TY - JOUR T1 - Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia JF - Tobacco Control JO - Tob Control DO - 10.1136/tobaccocontrol-2019-055412 SP - tobaccocontrol-2019-055412 AU - Jae Jeong Yang AU - Danxia Yu AU - Xiao-Ou Shu AU - Neal D Freedman AU - Wanqing Wen AU - Shafiur Rahman AU - Sarah K Abe AU - Eiko Saito AU - Prakash C Gupta AU - Jiang He AU - Shoichiro Tsugane AU - Yu-Tang Gao AU - Yong-Bing Xiang AU - Jian-Min Yuan AU - Yasutake Tomata AU - Ichiro Tsuji AU - Yumi Sugawara AU - Keitaro Matsuo AU - Yoon-Ok Ahn AU - Sue K Park AU - Yu Chen AU - Wen-Harn Pan AU - Mangesh Pednekar AU - Dongfeng Gu AU - Norie Sawada AU - Hui Cai AU - Hong-Lan Li AU - Woon-Puay Koh AU - Renwei Wang AU - Shu Zhang AU - Seiki Kanemura AU - Hidemi Ito AU - Myung-Hee Shin AU - Pei-Ei Wu AU - Keun-Young Yoo AU - Habibul Ahsan AU - Kee Seng Chia AU - Paolo Boffetta AU - Manami Inoue AU - Daehee Kang AU - John D Potter AU - Wei Zheng Y1 - 2020/06/16 UR - http://tobaccocontrol.bmj.com/content/early/2020/06/16/tobaccocontrol-2019-055412.abstract N2 - Background Little is known about the health harms associated with low-intensity smoking in Asians who, on average, smoke fewer cigarettes and start smoking at a later age than their Western counterparts.Methods In this pooled analysis of 738 013 Asians from 16 prospective cohorts, we quantified the associations of low-intensity (<5 cigarettes/day) and late initiation (≥35 years) of smoking with mortality outcomes. HRs and 95% CIs were estimated for each cohort by Cox regression. Cohort-specific HRs were pooled using random-effects meta-analysis.Findings During a mean follow-up of 11.3 years, 92 068 deaths were ascertained. Compared with never smokers, current smokers who consumed <5 cigarettes/day or started smoking after age 35 years had a 16%–41% increased risk of all-cause, cardiovascular disease (CVD), respiratory disease mortality and a >twofold risk of lung cancer mortality. Furthermore, current smokers who started smoking after age 35 and smoked <5 cigarettes/day had significantly elevated risks of all-cause (HRs (95% CIs)=1.14 (1.05 to 1.23)), CVD (1.27 (1.08 to 1.49)) and respiratory disease (1.54 (1.17 to 2.01)) mortality. Even smokers who smoked <5 cigarettes/day but quit smoking before the age of 45 years had a 16% elevated risk of all-cause mortality; however, the risk declined further with increasing duration of abstinence.Conclusions Our study showed that smokers who smoked a small number of cigarettes or started smoking later in life also experienced significantly elevated all-cause and major cause-specific mortality but benefited from cessation. There is no safe way to smoke—not smoking is always the best choice. ER -