Abstract
Objectives—Assess injury death relative risks (RR), dose-response, and attributable fractions for current cigarette smokers (smokers) in a recent representative sample of the United States population without and with adjustment for (a) demographic and (b) additional behavioral risk factors.
Setting—United States.
Methods—National Health Interview Survey (NHIS) adult (ages 18+ years) interviewees from 1990 or 1991 were followed through 1995. Referents had never smoked a total of 100 cigarettes. Relative risks were estimated with Stata software's Cox proportional hazard regressions, using NHIS final weights and primary sampling units. The resulting RR and published data were used to estimate population smoking attributable fractions of injury deaths in the United States.
Results—The crude, age-race-gender adjusted, and fully (demographic plus educational attainment, marital status, alcohol use level, and seat belt use) adjusted RRs for injury death in smokers were 1.86 (95% confidence interval (CI) 1.30 to 2.66), 1.60 (CI 1.12 to 2.29), and 1.42 (CI 0.99 to 2.05) respectively. Those RRs correspond to United States injury death smoking attributable fractions of 18%, 13%, and 9%, respectively. Those smoker/injury death RRs each showed a significant dose response relationship (p<0.030). Smokers' unadjusted unintentional injury, motor vehicle crash, and suicide RRs were 1.87 (CI 1.22 to 2.86), 2.14 (CI 1.12 to 4.11), and 2.17 (CI 1.02 to 4.62), respectively.
Conclusions—Smokers in the United States have significant dose-response excesses of injury death, independent of age, race, gender, alcohol use, seat belt use, education, and marital status. This supports earlier studies suggesting that smoking may be a leading contributor to injuries and injury may be a leading burden from smoking, both nationally and globally.
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Selected References
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- Cummings S. R., Rubin S. M., Oster G. The cost-effectiveness of counseling smokers to quit. JAMA. 1989 Jan 6;261(1):75–79. [PubMed] [Google Scholar]
- Dee T. S. The complementarity of teen smoking and drinking. J Health Econ. 1999 Dec;18(6):769–793. doi: 10.1016/s0167-6296(99)00018-1. [DOI] [PubMed] [Google Scholar]
- Friberg L., Cederlöf R., Lorich U., Lundman T., De Faire U. Mortality in twins in relation to smoking habits and alcohol problems. Arch Environ Health. 1973 Nov;27(5):294–304. doi: 10.1080/00039896.1973.10666384. [DOI] [PubMed] [Google Scholar]
- Heffron W. A., Skipper B. J., Lambert L. Health and lifestyle issues as risk factors for homelessness. J Am Board Fam Pract. 1997 Jan-Feb;10(1):6–12. [PubMed] [Google Scholar]
- Henningfield J. E., Clayton R., Pollin W. Involvement of tobacco in alcoholism and illicit drug use. Br J Addict. 1990 Feb;85(2):279–291. doi: 10.1111/j.1360-0443.1990.tb03084.x. [DOI] [PubMed] [Google Scholar]
- Hines D. Nonsmoking college students' attitudes toward smokers and smoking. Psychol Rep. 1996 Jun;78(3 Pt 1):860–862. doi: 10.2466/pr0.1996.78.3.860. [DOI] [PubMed] [Google Scholar]
- Hser Y. I., McCarthy W. J., Anglin M. D. Tobacco use as a distal predictor of mortality among long-term narcotics addicts. Prev Med. 1994 Jan;23(1):61–69. doi: 10.1006/pmed.1994.1009. [DOI] [PubMed] [Google Scholar]
- Hwang S. W. Mortality among men using homeless shelters in Toronto, Ontario. JAMA. 2000 Apr 26;283(16):2152–2157. doi: 10.1001/jama.283.16.2152. [DOI] [PubMed] [Google Scholar]
- Kermode M., Crofts N., Miller P., Speed B., Streeton J. Health indicators and risks among people experiencing homelessness in Melbourne, 1995-1996. Aust N Z J Public Health. 1998 Jun;22(4):464–470. doi: 10.1111/j.1467-842x.1998.tb01415.x. [DOI] [PubMed] [Google Scholar]
- Leistikow B. N., Martin D. C., Jacobs J., Rocke D. M. Smoking as a risk factor for injury death: a meta-analysis of cohort studies. Prev Med. 1998 Nov-Dec;27(6):871–878. doi: 10.1006/pmed.1998.0374. [DOI] [PubMed] [Google Scholar]
- Leistikow B. N., Shipley M. J. Might stopping smoking reduce injury death risks? A meta-analysis of randomized, controlled trials. Prev Med. 1999 Mar;28(3):255–259. doi: 10.1006/pmed.1998.0412. [DOI] [PubMed] [Google Scholar]
- Liao Y., Cooper R. S., Cao G., Kaufman J. S., Long A. E., McGee D. L. Mortality from coronary heart disease and cardiovascular disease among adult U.S. Hispanics: findings from the National Health Interview Survey (1986 to 1994). J Am Coll Cardiol. 1997 Nov 1;30(5):1200–1205. doi: 10.1016/s0735-1097(97)00278-7. [DOI] [PubMed] [Google Scholar]
- Mierley M. C., Baker S. P. Fatal house fires in an urban population. JAMA. 1983 Mar 18;249(11):1466–1468. [PubMed] [Google Scholar]
- Rich-Edwards J. W., Corsano K. A., Stampfer M. J. Test of the National Death Index and Equifax Nationwide Death Search. Am J Epidemiol. 1994 Dec 1;140(11):1016–1019. doi: 10.1093/oxfordjournals.aje.a117191. [DOI] [PubMed] [Google Scholar]
- Sachs-Ericsson N., Wise E., Debrody C. P., Paniucki H. B. Health problems and service utilization in the homeless. J Health Care Poor Underserved. 1999 Nov;10(4):443–452. doi: 10.1353/hpu.2010.0717. [DOI] [PubMed] [Google Scholar]
- Tverdal A., Thelle D., Stensvold I., Leren P., Bjartveit K. Mortality in relation to smoking history: 13 years' follow-up of 68,000 Norwegian men and women 35-49 years. J Clin Epidemiol. 1993 May;46(5):475–487. doi: 10.1016/0895-4356(93)90025-v. [DOI] [PubMed] [Google Scholar]
- Waller J. A. On smoking and drinking and crashing. N Y State J Med. 1986 Sep;86(9):459–460. [PubMed] [Google Scholar]
- Wu L. T., Anthony J. C. Tobacco smoking and depressed mood in late childhood and early adolescence. Am J Public Health. 1999 Dec;89(12):1837–1840. doi: 10.2105/ajph.89.12.1837. [DOI] [PMC free article] [PubMed] [Google Scholar]