• Dad, Can You Stop Smoking and Not Die?

    My 11 year old son posed this question to me last week after a group visited his school and discussed the dangers of smoking. They were of course seeking to discourage smoking initiation. We discussed some of what he retained from this session, some correct, some wrong. I could tell the real question lurked. He then asked me this:

    If Pop Pop had stopped smoking would I have met him?

    Pop Pop was my father in law, who was a lifelong smoker and who died about 3 months  before my son was born. My wife talks about her father often with the kids (the older ones are 16 and 14), and she usually doesn’t miss the opportunity to reinforce the dangers of smoking cigarettes.

    11 year old’s like direct answers, so I told him that if his Pop Pop had stopped smoking before he got sick (around a decade before his death) then he probably would have met him.

    A paper I published around a decade ago in the American Journal of Public Health, Benefits of Smoking Cessation for Longevity provides the essence for my answer; Table 5 denominates the benefits of smoking cessation by a given age in terms of life years gained as compared to continuing to smoke:

    Note, the expected survival of never smokers should be 78.2 (for men) in the table, as compared to that of 69.3 for those who smoked until death (a typo, Methuselah was not a subject). The benefits of cessation for longevity are notable, and we found benefits even for smokers who stopped at age 65 (contingent upon their not already being sick when they quit, which is actually the primary reason that older smokers quit). The figure below summarizes the life extension gained due to smoking cessation at a given age (35, 45, 55 and 65), contingent upon surviving to that age.

    There are a lot of things going on in the model that produced these results; I will amplify them over the next  few days.

    Donald H. Taylor, Jr, Vic Hasselblad, Jane Henley, Michael J. Thun, Frank A. Sloan. Benefits of Smoking Cessation for Longevity. American Journal of Public Health 2002;92(6):990-996.

    • Then there are always the outliers: my father in-law (a primary care physician in rural Japan) smokes like crazy and is still hanging in there at 97.

      • But if he didn’t smoke he’d be 105. 🙂

      • @David Littleboy
        there is some interesting research on such “focal” relatives. Many smokers in focus groups latch on to such a person in overstating their life expectancy per life tables. Of course, some of them could be correct. I will blog about some of this from my book The Smoking Puzzle: Information, Risk Perception and Choice and some other work down the road. Roughly though, men are much more likely to over-estimate life expectancy than are women.

    • For the record, I _do_ know what the word “outlier” means, and used it in its correct meaning, thank you.

      I don’t intend to belittle the carnage: from memory (of a special in Science earlier this year) lung cancer (70% or so of which is due to smoking) kills about 150,000 Americans a year, the next nastiest cancers are in the 35,000 victims a year class. Deaths per 100,000 population for the major cancers have remain largely unchanged over the last 50 years. So just hitting cigarettes with a tax of, say, US$40 per pack, making smoking not an option for most smokers would save about as many lives as completely curing the next three most common cancers, and several orders of magnitude more lives than all the amazing science you all have done over the last 50 years. (It’s amazing how nasty cancer is.)

      That said, as a wimp with allergies who can’t walk through the perfume section of a department store without serious nasal pain, I don’t understand why smoking doesn’t kill people way faster. Just the radiation exposure from smoking a pack of smokes is horrific. The idea of intentionally inhaling smoke into one’s lungs is stupid beyond words. The minimum time for smoking to cause any of the disease it causes is orders of magnitude longer than my intuition says it should be. Go figure.

    • @David L
      In terms of tax policy, it should at least cover the external costs and current levels of taxation on average cover $1.50/pack. I could support higher taxes as a public health measure to avoid excess death, esp given the epidemiology of initiation which is mostly in the teen years, but this would be more controversial. Regarding different diseases, the relative risk of death is lots higher for smoking among relatively rare cancers (10-20 fold for esophogeal), but smaller for very common causes of death such as heart disease (more like 1.5-1.6).
      I was not trying to belittle you for noting an outlier; I will write about some of that work at some point. It is most important in middle-to-late life cessation.

    • Great website, saw a post on twitter about it and lead me to your website.