Elsevier

Preventive Medicine

Volume 42, Issue 3, March 2006, Pages 193-199
Preventive Medicine

The association of cigarette smoking with self-reported disease before middle age: The Coronary Artery Risk Development in Young Adults (CARDIA) study

https://doi.org/10.1016/j.ypmed.2005.12.008Get rights and content

Abstract

Background.

Evidence that demonstrates the harmful effect of cigarette smoking during young adulthood is limited. Therefore, we assessed associations between cigarette smoking and several self-reported illnesses in a prospective cohort study in healthy young adults.

Methods.

Data were derived from 4472 adults aged 18 to 30 years at baseline participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study and reexamined at least once after 7, 10, or 15 years.

Results.

Cigarette smoking in 1985–86 was related to self-reported smoking-related cancers, circulatory disease, and peptic ulcer. Incidence of these diseases was 9.3/1000 person years among current smokers vs. 4.5/1000 person years among never smokers with no exposure to passive smoke, relative risk (adjusted for race, sex, education, and center) 1.96 (1.42–2.70). Assuming causal relationships, 32% of these premature incidents were attributable to smoking. The relative risks of liver disease, migraine headache, depression, being ill the day before the examination, and chronic cough and phlegm production were also higher in smokers.

Conclusions.

Smokers aged 18–30 followed for 7 to 15 years reported an excess of both major and minor ailments related to earlier and current smoking. Thus, prevention, cessation, and avoiding passive smoking should remain strong goals among young people.

Introduction

The harmful health effects of cigarette smoking are well accepted. The Surgeon General's Report, for example, identified smoking as a cause of cancer, cardiovascular diseases, peptic ulcer, or respiratory diseases (U.S. Department of Health and Human Services, 2004). In the United States, a national health objective for 2010 is to reduce adult cigarette smoking prevalence to ≤12% (U.S. Department of Health and Human Services, 2000). To assess progress toward this objective, the Centers for Disease Control (CDC) analyzed self-reported data from the 2002 National Health Interview Survey (NHIS) sample adult core questionnaire, which indicated that approximately 22.5% of adults were current smokers, ranging from 28.5% for those aged 18–24 years to 9.3% for those aged ≥65 years (CDC, 2004). Although this prevalence is slightly lower than the 22.8% prevalence among U.S. adults in 2001 and the 24.1% prevalence in 1998, the rate of decline has been insufficient to achieve the 2010 national health objective. Furthermore, the proportion of 18- to 24-year-old cigarette smokers increased to 28.5% in 2002 27.9% in 1998 (CDC, 2000).

It has been suggested that more information available to young adults about the immediate dangers of smoking would reduce smoking and result in a long-term public health gain. However, evidence that demonstrates the harmful effect of cigarette smoking during young adulthood is limited (U.S. Department of Health and Human Services, 1994, McCarron et al., 2001, Raitakari et al., 2003, Berenson et al., 1998, Paffenbarger et al., 1995, Navas-Nacher et al., 2001, Castle et al., 2002, Boffetta et al., 2001, Beckett et al., 2001, Strachan et al., 1996); few of the studies are comprehensive (U.S. Department of Health and Human Services, 1994, McCarron et al., 2001); none extensively assessed risk after only 7–15 years; and none separated passive smokers from unexposed never smokers. Therefore, we assessed the effect of active and passive cigarette smoking on self-reported clinical diseases during 15 years of follow-up of black and white men and women initially aged 18–30 in the Coronary Artery Risk Development in Young Adults (CARDIA) study. We hypothesized that smoking status is strongly related to an early excess of cancer, cardiovascular diseases, peptic ulcer, and respiratory diseases.

Section snippets

Participants

The CARDIA study, a biethnic, prospective, multicenter epidemiologic study of the evolution of risk factors in young adults, has been described (Friedman et al., 1988). Briefly, from 1985 to 1986, 5115 African American and White individuals aged 18 to 30 years were examined in Birmingham, Chicago, Minneapolis, and Oakland. Recruitment was stratified to achieve balance at each site in race, sex, education, and age. Fifty percent of invited individuals contacted were examined (47% African

Risk of smoking-related diseases

The 4472 participants included 55.2% women, 49.9% black, and 61.8% with education beyond high school. Mean age (standard deviation) was 24.9 (3.6) years for men and 25.0 (3.7) years for women at year 0. Smoking initiation mean age was 16.9 (3.2) years. Cessation among former smokers occurred at mean age 23.0 (3.7) years. The 4472 participants had mean age 38.9 (4.5) years at their final examination, 3.7% were under 30 years of age; 14.8% were 30–34 years; 32.7% were 35–39 years; and 48.8% were

Discussion

In this prospective study, we demonstrated that cigarette smoking was related to the incidence of smoking-related cancer, cardiovascular diseases, and peptic ulcer as hypothesized. If all relations reported here were causal, as might be suspected, and if excess risks among current smokers were eliminated, 21% or 81 of the 390 smoking-related disease events (smoking-related cancer, cardiovascular diseases, and peptic ulcer) would be avoided. Furthermore, if passive and former smoking were also

Acknowledgments

Supported in part by National Heart, Lung, and Blood Institute contracts N01-HC-48047, N01-HC-48048, N01-HC-48049, N01-HC-48050, and N01-HC-95095 (CARDIA). Dr. Hozawa was also supported by a grant to the Japan Society for the Promotion of Science (JSPS) Research (14010301) from the Ministry of Education, Culture, Sports, Science and Technology of Japan and the BANYU FELLOWSHIP PROGRAM sponsored by Banyu Life Science Foundation International.

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