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Measures of tobacco use and nicotine dependency with total and cause-specific mortality in PLCO

Principal Investigator
Name
Neal Freedman
Institution
NCI, DCEG, NEB
Position Title
Investigator
Email
About this CDAS Project
Study
PLCO (Learn more about this study)
Project ID
PLCO-29
Initial CDAS Request Approval
Apr 16, 2013
Title
Measures of tobacco use and nicotine dependency with total and cause-specific mortality in PLCO
Summary
Cigarette smoking is a leading preventable cause of mortality, with recent estimates suggesting that 2/3 of current smokers will ultimately be killed by their habit (1-3). Nevertheless, many questions about the tobacco epidemic remain. For example, in the U.S., 36% of all smokers and the vast majority (84%) of African-American smokers smoke mentholated cigarettes (4). Although it has been proposed that smokers of menthol cigarettes may be exposed to a greater total dose of carcinogens in tobacco smoke (5, 6), results from the few existing studies have been mixed and largely limited to lung cancer (7-9). In addition, recent data suggests the level of a person’s tobacco dependence may affect their risk of developing lung, head and neck, and other cancers, with those requiring a cigarette immediately after waking (Fagerstrom test for nicotine dependence) at higher risk than those who can wait longer before smoking (10-11), and that this association was independent of both smoking dose (cigarettes per day) and smoking duration. However, associations between measures of nicotine dependence and other health outcomes are less clear. Finally, a growing proportion of the US smokers are light or intermediate smokers, i.e. they smoke only a few cigarettes per day, or they smoke on some days but not others. However, little information is available about whether the number of days smoked is a determinant of disease risk.
Aims

To investigate whether menthol use, nicotine dependence and light and intermediate smoking are associated with total and cause-specific mortality using the PLCO supplemental questionnaire (SQX), administered in 2006-2007.

Analysis summary: We will utilize Cox proportional hazards regression to compare risk of death across different groups defined based on information from the SQX on menthol use, nicotine dependent and light and intermediate smoking. Models will be adjusted for relevant confounders including, but not limited to age, race, sex, socioeconomic status indicators, body mass index and alcohol use. Models will be examined both overall and stratified by sex.

In order to maximize our statistical power, we will examine total mortality, but will also look at cause-specific mortality, including deaths due to heart disease, stroke, respiratory disease, and cancer.

References
1. Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med 2013; 368(4): 341-50
2. Pirie K, Peto R, Reeves GK, et al. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 2013; 381(9861): 133-41
3. Thun MJ, Carter BD, Feskanich D, et al. 50-year trends in smoking-related mortality in the United States. N Engl J Med 2013; 368(4): 351-64
4. Rock VJ, Davis SP, Thorne SL, et al. Menthol cigarette use among racial and ethnic groups in the United States, 2004-2008. Nicotine Tob Res 2010; 12 Suppl 2: S117-S124
5. Clark PI, Gardiner PS, Djordjevic MV, et al. Menthol cigarettes: setting the research agenda. Nicotine Tob Res 2004; 6 Suppl 1: S5-S9
6. Okuyemi KS, Ebersole-Robinson M, Nazir N, et al. African-American menthol and nonmenthol smokers: differences in smoking and cessation experiences. J Natl Med Assoc 2004; 96(9): 1208-11
7. Blot WJ, Cohen SS, Aldrich M, et al. Lung cancer risk among smokers of menthol cigarettes. J Natl Cancer Inst 2011; 103(10): 810-6
8. Brooks DR, Palmer JR, Strom BL, et al. Menthol cigarettes and risk of lung cancer. Am J Epidemiol 2003; 158(7): 609-16
9. Murray RP, Connett JE, Skeans MA, et al. Menthol cigarettes and health risks in Lung Health Study data. Nicotine Tob Res 2007; 9(1): 101-7
10. Muscat JE, Ahn K, Richie JP, Jr., et al. Nicotine dependence phenotype, time to first cigarette, and risk of head and neck cancer. Cancer 2011; 117(23): 5377-82
11. Muscat JE, Ahn K, Richie JP, Jr., et al. Nicotine dependence phenotype and lung cancer risk. Cancer 2011; 117(23): 5370-76

Collaborators

Amanda Black, Neil Caporaso, Neal Freedman, Fangyi Gu, Patricia Hartge, Carolyn Reyes-Guzman, and Meredith Shiels
NCI