PT  - JOURNAL ARTICLE
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
TI  - Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia
AID  - 10.1136/tobaccocontrol-2019-055412
DP  - 2021 May 01
TA  - Tobacco Control
PG  - 328--335
VI  - 30
IP  - 3
4099  - http://tobaccocontrol.bmj.com/content/30/3/328.short
4100  - http://tobaccocontrol.bmj.com/content/30/3/328.full
SO  - Tob Control2021 May 01; 30
AB  - 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.Data are available on reasonable request. Data access can be through permission from the Asia Cohort Consortium only; please find more details on https://www.asiacohort.org/about/workingwith/index.html and send any inquiries to the Asia Cohort Consortium Coordinating Center at cc@asiacohort.org.