Cardarelli Kathryn, Westneat Susan, Dunfee Madeline, May Beverly, Schoenberg Nancy, Browning Steven
College of Public Health, University of Kentucky, Lexington, KY, USA.
Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA.
BMC Public Health. 2021 Feb 2;21(1):270. doi: 10.1186/s12889-021-10334-6.
Adult smoking prevalence in Central Appalachia is the highest in the United States, yet few epidemiologic studies describe the smoking behaviors of this population. Using a community-based approach, the Mountain Air Project (MAP) recruited the largest adult cohort from Central Appalachia, allowing us to examine prevalence and patterns of smoking behavior.
A cross-sectional epidemiologic study of 972 participants aged 21 years and older was undertaken 2015-2017, with a response rate of 82%. Prevalence ratios and 95% confidence intervals for current smoking (compared to nonsmokers) were computed for the entire cohort then stratified by multiple characteristics, including respiratory health. Adjusted prevalence ratios for current smoking versus not smoking were also computed.
MAP participants reported current smoking prevalence (33%) more than double the national adult smoking prevalence. Current smoking among participants with a reported diagnosis of chronic obstructive pulmonary disease and emphysema was 51.5 and 53.3%, respectively. Compared to participants age 65 years and older, those age 45 years or younger reported double the prevalence of smoking (PR: 2.04, 95% CI: 1.51-2.74). Adjusted analyses identified younger age, lower education, unmet financial need, and depression to be significantly associated with current smoking.
Despite declining rates of smoking across the United States, smoking remains a persistent challenge in Central Appalachia, which continues to face marked disparities in education funding and tobacco control policies that have benefitted much of the rest of the nation. Compared with national data, our cohort demonstrated higher rates of smoking among younger populations and reported a greater intensity of cigarette use.
美国中阿巴拉契亚地区的成年人吸烟率是全国最高的，但很少有流行病学研究描述该人群的吸烟行为。山地空气项目（MAP）采用基于社区的方法，从中阿巴拉契亚地区招募了最大规模的成年队列，使我们能够研究吸烟行为的患病率和模式。
2015 - 2017年对972名21岁及以上的参与者进行了横断面流行病学研究，应答率为82%。计算了整个队列当前吸烟（与不吸烟者相比）的患病率比值和95%置信区间，然后按包括呼吸健康在内的多个特征进行分层。还计算了当前吸烟与不吸烟的调整后患病率比值。
MAP参与者报告的当前吸烟率（33%）是全国成年人吸烟率的两倍多。报告诊断为慢性阻塞性肺疾病和肺气肿的参与者中，当前吸烟率分别为51.5%和53.3%。与65岁及以上的参与者相比，45岁及以下的参与者报告的吸烟率是其两倍（PR：2.04，95%CI：1.51 - 2.74）。调整分析确定年龄较小、教育程度较低、经济需求未得到满足和抑郁与当前吸烟显著相关。
尽管美国的吸烟率在下降，但吸烟在中阿巴拉契亚地区仍然是一个持续的挑战，该地区在教育资金和烟草控制政策方面继续面临明显差距，而这些政策使美国其他大部分地区受益。与全国数据相比，我们的队列显示年轻人群中的吸烟率更高，并且报告的吸烟强度更大。
