Esther García-Esquinas1, Angélica Jiménez2, Roberto Pastor-Barriuso3, Miranda R Jones4, Beatriz Perez-Gomez3, Ana Navas-Acien5, Maria Tellez-Plaza6. 1. Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. 2. Institute for Biomedical Research Hospital Clinic of Valencia (INCLIVA), Valencia, Spain. 3. National Center of Epidemiology, Carlos III Institutes of Health and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. 4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. 5. Department of Environmental Health Sciences, Columbia University, New York, NY, USA. Electronic address: an2737@cumc.columbia.edu. 6. Institute for Biomedical Research Hospital Clinic of Valencia (INCLIVA), Valencia, Spain; Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Abstract
BACKGROUND: The major decrease in exposure to secondhand smoke (SHS) in public places in recent decades could have contributed to the decline in smoking-related cancer mortality observed in the US population. METHODS: Prospective study among 11,856 non-smoking adults aged ≥40 years who participated in NHANES 1988-1994 or 1999-2004 and were followed for mortality through 2006. We estimated the amount of change in cancer mortality over time attributed to the intermediate pathway of changes in SHS exposure in public places, after adjustment for risk factors and SHS exposure at home. RESULTS: The adjusted smoking-related cancer mortality rate ratios (95% CI) for a two-fold increase in serum cotinine and a 1-hour increase in occupational SHS exposure time were 1.10 (1.03, 1.17) and 1.14 (1.06, 1.24) for all-cancer, and 1.13 (1.03, 1.24) and 1.14 (1.02, 1.26) for smoking-related cancer, respectively. The absolute reduction in mortality comparing 1999-2004 to 1988-1994 was 75.8 (-25.5, 177.0) and 77.0 (2.6, 151.4) deaths/100,000 person-years, for all-cancer and smoking-related cancer, respectively. Among these avoided all-cancer deaths, 45.8 (2.8, 89.5) and 18.1 (-1.2, 39.6)/100,000 person-year were attributable to changes in serum cotinine concentrations and occupational SHS exposure time, respectively. The corresponding numbers of smoking-related cancer avoided deaths were 36.4 (0.7, 72.8) and 9.9 (-3.8, 24.9)/100,000 person-year. CONCLUSIONS: Declines in SHS exposure were associated with reductions in all-cancer and smoking-related cancer mortality, supporting that smoking bans in public places may have reduced cancer mortality among non-smoking adults.
BACKGROUND: The major decrease in exposure to secondhand smoke (SHS) in public places in recent decades could have contributed to the decline in smoking-related cancer mortality observed in the US population. METHODS: Prospective study among 11,856 non-smoking adults aged ≥40 years who participated in NHANES 1988-1994 or 1999-2004 and were followed for mortality through 2006. We estimated the amount of change in cancer mortality over time attributed to the intermediate pathway of changes in SHS exposure in public places, after adjustment for risk factors and SHS exposure at home. RESULTS: The adjusted smoking-related cancer mortality rate ratios (95% CI) for a two-fold increase in serum cotinine and a 1-hour increase in occupational SHS exposure time were 1.10 (1.03, 1.17) and 1.14 (1.06, 1.24) for all-cancer, and 1.13 (1.03, 1.24) and 1.14 (1.02, 1.26) for smoking-related cancer, respectively. The absolute reduction in mortality comparing 1999-2004 to 1988-1994 was 75.8 (-25.5, 177.0) and 77.0 (2.6, 151.4) deaths/100,000 person-years, for all-cancer and smoking-related cancer, respectively. Among these avoided all-cancer deaths, 45.8 (2.8, 89.5) and 18.1 (-1.2, 39.6)/100,000 person-year were attributable to changes in serum cotinine concentrations and occupational SHS exposure time, respectively. The corresponding numbers of smoking-related cancer avoided deaths were 36.4 (0.7, 72.8) and 9.9 (-3.8, 24.9)/100,000 person-year. CONCLUSIONS: Declines in SHS exposure were associated with reductions in all-cancer and smoking-related cancer mortality, supporting that smoking bans in public places may have reduced cancer mortality among non-smoking adults.
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