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Show Many of these cigarette smokers will experience the deleterious health consequences of smoking such as lung cancer, other cancers, stroke, heart disease, chronic lung disease) (Rigotti and Pasternak, 1996; Shinton, 1997; United States Department of Health and Human Services, 1990a). The most likely reason for the historically low levels of cigarette smoking in Utah is the influence of The Church of Jesus Christ of Latter-day Saints (LDS). The state of Utah consists of about 70% LDS (Encyclopedia of Mormonism, 1992). Since 1832, the LDS Church has had a prescribed health code that discourages its members from using tobacco (Doctrine and Covenants, 1989, Section 89). Consequently, only Utah has been consistently near or below the national health objectives for the year 2000 goal of 15% current smokers (U.S. Department of Health and Human Services, 1990b) (see Table 1). Substantial public health burden and economic costs attributed to cigarette smoking in the United States are well documented (e.g., costs resulting from prescription drugs, hospitalizations, physician care, home-health care, and nursing-home care) (Bartlett, Miller, Rice, Max, 1993). The striking difference in cigarette smoking between Utah and the United States suggests that much lower smoking-related disease prevalence should exist in Utah. As illustrated, this was indeed the case, particularly for lung cancer. Although not presented above, a comparison was also made of nonsmoking-related cancer incidence and mortality rates for white men between Utah and SEER (with Utah removed) (data not shown). Trends in the nonsmoking-related cancer rates were very similar, suggesting that the differences observed for the smoking-related cancers are primarily due to smoking and not other extrinsic factors. Previous studies have evaluated the health benefits experienced by active members of the LDS Church in Utah (Enstrom, 1980; Lyon, Gardner, West, 1980; Gardner and Lyon, 1982). These studies have attempted to control for regional variation by comparing active and non-active members of the Church, with the belief that church activity is a surrogate for abstaining from tobacco and other potential disease risk factors. The current study indicates that cigarette smoking is an important explanation for the superior health found in these studies among active LDS versus inactive LDS or non-LDS members. Some of the observed differences in the smoking-related cancers between Utah and the United States may also be due to alcohol, as the LDS church also discourages alcohol use among its members (Doctrine and Covenants, 1989). Of the seven smoking-related cancers, alcohol is also a risk factor for the esophagus (Tuyns, 1983), larynx (Falk et al., 1989), oral cavity and pharynx (Weller, Blot, Feigal, 1993), and pancreas (Olsen, Mandel, Gibson, Wattenberg, Schuman, 1989), and smokers are significantly more likely to consume alcohol than nonsmokers (DHHS, 1995). In 1980, the prevalence of alcohol was 37% in Utah compared to 67% in the United States. However, per capita alcohol consumption in this country has remained fairly constant for whites in the last decade (Caetano and Clark, 1998), and the relative impact of alcohol compared to tobacco on cancer is small (Rothman, 1980; Harvard Report on Cancer Prevention, 1996). Hence, a small part of the fewer number of smoking-related cancers estimated in Utah is due to lower levels of alcohol consumption in the state compared to the United States. The objective of this study was to compare smoking-related cancer prevalence between white men in Utah and the United States according to years from diagnosis. United usually the demand for treatment and care are most concentrated immediately after diagnosis, falling with years already having survived. When considering the demands for health resources and services, estimated prevalence by time from diagnosis may be combined with treatment costs to obtain a measure of economic burden. Complete prevalence could not be directly computed from the SEER data because patients who had a cancer diagnosis before the beginning of the registration period and who were still living at the reference time were not included. 16 |