Smoking

Smoking

LASA filenames:
LASA154
LASEs815

Contact: Marjolein Visser

Background
Smoking is an important lifestyle variable that negatively influences health and physical functioning of older persons. In addition, smoking status often changes in old age as the consequence of incident disease.

Measurement instruments in LASA
In general, both current smoking status (never, former, current smoker) and smoking history (age when started smoking, age when stopped smoking) were assessed at each examination during the medical interview in LASA. In addition, for current smokers quantitative information was obtained for the following products: cigarettes, shag, cigars and pipes.

In the Migrant cohort, both current smoking status (never, former, current smoker) and smoking history (age when started smoking, age when stopped smoking) were assessed during the medical interview, but only for cigarette smoking. Furthermore, for current cigarette smokers quantitative information was gathered at a dichotomous level (1-20 or > 20 cigarettes).
From the LASA E examination (2001/2002) onwards, two slight adjustments to the smoking questionnaire were made. First, for current smokers the number of smoked cigarettes or shag per week was combined into one question. The same was done for the number of smoked cigars / pipes. Secondly, to allow the calculation of pack-years of smoking, former smokers were asked the average number of cigarettes or shag they smoked per week (or per day).

The calculation of pack-years is another way to indicate smoking history. Pack-years is the average number of packs of cigarettes smoked per day times the number of years smoking. It is always assumed that one pack contains 20 cigarettes. All non-smokers are set to 0 by definition. Only starting at the LASA E examination, former smokers are being asked to report the average number of cigarettes smoked, allowing the calculation of pack-years for former smokers.
In the LASA I wave, the smoking of e-cigarettes and comparable smoking equipment like e-smoker, shisha pen or FlavorVape were introduced. Current e-cigarette smoking status (never, former, current smoker) was assessed. Additionally, for both current and former e-cigarette users quantitative information was obtained by asking the extent of use of the e-cigarette. Finally, current e-cigarette smokers were asked the dosage of nicotine they used for their e-cigarette.

Questionnaires
LASAB154 / LASAC154 / LASAD154 / LASAE154 / LAS2B154 / LASAF154 / LASAG154 / LASAH154 / LAS3B154 / LASMB154 / LASAI154 / LASAJ154 / LASAK154 (medical interview, in Dutch)

Interim measurement:
LASEs815 (question 2 in self-admin. questionnaire, in Dutch)

Variable information
LASAB154 / LASAC154 / LASAD154 / LASAE154 / LAS2B154 / LASAF154 / LASAG154 / LASAH154 / LAS3B154 / LASMB154 / LASAI154 / LASAJ154 / LASAK154
(pdf)

Interim measurement:
estsmoke in LASEs815
(pdf)

Availability of information per wave ¹

* Cigarette and shag smoking were assessed separately in wave B (1992-93) and D (1998-99)
** Cigar and pipe smoking were assessed separately in B (1992-93), C (1995-96) and D (1998-99) and the number of packets (50 g) of pipe tobacco was assessed per month and not per week.
*** Only smoking of cigarettes was assessed in the Migrant cohort (2013-2014).

¹ More information about the LASA data collection waves is available here.

² IM=interim measurement between E and F (first cohort only);
2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort

Me-data collected in medical interview;
Sa=data collected in self-admin. questionnaire

Previous use in LASA
Smoking status: Many papers used current smoking status as a covariate or determinant in the statistical analyses (Pluijm et al., 2001, Furrer et al., 2014, Holvik et al., 2014, Buizert et al., 2013, Heima et al., 2013, Emerging Risk Factors Collaboration, 2012). Most often, respondents were classified into three (never, former, current) or two categories (never/former, current). The following smoking variable was also used to indicate current smoking status: never, former, pipe/cigar, cigarette/shag (Visser et al., 1999). The findings of a recent LASA study suggest that, compared to continued smokers, older adults who quit smoking are less likely to follow a unfavorable trajectory of functional limitations over time (i.e., lower initial level of functioning and an early onset of substantial decline) (Timmermans et al., 2018).

Quantitative information: To investigate a potential dose-response relationship among current smokers, heavy smokers (> 20 cigarettes/day) were contrasted with those smoking less than 20 cigarettes per day (Visser et al., 1999). Similarly, the number of years since smoking cessation was used to categorize former smokers (Visser et al., 1999). In research of Raho et al. (2015), the question ‘Did you ever smoke regularly?’ was used to define ever and never-smokers. Subsequently, they used the question ‘Do you smoke (at present)?’. They also used whether the ever smokers smoked cigarettes. This way, they determined whether younger and older generations may differ substantially in their lifetime smoking habits.

Smoking history: Smoking status at age 25 years, 40 years, and at the age during the LASA-B examination can also be assessed using a different approach. At each age, smoking status (never, former, current) was assessed based on the age of the respondent when smoking was started and stopped. A former smoker who stopped smoking at least 15 years ago was categorized as a never smoker. The rationale for this was that mortality among former smokers approaches the level of never smokers after a smoking cessation time of 10 to 20 years (Kawachi et al., 1993; Paganini-Hill and Hsu, 1994; Van Domburg et al., 2000; Wannamethee et al., 2001). As a cumulative measure of smoking exposure, the number of years smoked can be calculated for every age (Pluijm et al., 2007).

References

1. Buizert, P.J., Van Schoor, N.M., Simsek, S., Lips, P.T.A., Heijboer, A.C., Den Heijer, M., Deeg, D.J.H., Eekhoff, E.M.W. PTH: a new target in arteriosclerosis? Journal of Clinical Endocrinology & Metabolism, 2013;98, E1583-E1590.
2. Emerging Risk Factors Collaboration. Adult height and the risk of cause-specific death and vascular morbidity in 1 million people: individual participant meta-analysis. International Journal of Epidemiology, 2012;41, 1419-1433.
3. Furrer, R., Van Schoor , N.M., De Haan, A., Lips, P.T.A., De Jongh, R.T. Gender-specific associations between physical functioning, bone quality, and fracture risk in older people. Calcified Tissue International, 2014;94, 522-530.
4. Heima, N.E., Eekhoff, E.M.W., Oosterwerff, M.M., Lips, P.T.A., Van Schoor , N.M., Simsek, S. Thyroid function and the metabolic syndrome in older persons: a population-based study. European Journal of Endocrinology, 2013;168, 59-65.
5. Holvik, K., Van Schoor , N.M., Eekhoff, E.M.W., Den Heijer, M., Deeg, D.J.H., Lips, P.T.A., De Jongh, R.T. Plasma osteocalcin levels as a predictor of cardiovascular disease in older men and women: a population-based cohort study. European Journal of Endocrinology,2014; 171, 2, 161-170.
6. Kawachi, I., Colditz, G.A., Stampfer, M.J., Willet, W.C., Manson, J.E., Rosner, B., Hunter, D.J., Hennekens, C.H. and Speizer, F.E.Smoking cessation in relation to total mortality rates in women. Ann Intern Med 1993;119:992-1000.
7. Paganini-Hill, A., Hsu, G. Smoking and mortality among residents of California retirement community. Am J Public Health 1994;84:992-5.
8. Pluijm, S.M.F., Visser, M., Puts, M.T.E., Dik, M.G., Schalk, B.W.M., Van Schoor , N.M., Schaap, L.A., Bosscher, R.J., Deeg, D.J.H. Unhealthy lifestyles during the life course: association with physical decline in late life. Aging Clinical and Experimental Research, 2007;19, 1, 75-83.
9. Pluijm SM. Visser M, Smit JH, Popp-Snijders C, Roos JC, Lips P. Determinants of bone mineral density in older men and women: body composition as mediator. J Bone Miner Res 2001;16:2142-51.
10. Raho, E., van Oostrom, S.H., Visser, M., Huisman, M., Zantinge, E.M., Smit, H.A., Verschuren, W.M.M., Hulsegge, G., Picavet, H.S.J. Generation shifts in smoking over 20 years in two Dutch population-based cohorts aged 20-100 years. BMC Public Health, 2015;15, 142.
11. Van Domburg , R.T., Meeter, K., Van Berkel, D.F., Veldkamp, R.F., Van Herwerden, L.A. and Bogers, A.J.Smoking cessation reduces mortality after coronary artery bypass surgery: a 20-year follow-up study. J Am Coll Cardiol 2000;36:878-83.
12. Visser M, Launer LJ, Deurenberg P, Deeg DJH. Past and current smoking in relation to body fat distribution in older men and women. J Gerontol A Biol Sci Med Sci 1999;54:M293-8.
13. Wannamethee S.G., Schaper, A.G. and Perry, I.J. Smoking as a modifiable risk factor for type 2 diabetes in middle-aged men. Diabetes Care 2001;24:1590-5.
14. Timmermans, E.J., Huisman, M., Kok, A.A.L. Kunst, A.E. Smoking cessation and 16-year trajectories of functional limitations among Dutch older adults: results from the Longitudinal Aging Study Amsterdam. J Gerontol A Biol Sci Med Sci 2018;73:1722-28.

Date of last update: April 14, 2020 (ET)