Trends in lung cancer and cigarette smoking: California compared to the rest of the United States
Pierce JP, Shi Y, McMenamin SB, Benmarhnia T, Trindad DR, Strong DR, White MM, Kealey S, Hendrickson EM, Stone MD, Villasenor A, Kwong S, Zhang X, Messer K. Trends in lung cancer and cigarette smoking: California compared to the rest of the United States. Caner Prevention Research. 2018. DOI: 10.1158/1940-6207.CAPR-18-0341
Three cigarette smoking behaviors influence lung cancer rates: how many people start, the amount they smoke, and the age they quit. California has reduced smoking faster than the rest of the US and trends in these 3 smoking behaviors should inform lung cancer trends. We examined trends in smoking behavior (initiation, intensity, and quitting) in California and the rest of US by regression models using the 1974-2014 National Health Interview Surveys (n=962,174). Lung cancer mortality data for 1970-2013 was obtained from the national Surveillance, Epidemiology, and End Results (SEER) Program. Among those aged 18- 35 years, California had much larger declines than the rest of the US in smoking initiation and intensity, and increased quitting. In 2012-14, among this age group, only 18.6% (95% CI, 16.8%-20.3%) had ever smoked; smokers consumed only 6.3 cigarettes/d (95% CI, 5.6-7.0); and 45.7% (95% CI, 41.1%-50.4%) of ever-smokers had quit by age 35. Each of these metrics was at least 24% better than in the rest of the US. There was no marked California effect on quitting or intensity among seniors. From 1986-2013, annual lung cancer mortality decreased more rapidly in California and by 2013 was 28% lower (62.6 vs 87.5/100,000) than in the rest of the US. California's tobacco control efforts were associated with a major reduction in cigarette smoking among those under age 35 years. These changes will further widen the lung cancer gap that already exists between California and the rest of the US.