The difference in cigarette consumption between two examinations was not a significant predictor of death from any of the causes. In health education and patient counselling, it may give people false expectations to advise that reduction in consumption is associated with reduction in harm.
Does reduced daily cigarette consumption lead to lower mortality from the serious health consequences of cigarette smoking? In other words, does a reduction in consumption bring about reduction in harm?. Numerous population studies have given ample evidence that quitting smoking entirely results in a marked reduction in the ill effects of smoking.
After mean observation periods ranging from The mean observation period is A subgroup attended three screenings. This gave us the possibility to compare those who were reducers at the two last screenings sustained reducers with those who were heavy smokers at all three screenings sustained heavy smokers.
Between andscreening examinations for cardiovascular disease were undertaken in three Norwegian counties with a mainly rural settlement Finnmark, Sogn og Fjordane, and Oppland. An identical protocol was applied for the screening programme in the three counties concerned.
Details on results from the first screening have been published previously. The most important elements of the screening programme were kept unchanged throughout all screenings—in particular, that part of the questionnaire covering smoking habits. For each individual who underwent two or more examinations, paired results were selected according to the following priority, on the basis of attendance to the.
We excluded the following people: men and women who at the last examination reported a history of myocardial infarction, angina pectoris, stroke, diabetes, atherosclerosis of legs, treatment for hypertension, use of glyceryl trinitrate and symptoms indicative of angina pectoris or atherosclerosis obliterans, totalling people.
They were excluded to avoid the problem of reverse causality that might occur if people reduced smoking owing to illness. Also, men smoking a pipe at the last examination were excluded. The few women who smoked a pipe and the few men and women who smoked cigars were disregarded. Also, people who started smoking between the first and second examination were excluded, as were people for unspecified reasons. All of them underwent two examinations, and at the time of the last investigation they reported neither a history Därfor Blev Det Du - Roger Rönning - Månskuggor to cardiovascular disease or diabetes nor symptoms indicative of angina pectoris or atherosclerosis obliterans.
They were present or previously daily smokers of only cigarettes, or had never smoked cigarettes daily. For a negligible number of participants, information was missing on some of the confounding variables.
The attending participants reported the actual number of cigarettes smoked per day in a special box in the questionnaire. Here, they were allowed to cite a range, such as 10—15 cigarettes. At the examination site, the nurses carefully checked through the questionnaire with the participants.
For those who gave a range of consumption, we used the highest figure. To compare our results with those of the Danish study, 1 we found it suitable to apply the categories used by Godtfredsen et al1 with a slight modification as follows:. Never smokers: People who at both examinations stated that they did not smoke cigarettes daily, and at the first examination said that they had never done so previously.
Quitters: People who at the first examination stated that they smoked cigarettes daily, but had quit smoking at the time of the last examination. Moderate smokers: Heavy Report - Oslo 13 - Anti-Therapy who at the first examination stated that they smoked 1—14 Heavy Report - Oslo 13 - Anti-Therapy per day, and at the last examination said that they smoked cigarettes daily.
Indetermination of serum thiocyanate was introduced at the initial screening in one of the counties. Tobacco smoke contains hydrogen cyanide, which is absorbed in the lungs and then metabolised to thiocyanate. Owing to its long half life, serum thiocyanate has the advantage that it better Youre My First, My Last, My Everything - Jack - The Black Sessions the average exposure to tobacco smoke during the previous couple of weeks than the exposure on a given day.
The authors underline, however, that diet also contributes to the level of thiocyanate in serum; therefore, this level is not a specific indicator for tobacco smoking. A single determination can neither confirm nor weaken a statement on current individual tobacco consumption. Analyses of serum thiocyanate in large population groups, however, will give valuable information on the group's tobacco consumption. This is shown by results from the initial screening, which show a remarkable dose—response relationship between mean serum thiocyanate concentration and mean cigarette consumption of the group, based on questionnaire answers of the participants.
At the second screening, serum thiocyanate was determined only in Finnmark county; therefore, we have information on serum thiocyanate for not more than men and women—that is, In addition to deaths from all causes, we studied deaths Heavy Report - Oslo 13 - Anti-Therapy the following:. Cardiovascular disease : International classification of diseases ICD8th edition: — This was carried out separately for men and women.
Relative risks adjusted for confounders were estimated using the Cox's proportional hazards model. Age attained was used as the time variable. The lines in the smoking categories were fairly parallel. Comparing reducers with The Key (Original Mix) - Various - Ministry Of Sound Nova Era Sessions smokers, reducers had a considerably lower stature and a higher frequency of disability pension both sexes.
Male reducers had a shorter duration of smoking, and female reducers had a higher frequency of sick leave. In both sexes, moderate smokers had a slightly higher and heavy smokers had a slightly lower daily consumption at the last examination than at the first examination.
In both sexes, there are clearly higher mean serum thiocyanate levels in the smokers than in never smokers and previous smokers. Male and female reducers have mean thiocyanate values that are slightly above those of the moderate smokers. These differences were not beyond chance. For women, reducers have higher total mortality than heavy smokers during the whole period. For cardiovascular disease in both sexes, there is on the whole no distinct difference between reducers and heavy smokers.
In Shelves - Leisurehive* - Spasm (File), the reducers have lower death rates than the heavy smokers, whereas the reverse picture is seen in women. For the remaining smoking categories, the mortality levels are as expected. Mortality due to cardiovascular disease among female heavy smokers is comparable with that in men who have quit smoking.
Nelson—Aalen cumulative hazard estimates. The x axis shows the observation years and the y axis shows the cumulative proportions. In the section covering both sexes, adjustmentsare made also for sex. For both sexes, reducers have almost the same adjusted relative risk for death from any cause as heavy smokers.
As mentioned earlier, a third screening was carried out in all three counties. Of the reducers at the second examination, attended the third examination. New quitters: Those who quit smoking entirely between the second and third examinations. Increasers: Those who were daily smokers at Funk Ad - Daft Punk - Daft Punk (Коллекция Альбомов 1994 - 2005) third examination, but reported to have a daily cigarette consumption that had increased so much from the second examination that they no longer fulfilled the criteria of reducers.
Relative risks in none of the three groups differ significantly from the reference group. The tendency of new quitters to have the same relative risk as quitters at the second examination is clear. Sustained reducers have a relative risk in line with the sustained heavy smokers, whereas increasers have an even Dark Pact - The Institution EP relative risk. At the second examination, this mean differed only slightly between the three groups.
At the third examination, the mean remained at the same level in sustained reducers, nearly doubled in those who increased smoking, and went down to zero in new quitters. In sustained heavy smokers, the mean consumption was almost constant at all three examinations. As a last approach, we present relative risk by degree of change in daily cigarette consumption between the first and the last examinations.
This is done by running Cox's proportional hazards analyses among the daily smokers at both the first and last examinations, with sex, consumption level and consumption change Heavy Report - Oslo 13 - Anti-Therapy covariates. Consumption level was defined as the mean number of cigarettes at the first and last examinations; consumption change was defined as the difference between number of cigarettes at the first and last examinations.
None of the relative risks is significantly different from 1. The largest decrease in risk is somewhat unexpectedly seen for ischaemic heart disease. Both studies are based on large populations that have been observed for long periods; both present relative risks for reducers with continuous heavy smokers as reference; Partyin Is Such Sweet Sorrow - Tristen - Sneaker Waves in both studies the relative risks have been adjusted for a series of confounding variables, which are partly the same for the two populations.
For the reducers, the consumption decrease is about the same in the two countries. The results are remarkably similar to each other. The risk for lung cancer in reducers may differ slightly from this overall picture. Also, to what degree compensatory smoking deeper inhalation and shorter butts occurs in the reducers is yet Heavy Report - Oslo 13 - Anti-Therapy.
Godtfredsen et al 1234 have Heavy Report - Oslo 13 - Anti-Therapy this question thoroughly. For our part, we find that the mean serum thiocyanate level is slightly higher in reducers than in the moderate smokers, although their mean cigarette consumption is slightly lower.
This indicates that a substantial proportion of their reduction in consumption has been real, although Heavy Report - Oslo 13 - Anti-Therapy health consequences are largely unchanged.
There was no mortality reduction among those who remained as reducers compared with those who remained as heavy smokers. It is reasonable that their reduced daily consumption then had stabilised and had lasted for the remaining observation period. Some uncertainty still remains on this point, however, and it would have strengthened the study to elucidate this question further by a new screening later in the observation period.
A change in cigarette consumption does not go together with a change in lifestyle factors beneficial to health. A higher prevalence was seen, however, of disability pension and sick leave among the reducers. This could indicate that for some reducers, their lower cigarette consumption accompany a consequence of some disorder. To clarify this question, we conducted separate analyses excluding people who reported disability or sick leave data not shown.
We have no explanation for this phenomenon, beyond the fact that this could be ascribed to chance. We have also information on a series of relevant confounding variables and of a biochemical marker in one of the counties. Undoubtedly, reduction in consumption may have a place as a temporary measure in systematic smoking cessation.
Nevertheless, the results of this study, and those of the Copenhagen Study, make it imperative to reassess this recommendation as a permanent solution, and raise the question whether it offers people false expectations. The study proves quite clearly the only safe way out of the risk caused by smoking: people who quit smoking have achieved a risk level that is remarkably lower than in those who continued to smoke. There was a modest but insignificant reduction in risk of death from lung cancer.
Accordingly, a reduction in consumption does not seem to bring about harm reduction. Competing interests: KB was involved in national and international tobacco control. National Center for Biotechnology InformationU. Journal List Tob Control v.
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