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Changes in Active and Passive Smoking in the European Community Respiratory Health Survey

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Changes in Active and Passive Smoking in the European Community Respiratory Health Survey Eur Respir J 2006; 27: 517–524 DOI: 10.1183/09031936.06.00106605 CopyrightßERS Journals Ltd 2006 Changes in active and passive smoking in the European Community Respiratory Health Survey C. Janson*, N. Ku¨nzli#, R. de Marco", S. Chinn+, D. Jarvis+, C. Svanes1, J. Heinriche, R. Jo˜gi**, T. Gislason##, J. Sunyer"", U. Ackermann-Liebrich++, J.M. Anto´"", I. Cerveri11, M. Kerhofee, B. Leynaert***, C. Luczynska+, F. Neukirch***, P. Vermeire###, M. Wjste and P. Burney+ ABSTRACT: The aim of the present investigation was to study changes and determinants for AFFILIATIONS *Respiratory Medicine and Allergology, changes in active and passive smoking. University of Uppsala, Uppsala, Sweden. # The present study included 9,053 adults from 14 countries that participated in the European Keck School of Medicine, University of Southern California, Los Angeles, CA, Community Respiratory Health Survey II. The mean follow-up period was 8.8 yrs. Change in the USA. "University of Verona, Dept of Medicine prevalence of active and passive smoking was expressed as absolute net change (95% and Public Health, Division of confidence interval) standardised to a 10-yr period. Determinants of change were analysed and Epidemiology and Statistics, Verona, Italy. the results expressed as adjusted hazard risk ratio (HRR) or odds ratio (OR). +Dept of Public Health Sciences, King’s The prevalence of active smoking declined by 5.9% (5.1–6.8) and exposure to passive smoking College London, London, UK. 1Dept Thoracic Medicine, Haukeland in nonsmokers declined by 18.4% (16.8–20.0). Subjects with a lower educational level (HRR: 0.73 Hospital, Bergen, Norway. e (0.54–0.98) and subjects living with a smoker (HRR: 0.45 (0.34–0.59)) or with workplace smoking Institute of Epidemiology, GSF-National Research Center for Environment and (HRR: 0.69 (0.50–0.95)) were less likely to quit. Low socio-economic groups were more likely to Health, Neuherberg, Germany. become exposed (OR: 2.21 (1.61–3.03)) and less likely to cease being exposed to passive **Tartu University Clinics, Lung Clinic, Tartu, Estonia. smoking (OR: 0.48 (0.37–0.61)). ##Dept Allergy, Respiratory Medicine and Sleep, University Hospital, In conclusion, the quitting rate was lower and the risk of exposure to passive smoking higher Reykjavik, Iceland. among subjects with lower socio-economic status. Exposure to other peoples smoking decreased ""Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), quitting rates and increased the risk of starting to smoke. Barcelona, Spain. ++Institute of Social and Preventive Medicine, University of Basel, Basel, KEYWORDS: Epidemiology, passive smoking, smoking, socio-economic status Switzerland. 11Division of Respiratory Diseases, IRCCS ‘‘San Matteo’’ Hospital, University of Pavia, Pavia, Italy. obacco is the world’s biggest preventable extent, have been successful with declining pre- eeUniversity of Groningen, Dept Epidemiology and Bioinformatics, killer and with 1.3 billion current smokers valence of daily smoking in several countries [10– University Medical Center Groningen, T it is estimated that 450 million tobacco 12] and a decrease in exposure to passive smoking Groningen, The Netherlands. deaths will occur over the next 50 yrs unless in English children during the 1990s [13]. Results ***INSERM–The French Institute of Health and Medical Research, Paris, current use changes dramatically [1]. It has also from smoking cessation studies show a lower France. become evident that smoking is not only a success rate in participants from lower socio- ###University of Antwerp, Antwerp, problem for smokers, but also for those around economic groups [14, 15]. Having a smoking Belgium. them with mounting evidence of the harmful spouse [15, 16], a higher level of nicotine depen- CORRESPONDENCE effect of passive smoking [2–4]. In the UK alone, dency, or higher tobacco consumption are other C. Janson, Dept of Medical Sciences, Respiratory Medicine and Allergology, passive smoking at home and in the workplaces factors related to a lower quitting rate [15, 17]. Akademiska sjukhuset, SE 751 85 has been estimated to cause deaths of .10,000 Uppsala, Sweden. Fax: 46 186110228 The ECRHS II [18] was a follow-up study of the E-mail: [email protected] persons each year [4]. subjects that were investigated in the ECRHS I. Received: In the European Community Respiratory Health This study provided a unique opportunity to September 12 2005 Survey (ECRHS) I, which included young adults study determinants of changes for active and Accepted after revision: November 22 2005 (aged 20–44 yrs) from 16 countries, 37% were passive smoking in population cohorts from a active smokers [5] and 39% of the never-smokers large number of different countries. SUPPORT STATEMENT For further information regarding the were exposed to passive smoking [6]. The ECRHS I financial support received please see the was conducted in 1990–1994 and since then METHODS Acknowledgements section. measures to reduce active and passive smoking The design of the ECRHS I and ECRHS II have European Respiratory Journal have been introduced in many countries [7–9]. been published in detail [18, 19]. Each participant Print ISSN 0903-1936 There are indications that these measures, to some was sent a brief questionnaire (stage 1) and from Online ISSN 1399-3003 c EUROPEAN RESPIRATORY JOURNAL VOLUME 27 NUMBER 3 517 ACTIVE AND PASSIVE SMOKING IN EUROPE C. JANSON ET AL. those who responded, a random sample was selected to This analysis included data from 29 centres in the ECRHS undergo a more detailed clinical examination (stage 2). II (table 1). The target population was 15,468 subjects with smoking data in stage 2 of the ECRHS I, of these 9,053 (58.6%) In the ECRHS II, subjects who had participated in stage supplied data on smoking in the ECRHS II. The follow-up time 2 of the ECRHS I were invited to participate in the follow-up. was 8.8¡1.2 yrs (mean¡SD). TABLE 1 Prevalence of current and passive smoking in the European Community Respiratory Health Survey (ECRHS) I and II Country and centre Current smoking Passive smoking in nonsmokers Follow-up n ECRHS I % ECRHS II % n ECRHS I % ECRHS II % Iceland Reykjavik 457 38.5 28.4 257 48.4 24.5 8.9¡0.3 Norway Bergen 595 41.8 37.1 315 34.1 15.2 9.5¡0.2 Sweden Go¨teborg 497 34.2 23.9 294 43.9 9.9 9.1¡0.4 Umea˚ 421 22.1 16.6 315 19.4 8.6 8.5¡0.4 Uppsala 511 23.7 13.7 366 22.4 6.0 8.6¡0.4 Estonia Tartu 241 30.7 43.9 127 37.8 27.6 5.2¡0.4 The Netherlands Geleen 138 33.3 26.1 88 67.0 38.6 10.3¡0.3 Belgium Antwerp South 337 24.6 20.5 228 54.8 32.0 9.8¡0.4 Antwerp City 298 33.2 31.5 178 51.7 33.2 9.1 ¡0.4 Germany Hamburg 303 38.6 32.0 169 49.7 27.2 9.3¡0.6 Erfurt 286 38.1 37.4 141 39.7 27.0 9.2¡0.3 Switzerland Basel 447 33.8 30.4 268 23.9 16.8 10.3¡0.4 France Bordeaux 163 38.0 30.1 92 47.8 26.1 9.2¡0.5 Grenoble 384 30.5 23.4 244 36.1 25.0 9.1¡0.4 Montpellier 202 23.8 18.3 130 37.7 18.5 9.2¡0.7 Paris 433 34.9 32.8 246 44.7 36.2 8.2¡0.9 UK Cardiff 209 27.8 23.0 147 42.9 25.8 10.6¡0.2 Ipswich 296 24.3 19.6 199 38.2 24.6 8.5¡0.5 Norwich 257 20.2 17.5 190 38.4 16.8 9.0¡0.5 Italy Pavia 192 38.0 30.7 106 67.0 51.9 8.5¡0.7 Turin 123 25.2 22.8 85 55.3 27.1 8.4¡0.4 Verona 204 33.3 33.3 121 41.3 21.5 8.7¡0.6 Spain Barcelona 271 45.8 38.8 129 65.1 45.0 8.9¡0.7 Galdakao 358 49.4 39.9 172 74.4 48.3 8.6¡0.4 Albacete 308 52.3 46.8 133 60.9 42.1 8.7¡0.8 Oveido 240 57.5 44.6 97 57.7 55.7 8.4¡0.7 Huevla 204 52.9 46.1 83 67.5 65.1 8.4¡0.7 Australia Melbourne 482 23.0 20.5 351 19.7 10.8 7.0¡0.5 USA Portland 196 15.3 12.2 158 17.1 10.8 7.7¡0.4 All subjects 9053 33.9 28.7 5429 40.6 24.0 8.8¡1.2 Data are presented as mean¡SD, unless otherwise stated. 518 VOLUME 27 NUMBER 3 EUROPEAN RESPIRATORY JOURNAL C. JANSON ET AL. ACTIVE AND PASSIVE SMOKING IN EUROPE Smoking Ethics approval Information on smoking history was collected by an adminis- Local ethics committees at each centre approved the study tered questionnaire at each occasion. Those who answered protocols. ‘‘yes’’ to the lead question (‘‘Have you ever smoked for as long as one year?’’) were asked ‘‘Do you smoke now, as of one Statistics month ago?’’ Subjects that were current smokers in the ECRHS Absolute change in smoking status per year of follow-up was I but not in the ECRHS II were defined as quitters. Subjects that estimated using population averaged generalised estimating were never-smokers in the ECRHS I but smokers in the ECRHS equations for a binomial outcome with identity link.
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