{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:28:55Z","timestamp":1769560135052,"version":"3.49.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>California\u2019s tobacco control efforts have been associated with a decrease in cancer mortality, but these estimates are based on smoking prevalence of the general population. Patient-level tobacco use information allows for more precise estimates of the proportion of cancer deaths attributable to smoking.<\/jats:p><\/jats:sec>Objective<\/jats:title>To calculate the proportion (smoking-attributable fraction) and number (smoking-attributable cancer mortality) of cancer deaths attributable to tobacco use using patient-level data.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>The smoking-attributable fraction and smoking-attributable cancer mortality were calculated for a retrospective cohort of patients whose cancer was diagnosed from 2014 to 2019 with at least 1 year of follow-up using relative risks from large US prospective studies and patient-level smoking information. Follow-up continued through April 2022. A population-based cohort was identified from the California Cancer Registry. Participants included adults aged 20 years and older with a diagnosis of 1 of the 12 tobacco-related cancers (oral cavity or pharynx, larynx, esophagus, lung, liver, stomach, pancreas, kidney, bladder, colon or rectum, cervix, and acute myeloid leukemia).<\/jats:p><\/jats:sec>Exposures<\/jats:title>Tobacco use defined as current, former, or never.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcomes were the smoking-attributable fraction and smoking-attributable cancer mortality for each of the 12 tobacco-related cancers over 2 time periods (2014-2016 vs 2017-2019) and by sex.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 395\u202f459 patients with a tobacco-related cancer, most (285\u202f768 patients [72.3%]) were older than 60 years, the majority (228\u202f054 patients [57.7%]) were non-Hispanic White, 229\u202f188 patients were men (58.0%), and nearly one-half (184\u202f415 patients [46.6%]) had lung or colorectal cancers. Nearly one-half of the deaths (93\u202f764 patients [45.8%]) in the cohort were attributable to tobacco. More than one-half (227\u202f660 patients [57.6%]) of patients had ever used tobacco, and 69\u202f103 patients (17.5%) were current tobacco users, which was higher than the proportion in the general population (11.7%). The overall smoking-attributable fraction of cancer deaths decreased significantly from 47.7% (95% CI, 47.3%-48.0%) in 2014 to 2016 to 44.8% (95% CI, 44.5%-45.1%) in 2017 to 2019, and this decrease was seen for both men and women. The overall smoking-attributable cancer mortality decreased by 10.2%.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>California still has a substantial burden of tobacco use and associated cancer. The proportion of cancer deaths associated with tobacco use was almost double what was previously estimated. There was a modest but significant decline in this proportion for overall tobacco-associated cancers, especially for women.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.46651","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T16:01:06Z","timestamp":1671033666000},"page":"e2246651","source":"Crossref","is-referenced-by-count":4,"title":["Evaluation of Cancer Deaths Attributable to Tobacco in California, 2014-2019"],"prefix":"10.1001","volume":"5","author":[{"given":"Frances B.","family":"Maguire","sequence":"first","affiliation":[{"name":"California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ani S.","family":"Movsisyan","sequence":"additional","affiliation":[{"name":"California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cyllene R.","family":"Morris","sequence":"additional","affiliation":[{"name":"California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arti","family":"Parikh-Patel","sequence":"additional","affiliation":[{"name":"California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa H. 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