere between that of never and current smokers. Interactions between health and smoking status significantly improved the fit of the model. Conclusions: Smokers who quit reduced their absences over time but increase their absences immediately after quilting. Quitting ill may account for some but not all of this short run impact. [ABSTRACT FROM AUTHOR]

Objective: Past studies hove produced ambiguous or inconsistent results when testing whether smokers actually underestimate their own risks of experiencing tobacco related illness. Whereas smokers claim that they ore less at risk than the average smoker on self administered questionnaires, this unrealistic optimism has not been found in telephone or face-to-face interviews. We avoided the measurement problems of past studies and examined responses to a number of new questions to assess different aspects of smokers' perceptions. Methodology: A US national telephone survey (n = 6369; 1245 current smokers) posed a variety of questions designed to examine beliefs about the risks of smoking. For key questions, separate samples of smokers were asked either about their own risk or about the risk of the average smoker. Results: Smokers underestimated their relative risk compared to non-smokers and, contrary to previous interview surveys, believed they have a lower risk of developing lung cancer than the average smoker. Furthermore, their perceived risk of lung cancer and of cancer in general barely increases with the number of cigarettes smoked per day, and their estimates of their risk of cancer are actually slightly lower than their estimates of their risk of lung cancer. Substantial proportions of smokers and former smokers agree with several myths, more than half agreeing that exercise undoes most smoking effects. Conclusion: Smokers underestimate their risk of lung cancer both relative to other smokers and to non- smokers and demonstrate other misunderstandings of smoking risks. Smoking cannot be interpreted as a choice made in the presence of full information about the potential harm. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To: evaluate the impact of smoking status on objective productivity and absenteeism measures; evaluate the impact of smoking status on subjective measures of productivity; and assess the correlation between subjective and objective productivity measures. DESIGN: Prospective cohort study in a workplace environment. SUBJECTS: Approximately 300 employees (100 each of former, current, and never smokers) at a reservation office of a large US airline. MAIN OUTCOME MEASURES: Objective productivity and absenteeism data were supplied by the employer. Subjective assessments of productivity were collected using a self report instrument, the Health and Work Questionnaire (HWQ). RESULTS: Current smokers had significantly greater absenteeism than did never smokers, with former smokers having intermediate values; among former smokers, absenteeism showed a significant decline with years following cessation. Former smokers showed an increase in seven of 10 objective productivity measures as compared to current smokers, with a mean increase of 4.5%. While objective productivity measures for former smokers decreased compared to measures for current smokers during the first year following cessation, values for former smokers were greater than those for current smokers by 1-4 years following cessation. Subjective assessments of "productivity evaluation by others" and "personal life satisfaction" showed significant trends with highest values for never smokers, lowest for current smokers, and intermediate for former smokers. CONCLUSIONS: Workplace productivity is increased and absenteeism is decreased among former smokers as compared to current smokers. Productivity among former smokers increases over time toward values seen among never smokers. Subjective measures of productivity provide indications of novel ways of productivity assessment that are sensitive to smoking status. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To estimate health expectancy-- that is, the average lifetime in good health--among never smokers, ex-smokers, and smokers in Denmark. DESIGN: A method suggested by Peto and colleagues in 1992 for estimating smoking attributable mortality rates was used to construct a life table for never smokers. This life table and relative risks for death for ex-smokers and smokers versus never smokers were used to estimate life tables for ex-smokers and smokers. Life tables and prevalence rates of health status were combined and health expectancy was calculated by Sullivan's method. SETTING: The Danish adult population. MAIN OUTCOME MEASURES: The expected lifetime in self rated good health or without longstanding illness for never smokers and smokers. RESULTS: The expected lifetime of a 20 year old man who will never begin to smoke is 56.7 years, 48.7 (95% confidence interval (CI), 46.8 to 50.7) years of which are expected to be in self rated good health. The corresponding figures for a man who smokes heavily are 49.5 years, 36.5 (95% CI 35.0 to 38.1 ) years of which are in self rated good health. A 20 year old woman who will never begin to smoke can expect to live a further 60.9 years, with 46.4 (95% CI 44.9 to 47.8) years in self rated good health; if she is a lifelong heavy smoker, her expected lifetime is reduced to 53.8 years, 33.8 (95% CI 31.7 to 35.9) years of which are in self rated good health. Health expectancy based on long standing illness is reduced for smokers when compared with never smokers. CONCLUSIONS: Smoking reduces the expected lifetime in good health and increases the expected lifetime in poor health. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: To examine the long term impact of workplace smoking bans on employee smoking cessation and relapse. Over three years we studied a total of 1033 current or former smokers (intervention group) employed in smoke-free hospitals and 816 current or former smokers (comparison group) employed in non-smoke-free workplaces. The design of this natural experiment is a prospective cohort study. We randomly selected both hospitals and employees from 12 strata based on hospital size and state tobacco regulations, and sampled employees in the same communities. Main outcome measures were post-ban quit ratio and relapse rate. RESEARCH DESIGN: Between groups comparisons were conducted using the Cochran-Mantel-Haenszel statistic for general association, stratified Cox proportional hazards models, and the CMH analysis of variance statistic based on ranks. McNemar''s test and the sign test were used to test for changes over time within each group. RESULTS: Differences in the post-ban quit ratio were observed between intervention and comparison groups (p &les; 0.02). For employees whose bans were implemented at least seven years before survey, the post-ban quit ratio was estimated at 0.256, compared with 0.142 for employees in non-smoke-free workplaces (p = 0.02). After controlling for a variety of factors, time to quit smoking was shorter for the hospital employees (p < 0.001), with an overall relative risk of quitting of 2.3. Contrary to expectations, relapse rates were similar between the groups. CONCLUSION: Employees in workplaces with smoking bans have higher rates of smoking cessation than employees where smoking is permitted, but relapse is similar between these two groups of employees. The results of this investigation have international applicability for policy makers, clinicians, employers, and employees. Countries should review smoking policies in workplaces in light of their own smoking patterns and efforts to deal with environmental tobacco smoke. [ABSTRACT FROM AUTHOR]

Background: One of the most widely available heated tobacco products is IQOS by Philip Morris International. However, there is a lack of independent research exploring IQOS initiation and subsequent use among smokers and ex-smokers., Aims: To (1) explore the reasons why smokers and ex-smokers use and continue/discontinue IQOS and (2) consider implications for future research and policy., Participants: Adult (18+) current (n=22) and ex-users (n=8) of IQOS who either currently smoked or quit smoking in the last 2 years., Methods: Qualitative interview study in London, UK., Results: Six main factors influenced initiation and use of IQOS: (1) Health-wanting to reduce/quit smoking and perceptions of reduced harm (while understanding IQOS was not risk-free). Branded packaging, absence of pictorial warnings and physical health improvements conveyed reduced harm. (2) Financial-including high start-up costs, but cheaper ongoing costs than smoking. (3) Physical-mixed views on enjoyment and satisfaction. Sensory experiences influenced use including discreetness, cleanliness, reduced smell and tactile similarities relative to combustible cigarettes. (4) Practical-issues of accessibility, shortcomings with maintenance/operation limited ongoing use, whereas use in smoke-free places increased use. (5) Psychological-similarities in rituals and routines, although new practices developed to charge and clean; some liked trailblazing new technology. (6) Social-improved social interactions from using IQOS instead of smoking, but with more limited shared social experiences for some., Conclusion: For some, IQOS facilitated smoking substitution. Factors such as packaging, labelling, risk communication, price and smoke-free policies appear to influence initiation and use., Competing Interests: Competing interests: CNET has previously received salary support from Camurus AB and Mundipharma International Ltd on studies relating to the treatment of opioid dependence., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Life time smoking of ready made cigarettes can be readily quantified as "pack years" smoked, but methods For measuring loose tobacco use are less well established. In this study the frequency of loose tobacco use by 247 hospital in-patients was determined; 64%were current or ex-smokers, 41.3% of whom (25.9% of participants) had smoked loose tobacco. A formula was developed for converting loose tobacco use to pack years smoked; based on the weight of tobacco in ready made cigarettes; 12.59 or hail On ounce of loose tobacco was approximately equivalent to one packet of 20 cigarettes. Using a. questionnaire it was Found that hospital physicians of all grades were able to convert smoking histories of ready made cigarettes, but not loose tobacco, into number of "pack years" smoked. [ABSTRACT FROM AUTHOR]