Posted on February 11, 2002 at 10:30 a.m.

BIRMINGHAM, AL — The 35-year campaign against cigarette smoking in the United States has moderately reduced the number of smokers who are younger adults, but has failed to have an impressive impact on older smokers, say two UAB (University of Alabama at Birmingham) scientists in the February issue of the International Journal of Cancer.

“Smokers who continue the habit until they are 40 years old become irreversibly addicted to nicotine,” says Dr. Brad Rodu, a UAB oral pathologist. He and UAB epidemiologist Dr. Philip Cole called for the use of nicotine maintenance strategies to “directly address inveterate smokers over the age of 40.”

Such strategies may include products such as nicotine medications and smokeless tobacco, they say. “Innovation is overdue, and the implementation of harm reduction may serve to lower the appallingly high number of deaths among inveterate smokers,” the report concluded.

Rodu and Cole studied lung cancer death rates among white men born in the first half of the 20th century, a group with the highest smoking rates and consequently the highest smoking-related disease rates. Their study developed outcome measures based on lung cancer mortality and used them to assess the anti-smoking effort. “There really is no other very good measure of how well the campaign has worked,” says Rodu. “We looked at lung cancer because it is a ‘sentinel’ disease of smoking — its rates directly reflect an age-group’s rate of smoking.”

They looked at five-year birth cohorts of white men born from 1901 to 1942, and used each group’s lung cancer mortality rate at ages 40-44 to indicate its earlier smoking rate. A lung cancer mortality ratio was developed to describe each cohort’s continued smoking from ages 40-44 to 55-59. These ratios were then compared with the durations of their exposure to the anti-smoking campaign that began in 1965 with a landmark report from the U.S. Surgeon General.

Rodu said that lung cancer mortality in white men ages 40-44 peaked in 1970 and declined continuously thereafter, “indicating that the anti-smoking campaign promptly reduced significant smoking among younger men. However, the lung cancer mortality ratio indicates that only half of smokers in the specified birth groups were able to quit by ages 55-59, despite receiving ever more intensive anti-smoking messages.”

The researchers defined the anti-smoking campaign as anything that might have lowered lung cancer rates, “including changes in cigarette design, educational messages and warnings, advertising limits, the availability of nicotine substitution, reduced accessibility of young persons, and restrictions on smoking in public.”

From 1970 to 1996, lung cancer rates among younger white men (ages 40-44) declined 55 percent, indicating that the campaign was effective in reducing smoking among younger adults. However, the analysis revealed that “most of the 24 million smokers between ages 40-44 and 55-59 are inveterate,” they report.

According to the U.S. Centers for Disease Control and Prevention, 420,000 Americans over the age of 40 die annually from smoking related diseases.

Dr. Rodu was supported in part by an unrestricted gift from the United States Tobacco Company to the Tobacco Research Fund of UAB.