Mature smokers-

Metrics details. Large-scale quantitative evidence on the relationship of tobacco smoking to mortality in Australia is not available despite the potential to provide independent international evidence about the contemporary risks of smoking. Hazard ratios described here as relative risks, RRs for all-cause mortality among current and past smokers compared to never-smokers were estimated, adjusting for age, education, income, region of residence, alcohol, and body mass index. Overall, 5, deaths accrued during follow-up , person-years; mean: 4. Among past smokers, mortality diminished gradually with increasing time since cessation and did not differ significantly from never-smokers in those quitting prior to age

Mature smokers

Mature smokers

Mature smokers

Reprints and Permissions. Smoking habits among current and former smokers by sex and birth decade. Relative risk RR of all-cause mortality in current and past smokers relative to never smokers, by smoking intensity, separately for men and women. Additional file 1: Table S1, Smoking patterns at re-survey, by smoking status reported at baseline. The study ascertained smoking status from questionnaire items that are based on those used in the Million Women Study, allowing direct international comparison of results [ 23 ]. Open Peer Review reports. As well smokera providing local evidence, large-scale data from Australia have the potential to contribute to knowledge internationally by providing additional independent data on Mature smokers effects of prolonged, heavy, and widespread smoking. Mature smokers questionnaire data included information on socio-demographic factors, health behaviours, height and body The-dark-wrestling nude, medical and surgical history, functional Mature smokers, and physical activity. PubMed Google Scholar 5.

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While there are many reasons to continue to smoke in spite of its consequences for health, the concern that many smoke because they misperceive the risks of smoking remains a focus of public discussion and motivates tobacco control policies and litigation.

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Metrics details. Large-scale quantitative evidence on the relationship of tobacco smoking to mortality in Australia is not available despite the potential to provide independent international evidence about the contemporary risks of smoking. Hazard ratios described here as relative risks, RRs for all-cause mortality among current and past smokers compared to never-smokers were estimated, adjusting for age, education, income, region of residence, alcohol, and body mass index.

Overall, 5, deaths accrued during follow-up , person-years; mean: 4. Among past smokers, mortality diminished gradually with increasing time since cessation and did not differ significantly from never-smokers in those quitting prior to age In Australia, up to two-thirds of deaths in current smokers can be attributed to smoking. Cessation reduces mortality compared with continuing to smoke, with cessation earlier in life resulting in greater reductions.

The risks of cancer, cardiovascular disease, respiratory disease, and a range of other health problems are increased in tobacco smokers and, as a consequence, smokers are more likely than non-smokers to die prematurely [ 1 ].

Smoking is a leading cause of morbidity and mortality in virtually every country in the world and is second only to high blood pressure as a risk factor for global disease burden [ 2 ]. It is arguably the leading readily preventable factor. The relative risks of adverse health effects increase with increasing intensity of smoking, measured by the amount of tobacco smoked per day, and with increasing duration of smoking [ 3 ].

Smoking cessation imparts significant health benefits [ 3 ]. The overall effects of smoking on mortality in a population relate closely to the prevalence of current and past smoking and to the duration and intensity of smoking, among smokers. These indices relate, in turn, to the factors influencing smoking behaviour, including the stage of the smoking epidemic in the population under examination, to the relative success of tobacco control measures and to cultural and socioeconomic factors.

Hence, both the relative risks of mortality and the overall population impacts of smoking are not uniform across the world and may also vary across time, population groups, and birth cohorts within a single location [ 3 - 5 ]. Large-scale quantitative evidence on the relationship of tobacco smoking to mortality among countries with a mature smoking epidemic is accruing, but is not yet available for Australia. In common with many countries, Australia has relied on the findings from studies conducted in the UK and US, including the British Doctors Study [ 3 ] and the American Cancer Society Cancer Prevention Studies [ 6 ], to underpin estimation of the population impact of smoking [ 7 ].

As well as providing local evidence, large-scale data from Australia have the potential to contribute to knowledge internationally by providing additional independent data on the effects of prolonged, heavy, and widespread smoking. Prevalence of current tobacco smoking among Australian adults, — Data prior to are considered less reliable than from subsequent years and are represented with a dotted line [ 9 ].

This study aims to investigate the relationship of smoking to all-cause mortality in Australia, in the 45 and Up Study cohort. Although cause-specific mortality data have been used in analyses from other countries, these were not available for Australia at the time of writing.

Participants in this population-based cohort study were predominantly born between and , and have lived through the peak of the smoking epidemic, as well as through many changes in tobacco policy, legislation, and health information. Individuals joined the study by completing a postal questionnaire distributed from 1 January to 31 December and giving informed consent for follow-up through repeated data collection and linkage of their data to population health databases. The study methods are described in detail elsewhere [ 11 ].

Baseline questionnaire data included information on socio-demographic factors, health behaviours, height and body weight, medical and surgical history, functional capacity, and physical activity. The study questionnaire is available online [ 12 ].

To provide data to allow correction for regression dilution, repeat data on smoking status were taken from a resurvey of a sample of 60, participants a mean of 3. Questionnaire data from study participants were linked probabilistically to data from the NSW Register of Births, Deaths and Marriages up to 30 June to provide data on fact and date of death.

Death registrations capture all deaths in NSW. Cause of death information was not available at the time of analysis. In order to conduct sensitivity analyses, questionnaire data were also linked probabilistically to data from the NSW Admitted Patient Data Collection, which is a complete census of all public and private hospital admissions in NSW.

The linked data that were used contained details of admissions in participants from the year up to the point of recruitment, including the primary reason for admission using the International Classification of Diseases 10 th revision — Australian Modification ICDAM [ 14 ] and up to 54 additional clinical diagnoses.

There were , participants with valid data on age and date of recruitment. It was not possible to exclude all individuals with respiratory illness because this information was not available in an appropriate form from the baseline questionnaire. Are you a smoker now? If not, how old were you when you stopped smoking regularly?

Hazard ratios which are equivalent to, and described here as relative risks [RRs] for mortality in men and women were estimated separately for men and women and according to birth cohorts with sufficient amounts of data, using Cox regression modelling, in which the underlying time variable was age.

Estimates are shown initially accounting for age only automatically adjusted for as the underlying time variable. Missing values for covariates other than smoking status were included in the models as separate categories. Hypertension and dyslipidaemia were considered likely to be part of the causal pathway between smoking and mortality and were not adjusted for. Sensitivity analyses were conducted: i adjusting additionally for physical activity; and ii categorising current smokers as those who reported being current smokers at baseline and past smokers who had ceased smoking 3 or fewer years prior to baseline.

Mortality rates were then plotted against the mean number of cigarettes within each category reported at the 3-year resurvey among those who reported being current smokers at resurvey, as this was considered the best estimate of long-term mean consumption among all in that category, before the study started Additional file 1 : Table S1.

The proportionality assumption of the Cox regression models was verified by plotting the Schoenfeld residuals against the time variable in each model, with a stratified form or time-dependent form of the model used where covariates displayed non-proportionality of hazards.

No violations of the proportionality assumption were detected for the main exposure. Minor violations were observed in covariates for certain models and a stratified Cox model was fitted, as follows: overall analyses of current and past versus never-smokers — model stratified by education; analyses relating to birth decade — model stratified by alcohol, education, and income; analyses relating to number of cigarettes smoked per day — model stratified by income; analyses relating to age at smoking cessation — model stratified by alcohol and education.

The sponsors of this study had no role in study design, data collection, data analysis, data interpretation, or the writing of the report. All authors had full access to the data in the study and had final responsibility for the decision to submit for publication. At baseline, 7. The prevalence of smoking was similar in men and women. The mean age at commencing smoking was similar for male study participants born in the decades from — to — Additional file 2 : Table S2. The average duration of smoking in current smokers was Data from the 3-year resurvey indicated consistency of reporting of never-smoker and ex-smoker status, with little misclassification and very few indicating that they had taken up smoking between surveys Additional file 1 : Table S1.

Among current smokers at baseline who completed the 3-year resurvey, around one-third indicated that they were no longer smoking at resurvey, with those smoking fewer cigarettes per day being more likely to quit Additional file 1 : Table S1. Over a mean follow-up time of 4.

The adjusted RRs in past versus never-smokers were 1. The results remained similar following exclusion of individuals with a history of admission to hospital with a diagnosis of chronic obstructive pulmonary disease and other respiratory illness; compared to never-smokers, RRs of mortality were 2. RRs did not change materially when further adjusted for physical activity and when data among past smokers were restricted to individuals aged 55 and over who had the opportunity to cease smoking from age 45—54 data not shown.

Relative risks and absolute rates of all-cause mortality in the 45 and Up Study in current and past smokers relative to never-smokers, overall and by decade of birth.

Age standardised rates of all-cause mortality in current smokers and never-smokers, by smoking intensity. Rates are plotted against the mean number of cigarettes within each pre-defined category, based on smoking intensity reported at the 3-year resurvey among current smokers at resurvey, to minimise regression dilution bias.

The RR of dying during the follow-up period was 1. Relative risk of all-cause mortality in past smokers relative to never-smokers in the 45 and Up Study, by age at smoking cessation.

In Australia, male and female smokers were estimated to have the same risks of death 9. Starting from age 45, Corresponding figures for females were In this large-scale, population-based Australian study, death rates in current smokers were around three-fold those of people who had never smoked, in both men and women. Mortality rates increased substantially with increasing intensity of smoking, with rates approximately doubling in those smoking around 10 cigarettes per day and four- to five-fold those of never-smokers in current smokers of 25 or more cigarettes per day.

Cessation of smoking conferred large mortality benefits compared with continuing to smoke. These findings were adjusted for a range of potential confounding factors, including socioeconomic status, alcohol intake, and BMI.

These findings are virtually identical to those on the contemporary risks of smoking from the UK and US, where the RR of all-cause mortality in current versus never-smokers has been consistently reported at 2. The finding of similar RRs among smokers across successive birth cohorts in this study indicates that, in common with these countries, it is likely that the full mortality impacts of smoking are being realised among smokers in Australia.

The evolution of increasing smoking-attributable mortality over time is well documented, with RRs of all-cause mortality in current versus never-smokers of around 1. The findings from this and contemporary estimates from the US and UK indicate that up to two-thirds of deaths in smokers in the 21 st century in these settings are likely to have been caused by smoking [ 3 , 6 , 23 ].

The progressive increase in RRs has been attributed to the earlier commencement of smoking and greater intensity of smoking among successive birth cohorts, along with reductions in mortality among never-smokers [ 3 , 6 , 23 ]. In keeping with this, the smoking-related RRs in countries where widespread heavy and prolonged smoking from an early age began more recently are somewhat lower than those observed here [ 25 ].

The study provides the first large-scale direct evidence on the relationship of smoking to mortality in Australia. The population examined displays quantitatively many of the characteristics of a mature epidemic of smoking in the Western context, namely a relatively low prevalence of current smoking; similar prevalence of current smoking in men and women; long durations and stable intensities of smoking among current smokers; young and stable age at commencing smoking; a high prevalence of past smoking; and stable RRs of smoking-related mortality in successive birth cohorts [ 26 ].

Consistent RRs among successive birth cohorts were observed although the tar content in cigarettes in Australia has fallen over the last four decades [ 9 ].

The findings also demonstrate the continuing harms of smoking, despite highly successful tobacco control measures, and the need for continuing attention and control. This study has the strength of being large and population-based, with independent and virtually complete data on the outcome of all-cause mortality. The study ascertained smoking status from questionnaire items that are based on those used in the Million Women Study, allowing direct international comparison of results [ 23 ].

Repeat data collection on smoking status allowed correction for regression dilution, such that the findings relating to smoking intensity are likely to reflect long-term habits. In keeping with the continuing decline in smoking prevalence in Australia, the data indicate that a substantial minority of current smokers at baseline ceased smoking during the follow-up period. This suggests that the estimated hazard ratios for mortality among current smokers at baseline are likely to be conservative.

Although we do not have direct data on use of smokeless tobacco products among participants, importation and supply of these products has been illegal in Australia since and use has been negligible since then [ 27 ]. The study provides evidence on the effects of heavy and prolonged smoking in a setting where the prevalence of smoking is now low.

It should be noted that although the 45 and Up Study is, like the vast majority of cohort studies, not strictly representative of the general population, the results presented here are based on internal comparisons within the cohort and are likely to be reliable [ 28 ]. Moreover, as the British Doctors Study illustrates, cohort studies do not need to be representative to produce effect estimates that are generalizable.

Follow-up time was relatively short, which has the advantage of meaning that smoking status measured at baseline is likely to broadly represent smoking status during the follow-up period.

NSW is the most populous state in Australia, comprising around one-third of the total population. Smoking prevalence and cause-specific death rates for major causes of death in NSW are similar to those observed nationally [ 17 , 18 ]. To ensure that the study focussed on the likely causal effect of smoking on mortality, participants who had had cancer or cardiovascular disease at baseline were excluded. Although it was not possible to exclude individuals with chronic respiratory disease, sensitivity analyses indicated that the results did not change materially when individuals with a previous hospital admission including a diagnosis of respiratory illness were excluded.

Because of the tendency for smokers, particularly older smokers, to quit due to ill-health, it was not possible to reliably estimate the mortality risks in those ceasing smoking at older ages i. It should be noted that the findings here are contingent on surviving to age 45; however, few deaths attributable to smoking are likely to have occurred below this age.

The evidence presented here relates to death from any cause. Data on cause of death were not available at the time this study was conducted.

International evidence shows that the vast majority of excess deaths in smokers are caused by smoking and are due to conditions such as cardiovascular disease, cancer, and chronic lung disease.

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Mature smokers

Mature smokers

Mature smokers

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Why are more seniors getting high? Some feel liberated to abandon long-held proprieties. Elegant vape pens and other attractive, discreet products have helped de stigmatize the drug among older Americans. The generation that camped out at Woodstock is now in its seventies.

By contrast, in a survey of one, my year-old grandmother recently said she had no interest in medical marijuana. A study found that in states with access to medical marijuana, those using Medicare part D — a benefit primarily for seniors — received fewer prescriptions for other drugs to treat depression, anxiety, pain, and other chronic issues.

For the most part, scientific research has not confirmed marijuana as an effective treatment for these conditions. But proven or not, a number of seniors evidently prefer it to the medications they would otherwise be taking.

While some doctors have expressed concerns about seniors self-medicating with weed, virtually everyone agrees the public health consequences of opioids are far worse. And the most serious health concerns associated with marijuana, such as impaired brain development, tend to affect younger people. The Colorado edibles company Wana Brands , among many others, sells cannabis products reminiscent of medicines familiar to seniors. Wana sells extended release capsules as well as products with different ratios of THC and CBD , which intoxicate users to different degrees and can have a variety of effects on ailments.

Whether or not marijuana helps seniors to alleviate their conditions, many may enjoy a sense of control over their own wellbeing. Meanwhile, dispensaries in California and elsewhere cater to older clientele with discounts and shuttle busses. Perhaps someday soon it will be normal for seniors to pass their last decades in a cannabis-induced haze.

Got a question about cannabis? Alex Halperin wants to hear from you, and will protect your anonymity. Get in touch: high. Facebook Twitter Pinterest. Topics Older people High time: a grownup's guide to the cannabis revolution. Cannabis Drugs Society Drugs Science features. Reuse this content. Most popular.

Mature smokers

Mature smokers