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Original research
Low-intensity daily smoking and mortality risk among Mexican women
  1. Daniela Sarahí Gutiérrez-Torres1,
  2. Marion Brochier2,
  3. Dalia Stern3,
  4. Adrian Cortés-Valencia2,
  5. Juan Eugenio Hernández-Ávila4,
  6. Evangelina Morales-Carmona4,
  7. Tonatiuh Barrientos-Gutierrez2,
  8. Maki Inoue-Choi1,
  9. Martin Lajous2,5,
  10. Neal D Freedman1
  1. 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
  2. 2Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Ciudad de México, Mexico
  3. 3CONAHCyT – Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
  4. 4Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
  5. 5Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Martin Lajous, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Ciudad de México, 14000, Mexico; mlajous{at}insp.mx

Abstract

Objective To examine the association between low-intensity smoking (10 or less cigarettes per day) and all-cause and cause-specific mortality risk among women who smoke and by age at cessation among women who previously smoked.

Methods In this study, 104 717 female participants of the Mexican Teachers’ Cohort Study were categorised according to self-reported smoking status at baseline (2006/2008) and were followed for mortality through 2019. We estimated HRs and 95% CIs for all-cause and cause-specific mortality using multivariable Cox proportional hazards regression models with age as the underlying time metric.

Results Smoking as few as one to two cigarettes per day was associated with higher mortality risk for all causes (HR: 1.36; 95% CI 1.10 to 1.67) and all cancers (HR: 1.46; 95% CI 1.05 to 2.02), compared with never smoking. Similarly, slightly higher HRs were observed among participants smoking ≥3 cigarettes per day (all causes HR: 1.43; 95% CI 1.19 to 1.70; all cancers HR: 1.48; 95% CI 1.10 to 1.97; cardiovascular disease HR: 1.58; 95% CI 1.09 to 2.28).

Conclusions In this large study of Mexican women, low-intensity smoking was associated with higher mortality risk for all causes and all cancers. Interventions are needed to promote cessation among women who smoke at low-intensity in Mexico, regardless of how few cigarettes they smoke per day.

  • Low/Middle income country
  • Smoking Caused Disease
  • Prevention
  • Priority/special populations

Data availability statement

Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author, ML, on reasonable request. We have adopted a data enclave approach and guidelines are available on our website https://esmaestras.org/available-mtc-data/.

https://doi.org/10.1136/tc-2022-057839

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    Data availability statement

    Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author, ML, on reasonable request. We have adopted a data enclave approach and guidelines are available on our website https://esmaestras.org/available-mtc-data/.

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    Footnotes

    • Contributors Guarantor: ML. Conceptualisation: DSG-T, ML and NDF. Data curation: DS and AC-V. Methodology: TB-G, DSG-T, MI-C and NDF. Formal analysis and writing – original draft: DSG-T. Investigation: JEH-A, EM-C, MB and ML. Funding acquisition and supervision: NDF. Writing – review and editing: all authors.

    • Funding This study was supported by National Cancer Institute, Division of Cancer Epidemiology and Genetics, Intramural Research Program.

    • Disclaimer The comments and opinions expressed in this paper are those of the authors and does not reflect the official policy of the Department of Health and Human Service, National Institutes of Health and National Cancer Institute.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.