The health benefits of smoking cessation : a report of the Surgeon General

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LIST OF TABLES

Chapter 2

Table 1. Measures of false reports of not smoking from studies using

nicotine and cotinine as a marker . . 3X

Table 2. Measures of false reports from studies using CO as a marker 1 I Table 3. Examples of potential methodologic problems in investigating

the health consequences of smoking cessation 17

Chapter 3

Table 1. Summary of longitudinal studies of overall mortality ratios relative to never smokers among male current and former smokers

according to duration of abstinence (when reported I 76

Table 2. Overall mortality ratios among current and former smohers.

relative to never smokers. by sex and duration of abstinence at date of

enrollment. ACS CPS-II . . . , 7x

Table 3. Estimated probability of dying in the next 165year interval for quitting at various ages compared with never smohing and continuing

to smoke. by amount smoked and sex . . . x3

Table 4. Summary of overall mortality ratios in intervention studies in

which smoking cessation was a component . . . , . 8-t

Table 5. Summary of studies of medical care utilization among smokers andformersmokers . . . . .._...

Table 6. Relation of smoking cessation to various measures of general health status . . . .._...

Table 7. Age- and sex-specific mortality rates among never smokers.

continuing smokers. and former smokers by amount smoked and duration of abstinence at time of enrollment for subjects in ACS CPS-II study who did not have a history of cancer. heart disease. or stroke and were not sick at enrollment . . . , . . Table 8. Estimated probability of dying in the next 165year interval

(95% Cl) for quitting at various apes compared with never smohing and continuing to smoke. by amount smohed and sex .

xx

90

. 95

97

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Chapter 4

Table I. Histologic changes (?/ ) in bronchial epithelium by smoking status .___.____.___.,,..._.__,.._._._...,.._.,....,..._._

Table 2. Relative rishs of lung cancer among never, fomter. and current

smokers in selected epidemiologic studies . .

Table 3. Lung cancer mortality ratios among never. current. and former smokers by number of years since stopped smoking (relative to never

smokers). prospective studies . . . .

Table 4. Relative risks of lung cancer among former smokers. by number of years since stopped smoking. and current smokers. from selected case<ontrol studies . . . .

Table 5. Relative risks of lung cancer among never. current. and former smokers. by number of years since stopping smoking and histologic type . . . . Table 6. Relative risks of lung cancer among never. former. and current

smokers by types of tobacco products smoked . . . . Table 7. Standard mortality ratios of lung cancer among former smokers

in ACS CPS-II (relative to never smokers) by years of smoking abstinence, daily cigarette consumption at time of cessation. and

history of chronic disease . . . .

Table 8. Histologic changes in laryngeal epithelium by smoking status Table 9. Relative rishs of laryngeal cancer by smokin_e status

Chapter 5

Table I. Studies of oral cancer and smohing cessation . . . Table 2. Studies of esophageal csnccr that have examined the effect of

smoking cessation . .

Table 3. Studies of cancer of the pancreas and smohing cessation . Table 3. Studies of bladder cancer and smohing cessation

Table 5. Bladder cancer risk according to smoking dose. duration of smokitq. and smohing status

Table 6. Studies of cervical cancer and smohing cessation Table 7. Studies of breast cancer and smoking cessation

Table 8. Studies of cancer at selected sites that have examined the effect

of smoking cessation .

I20

IX) I32 I33

I18

153 I56 I60

165 167 I70

17-7

xxvi

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Chapter 6

Table 1. Case-control studies of CHD risk among former smokers . Table 2. Cohort studies of CHD risk among former smokers . . . Table 3. Estimated probability of dying from ischemic heart disease in

the next 16.5year interval (95% CL) for quitting at various ages compared with never smoking and continuing to smoke. by amount smokedandsex . . . .

201 . 206

Table 4. Intervention trials of smoking cessation and CHD risk . . . Table 5. Studies of the effect of smoking cessation on persons with

diagnosedCHD...231

Table 6. Studies of smoking cessation and risk of death due to aortic

aneurysm . . . ...242 Table 7. Case-control studies of smoking cessation and risk of stroke . . . 247 Table 8. Prospective cohort studies of smoking cessation and risk of

stroke...253

Chapter 7

Table I. Percentages of subjects in cross-sectional studies with

respiratory symptoms. by cigarette smoking status and gender . . . 289 Table 2. Percentages of subjects in cross-sectional surveys with

respiratory symptoms by smoking and occupational exposure status . . 297 Table 3. Change (o/c) in presence of respiratory symptoms. longitudinal

studies, by cigarette smoking status . . . .300 Table 4. Percentage of subjects with respiratory symptoms by smoking

status, 1961 and 197 1, in a cohort of middle-aged, rural Finns . . . 305 Table 5. Age-standardized mortality ratios for influenza and pneumonia

for current and former smokers compared with never smokers . . Table 6. Association between cigarette smoking status and FEVI levels

in selected cross-sectional studies of adult populations . . , . . . Table 7. Spirometric studies of participants in smoking cessation

programs . . . . Table 8. Studies of closing volume (CV/VC%), closing capacity

(CC/TLC%), and slope of alveolar plateau (SBNl/L) among

participants in smoking cessation programs . . . . Table 9. Population-based longitudinal studies of annual decline in

pulmonary function . . . _ . . . . . Table 10. Decline of FEVt (mL/yr) in subjects in the Copenhagen City

HeartStudy . . . .

309

.3ll

. 320

. 334 . 330

337

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Tahlc 12. Prwpectiw \tudic\ of COPD mortalit) in relation to cigarette

smol\inf 413tus. . . 313

Table 13. Standardized mortalit> ratio\ for COPD among current and former smoher\ hrohen down h) y;Lr\ of ah5tinence .

Chapter 8

Table 1, Possible mechanisms for effect of smohing on pregnant!’ and pregnancy outcome ,..._..., . . . Table 2. Summary of studie\ of fertility among smokers and former

smoker\ . . . . Table 3. Summary of studies of perinatal and neonatal mortality in

smokers and nonsmoker\ during pregnanq . .

Table 3. Estimated relative risk of fetal plu\ infant mortality for maternal smoking in several birthweight groups. adjusting for maternal marital

statu\. education. age. and parity . . .

Table 5. Summary of studies of perinatal mortality in wloher\

throughout pregnancy. smohers who quit in the early month\ of pregnancy. and nonsmokers during pregnancy

Table 6. Summary of studieh of mean birthweight. b>, smoking statuh . Table 7. Summar\, of nonexperimental studie\ of smoking cewttion

after conception. mean increase (+) or decrease (6) in birthueight (g) according to timing of cessation

Table 8. Summary of nonexperimental studies of relative risk of IOU birthweight for smoking ceaation after conception

Table 9. Summary of birthweight outcome in randomized trials ot

smohing cessation in pregnancy . . . .

Table IO. Smoking and smoking! cehation during pregnancy. summq of results of two wrveys of national probability \ample\

Table I I. Patterns of smoking cessation during pregnarq among

selected population4 . . .

Table 12. Summary of \tudit‘s that estimated relative rish of \ariou~

pregnancy outcome\ for \mohing based on ;t “SJ nthe\ih” of the literature. and attributable risk percent based on several estimate\ of

the prevalence of smohing during pregnancy . 3%

Table 13. Summary of studies reporting relationship of cigarette

smoking and age at natural menopause . . . 3’97

Table II. Summary of studit‘\ of age of natural menopause among

former smoker5 . . . 399

Table 15. Sexual performance among male former smoher\ 104

Table 16. Sperm quality among smokers and nonsmokers 406

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Table 17. Estimated relative risk of azoospermia or oligospermia among

smokers versus nonsmokers or never smokers . . . 408 Table 18. Sperm quality among former smokers . . . 409

Chapter 9

Table I. Percentage of healed duodenal ulcers among smoking and

nonsmokingpatients . . . .._..._...._..._..._ 433 Table 2. Results of statistical analysis of pooled data from Table I . 437 Table 3. Recurrences of duodenal ulcer in smokers and nonsmoker\ in

clinical trials _ ~. . . 43X Table 4. Recurrences of gastric ulcer in smokers and nonsmokers in

clinical trials . . . 442 Table 5. Summary of studies of smoking and bone ma\< . . 445 Table 6. Summary of case<ontrol studies of smoking and fractures . 450 Table 7. Summary of cohort studies of smoking and fractures . . 454

Chapter 10

Table I. Summary of prospective studies on smoking and body weight . 374 Table 2. Details of prospective studies in which change in weight

relative to continuing smokers was reported . . . 477 Table 3. Mortality ratios for all ages combined in relation to the death

rate of those 9Q109% of average weight . . . . Table 4. Mortality ratios for all ages combined according to smoking

status in relation to those 90-109% of average age . . . .

.

393

. 494

Chapter 11

Table I. Diagnostic categorization and criteria for nicotine

withdrawal-Nicotine-induced organic mental disorder . . . . Table 2. Prospective studies of quitting-related changes in mood,

anxiety. stress reactivity, perceived stress. self-image. and

psychological well-being . . . .

Table 3. Summary of data from 1985 NHIS. behaviors of never. former.

and current smokers aged 20 and older . . . . .

Table 4. Summary of data from 19X7 NHIS. behaviors of never. former.

and current smokers aged IX and older . . . .

536 . _

. _ 548

. 539

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Table 6. Summary of data from I987 BRFSS. bchav iors of former smohers aged IX and older by, duration of abstinence . Table 7. Pet-cent distribution of persons aged IX and older by tobacco

product and use status. according to gender and cigarette smohing

status. United States. 1987 . .

Table 8. Physician visits and medical tests vv ithin the past y’ear amon?

AARP members ayed SO and older. by smoking status

SS?

557

563

Volume Appendix

Table I. Quit ratio in selected States. by age group and gender-BRFSS.

198X...5X6

Table 2. Cigarette smoking continuum by year. percentage of ever cigarette smokers. by NHISs, United States. 1978-X7. adults aged 20

and older . . . 5x9 Table 3. Trends in quit ratio (‘;/( ) (percentage of ever cigarette smokers

who are fomrer cigarette smokers). by age and by education. NHISs.

United States. 1965-87. adults aged 20 and older 592

Table 4. Effect of adjusting for use of other tobacco products on quit ratio (percentage of evjer cigarette smokers wlto are former cigarette

smohers). 1987. NHIS. United States . . . 59-I Table 5. Selected measures of quittin g activity (V t. NHISs. United

States. adults aged 20 and older 600

Table 6. Percentage of those intending to smoke in 5 years. by gender.

AUTSs. United States. 1964-86. current smokers aged 21 and older 609 Table 7. Percentage who report having ever received advice to quit from

a doctor. by smohing status and gender. United States. 1964-87. adults

aged2landolder . . . ...610

xxx

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LIST OF FIGURES

Figure I. Cyclical model of the stages of change . . 73

Figure 2. Hypothetical examples of disease incidence rates for current.

former, and never smokers, by age . . . 55

Chapter 3

Figure I. Compared with never smokers. relative risk of mortality in current and former smokers aged 50-54. 60-63. and 70-74 at

enrollment, by amount smoked and duration of abstinence . . Xl Figure 2. Estimated probability of dying in the next 16.5yr interval for

quitting at ages 55-59 compared with never smohing and continuing to

smoke.by sex . . . 9X

Chapter 4

Figure I. Rish of lung cancer by number of cigarettes smohed per day before quitting. number of years of abstinence. sex. and histologic types Figure 2. Relative risk of lung cancer among ex-smokers compared with

continuing smokers as a function of time since stopped smoking.

estimated from logistic regression model, pattern adjusted for smoking duration compared with pattern unadjusted for duration . . Figure 3. Incidence of bronchial carcinoma among continuing cigarette

smokers in relation to age and duration of smoking and among never smokers in relation to age. double logarithmic scale . . . .

.

I21

.

I23

I17

Chapter 6

Figure I. Hypothetical effects of smoking cessation on risk of CHD if

mechanisms are predominantly rapidly reversible . . . 19X Figure 2. Estimated relative rish of MI after quitting smoking among

men under age 55. adjusted for age . . . 304

Figure 3. Mortality ratios due to coronary artery diseases; rates for men who have stopped smoking are compared with those for men who

never smoked and those for men still smoking in 1952 2 I J Figure 4. Mortality ratios for all cardiovascular diseases and CHD. by

daily cigarette consumption. US Veterans Study. 195449 2 I9

Figure 5. Mortality ratio for current and fomter cigarette smohers by,

years of smoking cessation. US Veterans Study. 1954-W . 770

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Figure 6. Effect of smoking cessation on survival among men with documented coronary atherosclerosis; pooled survival among quitters tN=1.390) and continuers (N=2.675) . . . . Figure 7. Mortality ratios for stroke for current smokers and ex-smokers

compared with never smokers, by daily cigarette consumption, US VeterdnsStudy,l954-69 . . . . Figure 8. Survival free of stroke in cigarette smokers. never smokers,

and former smokers, aged 60, using Cox proportional hazard

regression model. among men and women . . . .

Chapter 7

Figure I. Nonproportional Venn Diagram of the interrelationship among chronic bronchitis. emphysema, asthma, and airways obstruction . . . Figure 2. Theoretical curves depicting varying rates of decline of FEVt Figure 3. Hypothesized mechanisms by which airway

hyperresponsiveness may be associated with developing or established COPD without necessarily being a preexisting risk factor . . Figure 4. Symptom ratio (number of observed symptoms to number of

possible symptoms) in nonmodifiers, modifiers, and quitters at each test period; symptoms are cough, sputum production. wheezing. and shortness of breath . . . . Figure 5. Prevalence of cough and phlegm by smoking group . . . Figure 6. Prevalence of dyspnea by smoking group . . . . . Figure 7. Sex-specific mean height-adjusted FEV I residuals versus

pack-years for current and ex-smokers. and distributions of number of

subjects by pack-years . . . .

Figure 8. Mean values FVC and FEV 1. expressed as a percentage of predicted values. in IS quitters and 32 smokers during 30 months after

2 smoking cessation clinics . . . .

Figure 9. Mean values for the ratio of CV/VC. of CC/TLC. and slope for phase III of the single breath N? test (Nfi). expressed as a percentage of predicted values in IS quitters and 42 smokers during 30 months

after 2 smoking cessation clinics . . . .

Figure IO. Percent-predicted diffusing capacity (%pDL) by pack-years of smoking. current smokers and former smokers. in a study of adults inTucson.AZ . . . . Figure I I. Mean AFEV t values in never smokers, consistent

ex-smokers. subjects who quit smoking during followup, and

consistent smokers in several age groups . . . . Figure 12. Effects of quitting smoking during followup among men aged

5~9...

23x

252

259

280

‘XI

2x4

2x7 293 295

317

322

336

xxxii

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Chapter 8

Figure I. Perinatal. neonatal. and fetal mortality rates by birth&eight in

singleton white males. 19x0 3X0

Chapter 11

Figure 1. Performance on a meter (i.e.. visual) vigilance task.

Perfomrance on the continuous clock task. a visual vigilance tash 517 Figure 2. Self-reported withdrawal discomfort among abstinent smokers 53 I Figure 3. Drinking relative to smoking status for men. 19X3 THIS SSX Figure 4. Drinking relative to smoking status for vvomen. IYX3 NHIS SSY

Appendix

Figure I. Trends in the quit ratio. United States. 1965-X7. by gender . . SYO Figure 2. Trends in the quit ratio. United States. 1965-87. by race . SYI Figure 3. Flow chart of quitting history. attempts lasting longer than I

year. NHEFS . . . ..SY7 Figure 4. Estimated duration of abstinence on first l-year or longer quit

attempt, product-limit method, N=3,363 . . 59X

Figure 5. Percentage of ever smokers who never tried to quit. by

education. United States, 1974-87 . 601

Figure 6. Percentage of persons smoking at I2 months prior to the survey interview who quit for at least I day during those I2 months,

United States, 197X-80. 1987. by education . . . 602 Figure 7. Percentage of ever smokers who had been abstinent for less

than I year. United States. 1966~87. by education 603

Figure 8. Percentage of ever smokers who had been abstinent for IL-I

years. United States. 1966-X7. by education 60-t

Figure 9. Percentage of ever smokers who had been abstinent for 5 years

or more. United States. 1966-X7. by education . 605

The health benefits of smoking cessation : a report of the Surgeon General

TABLE OF CONTENTS

LIST OF TABLES

Chapter 5

Chapter 7

. 334 . 330

Chapter 8

.

Volume Appendix

LIST OF FIGURES

Chapter 3

Chapter 4

.

.

Chapter 6