title: Using rate advancement periods for communicating the benefits of quitting smoking to older smokers.
abstract: OBJECTIVE
  Standard epidemiological measures of the risk of premature death from smoking might be unsuitable for risk communication in actual counselling situations. The rate advancement period (RAP) is an epidemiologic metric that could be useful for conveying information on the benefits of quitting. More effective risk communication could motivate older smokers to make an attempt at quitting. We provide empirical evidence on the impact of smoking, and the benefits of quitting on all-cause mortality and RAPs for people aged 60 years and older in a large cohort of older adults.
  
  
  METHODS
  Smoking information was obtained from 6545 participants aged 60-74 years of ESTHER, a population-based German cohort. Cox proportional hazards regression was applied to estimate associations of smoking status, amount of smoking and time since smoking cessation with all-cause mortality. Premature mortality was quantified by RAPs.
  
  
  RESULTS
  Current smokers had a 2.5-fold increased risk for all-cause mortality (adjusted HR: 2.53, 95% CI 2.10 to 3.03) and an RAP of 10.7 years when compared with never smokers. Strong dose-response relationships were seen with both current and life-time amount of smoking. Compared with current smokers, significant mortality reductions by 30%, 39% and 59%, and rate advancement reductions of 4.0, 5.6 and 10.0 years within <10 years, 10-19 years and ≥20 years after cessation were found for former smokers, respectively.
  
  
  CONCLUSIONS
  Smoking remains a strong risk factor for premature mortality, and smoking cessation remains highly beneficial also at older ages.
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Gellert
authors.forename: Ben
authors.initials: B
authors.lastname: Schöttker
authors.forename: Bernd
authors.initials: B
authors.lastname: Holleczek
authors.forename: Christa
authors.initials: C
authors.lastname: Stegmaier
authors.forename: Heiko
authors.initials: H
authors.lastname: Müller
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003142:Communication; D005260:Female; D005858:Germany; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D009042:Motivation; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D016540:Smoking Cessation; D014029:Tobacco Use Disorder / Q000401:mortality