Objectives: To estimate smoking attributable mortality (SAM) in Taiwan for the years 2001 through 2020 under scenarios of reductions in smoking rates by 0%, 2%, 4%, and 10% per year. Method: The smoking attributable fraction (SAF) was used to calculate SAM from the risk experience in following up a large cohort (86 580 people) in Taiwan. Smoking rates were based on the 2001 National Health Interview Survey and other national surveys. An average 10 year lag was assumed between smoking rates and subsequent mortality. Results: In 2001, 18 803 deaths, or 1 out of 4 deaths (27%), in middle aged men (35-69 years old) were attributable to smoking. SAM has been increasing and will continue to increase if smoking rates remain constant or even if reduced annually by 2%. SAM would begin to decrease only if rates were to be reduced by at least 4% a year. Conclusions: The projected SAM in this study illustrates the seriousness of smoking caused mortality. Current efforts in tobacco control would lead to a progressive increase in SAM, unless efforts were doubled and smoking rates reduced by more than 4% a year. The urgency in requiring stronger tobacco control programmes to attenuate the staggering death tolls is compelling.
Objective: To assess the benefits of smoking cessation regarding mortality reduction after smokers quit, and regarding the health of newborns after smoking mothers quit. Methods: Relative mortality risks (RR) for smokers aged 35 or older who quit years ago were calculated from the follow up of 71 361 civil servants and teachers recruited since 1989. Data from the Pregnancy Risk Assessment Monitoring System in Taipei City were used to calculate the odds ratios of body weights of newborns born to mothers of different smoking status. Results: Mortality risk for ex-smokers was significantly lower than that of current smokers for all causes (18%), all cancer (22%), lung cancer (39%), and ischaemic heart disease (54%). These benefits were not distinguishable initially, up to five years, but by year 17 and thereafter, substantial benefits of cessation accrued. Two thirds of smoking women quit during the first trimester of pregnancy, and only 2.2% of mothers smoked throughout pregnancy. The newborns from smoking mothers were smaller than those from never smoking mothers, but, if these mothers quit early in the first trimester, birth weights were normal. Conclusions: The health benefits of smoking cessation, rarely reported for Asian populations, have been largely ignored by smokers in Taiwan, where cessation activities have been extremely limited. Findings of this study that risks from smoking can be attenuated or reversed should be widely communicated to motivate smokers to quit. Smokers should quit early, including smoking mothers, and not wait till medical conditions surfaced, to have the maximal benefits of cessation.
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