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