International Journal of Epidemiology O Oxford Unrvenity Press 1975
Vol. 4, No. 1 Printed in Great Briuin
Smoking Habits in Romania CARMEN RACOVEANU, 1 D. TECULESCU,2 M. MANICATIDE 3 and V. NICOLAESCU4
It is widely accepted today that smoking exerts a deleterious influence on human health. The effect of tobacco smoking (especially cigarettes) on a long series of morbid conditions including vascular, respiratory, neoplastic, digestive and endocrine diseases has been officially recognized (1, 2, 3). The health consequences of smoking depend on many factors. Some of these are related to the smokers themselves (proportion of smokers in a population, type of tobacco smoked—cigarette, cigar or pipe—depth of inhalation, age at starting to smoke), others to the product consumed (nicotine and tar content, presence or absence of filter). The present paper is a review of the Romanian literature concerning tobacco consumption, with some reference to the effects of smoking on the prevalence of respiratory symptoms. The review will deal with the main factors conditioning the effect of smoking on the respiratory system, as mentioned above.
9 to 12 per cent were present smokers (4, 5) while 55 to 87 per cent had never smoked (9, 10). In men, the 'open' (in respect to age) population groups had a lower proportion of smokers (33 to 37 per cent) as compared to groups of middle-aged subjects (4, 10). Three studies carried out by the staff of the Institute of Hygiene and Public Health in Bucharest, on industrial workers in the third to the sixth decade in Bucharest (7) and Galafi (12), and on coalminers of the same age span in the Jiu Valley (13) yielded very similar proportions of smokers (49 • 5,46 • 3 and 48 • 8 per cent respectively). These figures are close to those obtained in the general male population by Racoveanu and coworkers (52 0 and 46-2 per cent) in Bucharest, in two rural areas and in the highly industrialized city of Hunedoara (5, 11). Males who had never smoked represented about one-third (27-5 to 36-8 per cent), while former smokers represented about one-fifth (17-0 to 23-7 per cent) of the population. In Romania, as in other countries, some subjects stop smoking as they get older, thus reducing the number of current smokers in higher age groups (6, 10, 11, 12). The results quoted above are very similar to those of Boudik and colleagues in Prague (14), and of Anderson and co-workers in Canada (15), and similar also to findings in France (16), Sweden (17) and the United States (18). In other countries such as the United Kingdom (19) and the German Democratic Republic (20), smokers represent from 68 to 75 per cent of the population, and subjects who never smoked only 7 to 11 per cent. A recent study by Anastasatu and co-workers has stressed the high prevalence of
1. THE PROPORTION OF SMOKERS IN THE POPULATION
This must be considered, taking into account such variables as sex, age, social status, occupation, etc. As seen in Table I, field surveys carried out in this country in the last five years have found a wide variation (from 9 to 74 per cent) in the proportion of smokers in the samples studied. Among women, 1
' * 'N.Gh.Lupu' Institute of Internal Medicine. Colentina Hospital, Department of Occupational Diseases, Bucharest, Romania. Reprint requests should be addressed to Dr. C. Racoveanu. 1
25
Downloaded from http://ije.oxfordjournals.org/ at University of Saskatchewan on June 21, 2015
Racoveanu, Carmen (Division of Pulmonary Diseases, Institute of Internal Medicine, Colentina Hospital, Bucharest 10, Romania), Teculescu, D., Manicatide, M., and Nicolaescu, V. Smoking habits in Romania. Int. J. Epid. 1975, 4 : 25-29. The main aspects and consequences of tobacco use resulting from a series of field surveys in Romania are reviewed. The proportion of smokers in middle-aged adults is about 10 per cent for women and 40 to 50 per cent for men. Cigarettes are practically the only form of tobacco consumed—cigars are very rarely smoked and piposmoking accounts for less than 1 per cent of tobacco usa. Less than 10 per cent of smokers use more than 25 cigarettes a day. Age at starting to smoke is low, with a quarter of smokers taking up the habit by the age of 15. Ninety per cent of the smokers admit to inhaling, and about half the men and nearly all the women smoke filter cigarettes.
26
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY TABLE!
in Romania 1970-1974 Smoking habits recorded in the main field surveys for chronic non-specific lung diseases Per cent of total Authors, year
Sex
Number of subjects
Age range (years)
Smokers
Exsmokers
Nonsmokers
30-5 4-7
32-9 83-4
General population, Bucharest
M W
380 620
Over 30
36-6 11-9
Racoveanu et al., 1970 (5)
M W
283 351
20-65
520 90
48 0 91 •0
General population, two rural areas and Bucharest
Golli et al., 1971 (6)
M
1,329
Over 15
33-3
66 •7
General population, Craiova
Lilis et al., 1971 (7)
M
444
35-55
40-9
Preda et al., 1971 (8)
M
545
25-55
Anastasatu et al., 1972 (9)
M W
281 353
21-25
Dutu et al., 1972 (10)
M W
780 1,024
Over 40
33-5 9-2
Nicolaescu et al., 1972 (10b)
M M
1,059 626
40-49 50-59
Racoveanu et al., 1972(11)
M
636
Barhad et al., 1973 (12)
M
Preda et al, 1974(13)
M
40-3
Industrial workers, Bucharest
71 0
29 0
Coalminers, Jiu Valley
73-7 45-4
26-3 54-6
Medical students, Bucharest
29-5 41
370 86-7
General population, Bucharest
53-0 52-1
9-1 14-8
37-9 33-1
General population, Bucharest
40-59
46-2
170
36-8
General population, Hunedoara (polluted city)
173
19-57
46-3
190
34-7
Industrial workers, Gala^i
554
35-40
46-6
25-5
27-9
Coalminers, exposure 10-15 years, Jiu Valley
Key: M = Men
18-8
W = Women
Pipe or cigar smokers represent a considerable proportion of tobacco users in the GDR (20), Czechoslovakia (14), Finland (21), USA (18) and Great Britain (22). In Romania, cigars are hardly used, and pipe-smoking is rare: two out of 207 male medical student smokers (9), two out of 251 middleaged male inhabitants of Hunedoara (11), and only one out of 258 smoking miners in the Jiu Valley (13) smoked pipes.
day), 49 per cent were moderate smokers (15 to 24 cigarettes per day), and only 6 per cent were heavy smokers (25 or more cigarettes per day). Miners smoked even less. Only four out of 258 smokers in a group of working miners aged 35 to 40 years smoked 25 or more cigarettes per day, while 63 per cent of the smokers in this group smoked five to 14 cigarettes per day (13) (Fig. 1). These figures are well below those quoted for other countries [USA (15, 18), Finland (21), The Netherlands (23)] where many smokers smoke more than 25, or even 35, cigarettes per day. In Romania, as elsewhere, women smoke less than men (9).
3. AMOUNT SMOKED
4. AGE AT TAKING UP SMOKING
In the study of Barhad and colleagues (12), 45 per cent of the male smokers in a shipyard were light smokers (consumption of 14 or less cigarettes per
It can reasonably be assumed that the deleterious effects of tobacco consumption are greater at younger ages. As Fig. 2 shows, 26 per cent of the
smoking among male (74 per cent) and female (45 per cent) medical students in Bucharest (9). 2. TYPE OF SMOKING
Downloaded from http://ije.oxfordjournals.org/ at University of Saskatchewan on June 21, 2015
Manu et al., 1970 (4)
SMOKING HABITS IN ROMANIA
70-
27
out (18), the prevalence of respiratory symptoms increased with the depth of the inhalation of smoke.
163
6. PRESENCE OF FILTER; BUTT LENGTH 50-
30-
62
10 0 15
25 CISARETTZS/PM
Fro. 1 Distribution of 258 underground miners according to the number of cigarettes smoked per day (13).
smokers in a group of 178 shipyard welders did so at 15 years (two subjects admitted to smoking at the age of 7!) and 85 per cent started smoking before 21 years (12). Similar results were obtained by Golli (6) and Anastasatu and colleagues (9) in Romania and by Freour and colleagues (16) in France. Holland and Elliott (24) were impressed by the high proportion of smokers among 9,786 schoolchildren of both sexes in Great Britain and by the poor results of the anti-smoking propaganda. 5. INHALATION
Eighty-eight per cent of the smoking shipyard workers in Galat,i (12) habitually inhaled the smoke deeply. Similar results have been reported by Eule, Horn and Laugwitz (20), Mueller and colleagues (18), and Hammond (25). And as Mueller pointed 60-,
7. QUALITY OF TOBACCO USED
In Hammond's study (25), the prevalence of chronic cough was greater in subjects smoking cigarettes with a high nicotine and tar content. The amount of nicotine in Romanian cigarettes is in the order of 1-6 to 2-4 per cent of tobacco weight (26). Using a specially designed automated smoking device, Barnea et al. (26) collected 16 • 2 to 25 • 5 mg. of tar per cigarette from four different brands of Romanian cigarettes. The latter figure is similar to the content of most of the American brands of cigarette (30). 8. CESSATION OF SMOKING
, A0-
20-
fl
Vol. 4, No. 1 Printed in Great Briuin
Smoking Habits in Romania CARMEN RACOVEANU, 1 D. TECULESCU,2 M. MANICATIDE 3 and V. NICOLAESCU4
It is widely accepted today that smoking exerts a deleterious influence on human health. The effect of tobacco smoking (especially cigarettes) on a long series of morbid conditions including vascular, respiratory, neoplastic, digestive and endocrine diseases has been officially recognized (1, 2, 3). The health consequences of smoking depend on many factors. Some of these are related to the smokers themselves (proportion of smokers in a population, type of tobacco smoked—cigarette, cigar or pipe—depth of inhalation, age at starting to smoke), others to the product consumed (nicotine and tar content, presence or absence of filter). The present paper is a review of the Romanian literature concerning tobacco consumption, with some reference to the effects of smoking on the prevalence of respiratory symptoms. The review will deal with the main factors conditioning the effect of smoking on the respiratory system, as mentioned above.
9 to 12 per cent were present smokers (4, 5) while 55 to 87 per cent had never smoked (9, 10). In men, the 'open' (in respect to age) population groups had a lower proportion of smokers (33 to 37 per cent) as compared to groups of middle-aged subjects (4, 10). Three studies carried out by the staff of the Institute of Hygiene and Public Health in Bucharest, on industrial workers in the third to the sixth decade in Bucharest (7) and Galafi (12), and on coalminers of the same age span in the Jiu Valley (13) yielded very similar proportions of smokers (49 • 5,46 • 3 and 48 • 8 per cent respectively). These figures are close to those obtained in the general male population by Racoveanu and coworkers (52 0 and 46-2 per cent) in Bucharest, in two rural areas and in the highly industrialized city of Hunedoara (5, 11). Males who had never smoked represented about one-third (27-5 to 36-8 per cent), while former smokers represented about one-fifth (17-0 to 23-7 per cent) of the population. In Romania, as in other countries, some subjects stop smoking as they get older, thus reducing the number of current smokers in higher age groups (6, 10, 11, 12). The results quoted above are very similar to those of Boudik and colleagues in Prague (14), and of Anderson and co-workers in Canada (15), and similar also to findings in France (16), Sweden (17) and the United States (18). In other countries such as the United Kingdom (19) and the German Democratic Republic (20), smokers represent from 68 to 75 per cent of the population, and subjects who never smoked only 7 to 11 per cent. A recent study by Anastasatu and co-workers has stressed the high prevalence of
1. THE PROPORTION OF SMOKERS IN THE POPULATION
This must be considered, taking into account such variables as sex, age, social status, occupation, etc. As seen in Table I, field surveys carried out in this country in the last five years have found a wide variation (from 9 to 74 per cent) in the proportion of smokers in the samples studied. Among women, 1
' * 'N.Gh.Lupu' Institute of Internal Medicine. Colentina Hospital, Department of Occupational Diseases, Bucharest, Romania. Reprint requests should be addressed to Dr. C. Racoveanu. 1
25
Downloaded from http://ije.oxfordjournals.org/ at University of Saskatchewan on June 21, 2015
Racoveanu, Carmen (Division of Pulmonary Diseases, Institute of Internal Medicine, Colentina Hospital, Bucharest 10, Romania), Teculescu, D., Manicatide, M., and Nicolaescu, V. Smoking habits in Romania. Int. J. Epid. 1975, 4 : 25-29. The main aspects and consequences of tobacco use resulting from a series of field surveys in Romania are reviewed. The proportion of smokers in middle-aged adults is about 10 per cent for women and 40 to 50 per cent for men. Cigarettes are practically the only form of tobacco consumed—cigars are very rarely smoked and piposmoking accounts for less than 1 per cent of tobacco usa. Less than 10 per cent of smokers use more than 25 cigarettes a day. Age at starting to smoke is low, with a quarter of smokers taking up the habit by the age of 15. Ninety per cent of the smokers admit to inhaling, and about half the men and nearly all the women smoke filter cigarettes.
26
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY TABLE!
in Romania 1970-1974 Smoking habits recorded in the main field surveys for chronic non-specific lung diseases Per cent of total Authors, year
Sex
Number of subjects
Age range (years)
Smokers
Exsmokers
Nonsmokers
30-5 4-7
32-9 83-4
General population, Bucharest
M W
380 620
Over 30
36-6 11-9
Racoveanu et al., 1970 (5)
M W
283 351
20-65
520 90
48 0 91 •0
General population, two rural areas and Bucharest
Golli et al., 1971 (6)
M
1,329
Over 15
33-3
66 •7
General population, Craiova
Lilis et al., 1971 (7)
M
444
35-55
40-9
Preda et al., 1971 (8)
M
545
25-55
Anastasatu et al., 1972 (9)
M W
281 353
21-25
Dutu et al., 1972 (10)
M W
780 1,024
Over 40
33-5 9-2
Nicolaescu et al., 1972 (10b)
M M
1,059 626
40-49 50-59
Racoveanu et al., 1972(11)
M
636
Barhad et al., 1973 (12)
M
Preda et al, 1974(13)
M
40-3
Industrial workers, Bucharest
71 0
29 0
Coalminers, Jiu Valley
73-7 45-4
26-3 54-6
Medical students, Bucharest
29-5 41
370 86-7
General population, Bucharest
53-0 52-1
9-1 14-8
37-9 33-1
General population, Bucharest
40-59
46-2
170
36-8
General population, Hunedoara (polluted city)
173
19-57
46-3
190
34-7
Industrial workers, Gala^i
554
35-40
46-6
25-5
27-9
Coalminers, exposure 10-15 years, Jiu Valley
Key: M = Men
18-8
W = Women
Pipe or cigar smokers represent a considerable proportion of tobacco users in the GDR (20), Czechoslovakia (14), Finland (21), USA (18) and Great Britain (22). In Romania, cigars are hardly used, and pipe-smoking is rare: two out of 207 male medical student smokers (9), two out of 251 middleaged male inhabitants of Hunedoara (11), and only one out of 258 smoking miners in the Jiu Valley (13) smoked pipes.
day), 49 per cent were moderate smokers (15 to 24 cigarettes per day), and only 6 per cent were heavy smokers (25 or more cigarettes per day). Miners smoked even less. Only four out of 258 smokers in a group of working miners aged 35 to 40 years smoked 25 or more cigarettes per day, while 63 per cent of the smokers in this group smoked five to 14 cigarettes per day (13) (Fig. 1). These figures are well below those quoted for other countries [USA (15, 18), Finland (21), The Netherlands (23)] where many smokers smoke more than 25, or even 35, cigarettes per day. In Romania, as elsewhere, women smoke less than men (9).
3. AMOUNT SMOKED
4. AGE AT TAKING UP SMOKING
In the study of Barhad and colleagues (12), 45 per cent of the male smokers in a shipyard were light smokers (consumption of 14 or less cigarettes per
It can reasonably be assumed that the deleterious effects of tobacco consumption are greater at younger ages. As Fig. 2 shows, 26 per cent of the
smoking among male (74 per cent) and female (45 per cent) medical students in Bucharest (9). 2. TYPE OF SMOKING
Downloaded from http://ije.oxfordjournals.org/ at University of Saskatchewan on June 21, 2015
Manu et al., 1970 (4)
SMOKING HABITS IN ROMANIA
70-
27
out (18), the prevalence of respiratory symptoms increased with the depth of the inhalation of smoke.
163
6. PRESENCE OF FILTER; BUTT LENGTH 50-
30-
62
10 0 15
25 CISARETTZS/PM
Fro. 1 Distribution of 258 underground miners according to the number of cigarettes smoked per day (13).
smokers in a group of 178 shipyard welders did so at 15 years (two subjects admitted to smoking at the age of 7!) and 85 per cent started smoking before 21 years (12). Similar results were obtained by Golli (6) and Anastasatu and colleagues (9) in Romania and by Freour and colleagues (16) in France. Holland and Elliott (24) were impressed by the high proportion of smokers among 9,786 schoolchildren of both sexes in Great Britain and by the poor results of the anti-smoking propaganda. 5. INHALATION
Eighty-eight per cent of the smoking shipyard workers in Galat,i (12) habitually inhaled the smoke deeply. Similar results have been reported by Eule, Horn and Laugwitz (20), Mueller and colleagues (18), and Hammond (25). And as Mueller pointed 60-,
7. QUALITY OF TOBACCO USED
In Hammond's study (25), the prevalence of chronic cough was greater in subjects smoking cigarettes with a high nicotine and tar content. The amount of nicotine in Romanian cigarettes is in the order of 1-6 to 2-4 per cent of tobacco weight (26). Using a specially designed automated smoking device, Barnea et al. (26) collected 16 • 2 to 25 • 5 mg. of tar per cigarette from four different brands of Romanian cigarettes. The latter figure is similar to the content of most of the American brands of cigarette (30). 8. CESSATION OF SMOKING
, A0-
20-
fl
