Lung cancer trends in young adults: an early indicator of progress in tobacco control (United States)

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Abstract
Objective: Tobacco smoking is known to increase lung cancer occurrence beginning in young adulthood, although age-specific rates have not been used to monitor the early consequences of tobacco control efforts in the United States. We evaluated state trends in lung cancer death rates among young adults in relation to an index of state tobacco control activities and conventional indices of current smoking and cessation. Methods: We calculated lung cancer death rates in young adults (age 30–39 years) over two time intervals from 1990–1994 through 1995–1999 in states with at least 25 deaths per interval. We measured the correlation of an index of state tobacco control in 1992–1993 with absolute rates and with total percent change during the two time intervals. Results: Both lung cancer death rates during the recent time interval (1995–1999) and the change in these rates from 1990–1994 correlated strongly and inversely with the index of state tobacco control efforts measured in 1992–1993. Lung cancer death rates decreased in states with high tobacco control efforts, but increased in states with low tobacco control efforts. Tobacco control indices were strongly and positively correlated with cessation of smoking by age 30–39 years. Conclusions: Lung cancer death rates among young adults are strongly and inversely correlated with recent indices of tobacco control. Future monitoring of the effectiveness of statewide comprehensive tobacco control programs should assess trends in lung cancer rates in young adults as well as youth and adult smoking prevalence.