“50-Year Trends in Smoking-Related Mortality in the United States” by Thun et al.

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The title of the paper

The title presents a clear idea of the question that will be investigated.

The author’s expertise

Michael J. Thun, MD, MS

Vice President, Emeritus
Surveillance and Epidemiology Research
Dr. Thun is affiliated with the American Cancer Society, but his research interests cover several areas.

Brian D Carter, MA, MPH

Carter is affiliated with the American Cancer Society, Epidemiology Research Program.

Diane Feskanich, Sc.D.

Assistant Professor
Harvard Medical School
Associate Epidemiologist, Department of Medicine
Brigham and Women’s Hospital
Dr. Feskanich also works with the Nurses’ Health Study and the Health Professionals Follow-up Study to examine the changing nutritional needs associated with aging in men and women.

Neal D. Freedman, Ph.D., MPH

National Cancer Institute (USA)
Division of Cancer Epidemiology and Genetics
Bethesda, USA

Ross Prentice, Ph.D.

Professor, Biostatistics
Ross currently works with Fred Hutchinson Cancer Research Center, and his research interests include failure time analysis, disease prevention trials, epidemiologic methods, dietary factors, and disease.

Alan D. Lopez, Ph.D.

Head of the School of Population Health
University of Queensland
Prof. Lopez’s areas of expertise include Burden of disease assessment; mortality analysis and causes of death; tobacco epidemiology and the global tobacco epidemic; global descriptive epidemiology of major diseases, injuries, and risk factors; measurement of mortality and causes of death.

Patricia Hartge, Sc.D.

Deputy Director, Epidemiology and Biostatistics Program
National Cancer Institute
Division of Cancer Epidemiology & Genetics, Epidemiology and Biostatistics Program

Susan M. Gapstur, Ph.D., MPH

Vice President
Research Department at the American Cancer Society, the Epidemiology Research Program
Adjunct Professor in the Department of Epidemiology at the Rollins School of Public Health at Emory University
Dr. Gapstur is a cancer epidemiologist.

The problem that is being addressed

A central question is whether the hazards for women are now approaching those for men as their lifetime smoking behaviors have become increasingly similar (Thun et al., 2013).

The authors have shown that the disease risks from cigarette smoking have escalated in both men and women smokers similarly (Thun et al., 2013).

The author noted that relative death risks for smokers had increased in both men and women. Hence, it was important to understand changes in health risks incurred by smokers, female and male smokers, and contemporary and past smokers.

The investigators did not make any predictions before doing the research.

The literature revelations on this topic

The researchers used 36 references in this study. This shows that the field of health risks associated with smoking is extensively studied. Only 12 sources in the study were current, i.e., from 2003 to 2013. The rest of the 36 sources ranged from the 1950s to 2002. The authors have clearly acknowledged all their sources in in-text citation and on the reference list page. The researchers did not condemn any previous studies.

This is an area with a great amount of controversy. Cigarette smoking and associated lung cancer is controversial.

The researcher methods

This was a longitudinal study among smokers for over 50 years. The researchers measured sequential trends in death during three time periods (1959–1965, 1982–1988, and 2000–2010) (Thun et al., 2013). They compared absolute and relative risks based on sex and self-reported smoking status in two historical cohort studies and in five pooled contemporary cohort studies among participants who became 55 years of age or older during follow-up (Thun et al., 2013).

The selection and criteria methods used

The researcher controlled participants to only those aged 55 years and above.

CPS I consisted of “183,060 men and 335,922 women” (Thun et al., 2013). These participants were enrolled in 1959, and the follow-up went through to September 30, 1965. There were “293,592 men and 452,893 women in CPS-II enrolled in 1982 and were followed until December 31, 1988” (Thun et al., 2013). There were five contemporary cohort studies between 2000 and 2010.

There were current smokers, former smokers, and nonsmokers.

Participants did not receive any incentives to take part in the study.

Materials, procedures, and interventions used

This was an observational study. There were no interventions.

The data collected, including variables measured, variables controlled

The researchers only used data gathered during enrolment in CPS I and CPS-II. They used updated data in contemporary cohort studies, but frequencies of data update differed among cohorts.

Analyses of former smokers involved only those who had “quit in two or more years prior to follow-ups” (Thun et al., 2013).

The researcher restricted follow-up time in CPS-II and I to six years in order to reduce “the impacts smoking on cessation on mortality” (Thun et al., 2013).

Study variables included mortality rate and smoking cessation, male and female smokers, former smokers, and education levels.

The study was not randomized, and the researchers did not manipulate any variable.

The research findings and interpretations

“Relative and absolute risks of death” (Thun et al., 2013) have increased among female smokers. In short, risks for women and men smokers are now the same. However, risks for male smokers have flattened.

The discussion section

The researchers showed five significant outcomes of the study in the discussion.

They compared findings to some in the British Doctors’ Study, the Million Women Study, and the U.S. National Health Interview Survey, and they all concurred (Doll, Peto, Wheatley, Gray and Sutherland, 1994).

The study limitation was including “white participants, 50 or more years born between 1870 and 1954, and it did not assess risks to younger smokers” (Thun et al., 2013). Contemporary cohorts had only smoked for 30 years, limiting assess of time on smoking.

Perspectives regarding the conclusions

The conclusion is precise to the study. The research design answered the research question. The researchers used a sufficiently large sample for the study.

The article’s clinical relevance to the Respiratory Care profession

The article is relevant to the Respiratory Care Profession because it explores smoking, lung cancer, ischemic heart diseases, obstructive pulmonary disease (COPD), and stroke.

References

Doll, R., Peto, R., Wheatley, K., Gray, R., and Sutherland, I. (1994). Mortality in relation to smoking: 40 years’ observations on male British doctors. BMJ, 309, 901-11.

Thun, M. J., Carter, B. D., Feskanich, D., Freedman, N. D., Prentice, R., Lopez, A D., … Susan, M. (2013). 50-Year Trends in Smoking-Related Mortality in the United States. The New England Journal of Medicine, 368(4), 351-364.