Article

Estimating Benefits of Past, Current, and Future Reductions in Smoking Rates Using a Comprehensive Model With Competing Causes of Death

Department of Health Services, University of California, Los Angeles School of Public Health, Los Angeles, CA 90095-1772, USA.
Preventing chronic disease (Impact Factor: 1.96). 07/2012; 9:E122. DOI: 10.5888/pcd9.110295
Source: PubMed

ABSTRACT Despite years of declining smoking prevalence, tobacco use is still the leading preventable contributor to illness and death in the United States, and the effect of past tobacco-use control efforts has not fully translated into improvements in health outcomes. The objective of this study was to use a life course model with multiple competing causes of death to elucidate the ongoing benefits of tobacco-use control efforts on US death rates.
We used a continuous-time life course simulation model for the US population. We modeled smoking initiation and cessation and 20 leading causes of death as competing risks over the life span, with the risk of death for each cause dependent on past and current smoking status. Risk parameters were estimated using data from the National Health Interview Survey that were linked to follow-up mortality data.
Up to 14% (9% for men, 14% for women) of the total gain in life expectancy since 1960 was due to tobacco-use control efforts. Past efforts are expected to further increase life expectancy by 0.9 years for women and 1.3 years for men. Additional reduction in smoking prevalence may eventually yield an average 3.4-year increase in life expectancy in the United States. Coronary heart disease is expected to increase as a share of total deaths.
A dynamic individual-level model with multiple causes of death supports assessment of the delayed benefits of improved tobacco-use control efforts. We show that past smoking reduction efforts will translate into further increases in life expectancy in the coming years. Smoking will remain a major contributor to preventable illness and death, worthy of continued interventions.

Download full-text

Full-text

Available from: Jeroen van Meijgaard, Jul 29, 2014
0 Followers
 · 
134 Views
  • Source
    • "The use of combustible tobacco products (e.g., cigarettes, cigars, pipe, bidis, kreteks, and hookah) among adults remains widespread around the world. Unless dramatic progress is made diminishing the initiation and increasing cessation of combustible tobacco product use, a billion preventable deaths will occur in the 21st century [1]. These deaths will be accompanied by unimaginable human suffering and unaffordable economic loss from both preventable healthcare expenditures and loss of productivity from early death and disease. "
    Journal of Environmental and Public Health 12/2012; 2012:564390. DOI:10.1155/2012/564390
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this article, the authors briefly review the pharmacotherapeutic agents that are currently available for the treatment of substance use disorders. Nicotine replacement therapies are most effective for tobacco cessation. Naltrexone, acamprosate, and disulfiram are effective for reducing alcohol use. The most effective pharmacotherapies for opiate use disorders are agonist therapies, including methadone and buprenorphine. The authors also examine recent advances in medication development for other substance use disorders such as stimulant addiction. The role of medication adherence and behavioral treatments and the integration of behavioral and pharmacotherapeutic interventions are also discussed.
    Social Work in Public Health 05/2013; 28(3-4):264-78. DOI:10.1080/19371918.2013.759031 · 0.31 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Answer questions and earn CME/CNE Esophageal adenocarcinoma (EAC) is characterized by 6 striking features: increasing incidence, male predominance, lack of preventive measures, opportunities for early detection, demanding surgical therapy and care, and poor prognosis. Reasons for its rapidly increasing incidence include the rising prevalence of gastroesophageal reflux and obesity, combined with the decreasing prevalence of Helicobacter pylori infection. The strong male predominance remains unexplained, but hormonal influence might play an important role. Future prevention might include the treatment of reflux or obesity or chemoprevention with nonsteroidal antiinflammatory drugs or statins, but no evidence-based preventive measures are currently available. Likely future developments include endoscopic screening of better defined high-risk groups for EAC. Individuals with Barrett esophagus might benefit from surveillance, at least those with dysplasia, but screening and surveillance strategies need careful evaluation to be feasible and cost-effective. The surgery for EAC is more extensive than virtually any other standard procedure, and postoperative survival, health-related quality of life, and nutrition need to be improved (eg, by improved treatment, better decision-making, and more individually tailored follow-up). Promising clinical developments include increased survival after preoperative chemoradiotherapy, the potentially reduced impact on health-related quality of life after minimally invasive surgery, and the new endoscopic therapies for dysplastic Barrett esophagus or early EAC. The overall survival rates are improving slightly, but poor prognosis remains a challenge. CA Cancer J Clin 2013;63:232-248. (©) 2013 American Cancer Society.
    CA A Cancer Journal for Clinicians 07/2013; 63(4):232-48. DOI:10.3322/caac.21185 · 162.50 Impact Factor
Show more