{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:29:15Z","timestamp":1753892955618,"version":"3.41.2"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T00:00:00Z","timestamp":1708992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To quantify and communicate risk equivalencies for alcohol-and tobacco-attributable mortality by comparing per standard drinks consumed to per number of cigarettes smoked in Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Alcohol-and tobacco-attributable premature deaths (\u226475\u2009years of age) and years of life lost (YLL) were estimated using a lifetime risk modeling approach. Alcohol-attributable death statistics were obtained from the 2023 Canadian Guidance on Alcohol and Health data source. Tobacco-attributable death statistics were derived from the Mortality Population Risk Tool (MPoRT) model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The risk of alcohol use on premature death and YLL increased non-linearly with the number of drinks consumed, while the risk for tobacco use on these two measures increased linearly with the number of cigarettes smoked. Males who consumed 5 drinks\/day\u2014a standard drink contains 13.45 grams of alcohol in Canada\u2014had an equivalent risk as smoking 4.9 cigarettes\/day (when modeling for premature death) and 5.1 cigarettes\/day (when modeling for YLL). Females who consumed 5 drinks\/day experienced an equivalent risk as smoking 4.2 cigarettes\/day for premature deaths and YLL. At all levels of alcohol consumption females and males who consumed &amp;lt;5 drinks\/day have less risks from consuming a standard drink than from smoking a cigarette. For males who consumed 5 drinks\/day, the increased risks of death from per drink consumed and per cigarette smoked were equal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Risk equivalencies comparing alcohol use to tobacco use could help people who drink improve their knowledge and understanding of the mortality risks associated with increased number of drinks consumed per day.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1331190","type":"journal-article","created":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T04:59:12Z","timestamp":1709009952000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A drink equals how many cigarettes? Equating mortality risks from alcohol and tobacco use in Canada"],"prefix":"10.3389","volume":"12","author":[{"given":"Harpreet","family":"Jaswal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivneet","family":"Sohi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Rehm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Churchill","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Sherk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Stockwell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Levesque","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nitika","family":"Sanger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanie","family":"Edalati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter R.","family":"Butt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Paradis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin D.","family":"Shield","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,2,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1111\/add.13757","article-title":"The relationship between different dimensions of alcohol use and the burden of disease\u2014an update","volume":"112","author":"Rehm","year":"2017","journal-title":"Addiction"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1001\/archinternmed.2009.481","article-title":"Statistical numeracy for health: a cross-cultural comparison with probabilistic national samples","volume":"170","author":"Galesic","year":"2010","journal-title":"Arch Intern Med"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1177\/17423953231213853","article-title":"Knowledge of the health consequences of heavy alcohol consumption among individuals with different substance use statuses: a cross-sectional analysis of 2019 HINT survey","author":"Lin","year":"2023","journal-title":"Chronic Illn"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-016-3855-6","article-title":"Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey","volume":"16","author":"Buykx","year":"2016","journal-title":"BMC Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"238","DOI":"10.15288\/jsad.2020.81.238","article-title":"Baseline assessment of alcohol-related knowledge of and support for alcohol warning labels among alcohol consumers in northern Canada and associations with key sociodemographic characteristics","volume":"81","author":"Vallance","year":"2020","journal-title":"J Stud Alcohol Drugs"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1916","DOI":"10.3390\/ijerph10051916","article-title":"Canadian lung cancer relative risk from radon exposure for short periods in childhood compared to a lifetime","volume":"10","author":"Chen","year":"2013","journal-title":"Int J Environ Res Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e0142879","DOI":"10.1371\/journal.pone.0142879","article-title":"Graphic warning labels elicit affective and thoughtful responses from smokers: results of a randomized clinical trial","volume":"10","author":"Evans","year":"2015","journal-title":"PLoS One"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1080\/14622200802325873","article-title":"Smoking knowledge and behavior in the United States: sociodemographic, smoking status, and geographic patterns","volume":"10","author":"Rutten","year":"2008","journal-title":"Nicotine Tob Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e12-e","DOI":"10.1136\/tobaccocontrol-2011-050249","article-title":"Knowledge of the health impacts of smoking and public attitudes towards tobacco control in the former Soviet Union","volume":"22","author":"Roberts","year":"2013","journal-title":"Tob Control"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"18707","DOI":"10.3402\/gha.v6i0.18707","article-title":"Knowledge of the health consequences of tobacco smoking: a cross-sectional survey of Vietnamese adults","volume":"6","author":"Minh An","year":"2013","journal-title":"Glob Health Action"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12905-018-0640-y","article-title":"An exploratory study of knowledge, attitudes, and beliefs related to tobacco use and secondhand smoke among women in Aleta Wondo","volume":"18","author":"Petersen","year":"2018","journal-title":"Ethiopia BMC Women Health"},{"volume-title":"Life tables, Canada, provinces and territories, catalogue no. 84-537-X","year":"2021","key":"ref12"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1111\/dar.13165","article-title":"Use as directed: do standard drink labels on alcohol containers help consumers drink (ir) responsibly? Real-world evidence from a quasi-experimental study in Yukon","volume":"40","author":"Schoueri-Mychasiw","year":"2021","journal-title":"Canada Drug Alcohol Rev"},{"volume-title":"Lifetime risk of alcohol-attributable death and disability","year":"2023","author":"Shield","key":"ref14"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1111\/add.13827","article-title":"Life-time risk of mortality due to different levels of alcohol consumption in seven European countries: implications for low-risk drinking guidelines","volume":"112","author":"Shield","year":"2017","journal-title":"Addiction"},{"key":"ref16","first-page":"531","article-title":"The occurrence of lung cancer in man","volume":"9","author":"Levin","year":"1953","journal-title":"Acta Unio Int Contra Cancrum"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1093\/aje\/kwn093","article-title":"Are lifetime abstainers the best control group in alcohol epidemiology? On the stability and validity of reported lifetime abstention","volume":"168","author":"Rehm","year":"2008","journal-title":"Am J Epidemiol"},{"volume-title":"Table 10-10-0010-01 Sales of alcoholic beverages types by liquor authorities and other retail outlets, by value, volume, and absolute volume","year":"2021","key":"ref18"},{"volume-title":"Canadian vital statistics-death database","year":"2021","key":"ref19"},{"volume-title":"Table 17-10-0005-01; population estimates on July 1st, by age and sex","year":"2021","key":"ref20"},{"key":"ref21","first-page":"30","article-title":"Biomarkers for alcohol use and abuse: a summary","volume":"28","author":"Peterson","year":"2004","journal-title":"Alcohol Res Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1016\/S0735-1097(00)00565-9","article-title":"Early changes in left ventricular function in chronic asymptomatic alcoholics: relation to the duration of heavy drinking","volume":"35","author":"Lazarevi\u0107","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e1002082","DOI":"10.1371\/journal.pmed.1002082","article-title":"Measuring burden of unhealthy behaviours using a multivariable predictive approach: life expectancy lost in Canada attributable to smoking, alcohol, physical inactivity, and diet","volume":"13","author":"Manuel","year":"2016","journal-title":"PLoS Med"},{"volume-title":"Canadian tobacco, alcohol and drugs survey (CTADS) 2018","year":"2018","key":"ref24"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1056\/NEJMsa1211127","article-title":"50-year trends in smoking-related mortality in the United States","volume":"368","author":"Thun","year":"2013","journal-title":"N Engl J Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/S0140-6736(12)61720-6","article-title":"The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK","volume":"381","author":"Pirie","year":"2013","journal-title":"Lancet"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2652","DOI":"10.3390\/nu13082652","article-title":"Baseline assessment of alcohol-related knowledge of and support for alcohol warning labels among alcohol consumers in northern Canada and associations with key sociodemographic characteristics","volume":"13","author":"Rehm","year":"2021","journal-title":"Nutrients"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/j.drugpo.2014.08.006","article-title":"Public support for alcohol policies associated with knowledge of cancer risk","volume":"26","author":"Buykx","year":"2015","journal-title":"Int J Drug Policy"},{"volume-title":"Update of Canada\u2019s low-risk alcohol drinking guidelines: Summary of findings from public consultation","year":"2021","key":"ref29"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1093\/ntr\/ntx085","article-title":"A proactive smoking cessation intervention for socioeconomically disadvantaged smokers: the role of smoking-related stigma","volume":"20","author":"Hammett","year":"2018","journal-title":"Nicotine Tobacco Res"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"104154","DOI":"10.1016\/j.ebiom.2022.104154","article-title":"Appraising the causal role of smoking in multiple diseases: a systematic review and meta-analysis of Mendelian randomization studies","volume":"82","author":"Larsson","year":"2022","journal-title":"EBioMedicine"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/1477-7517-3-37","article-title":"Tobacco harm reduction: an alternative cessation strategy for inveterate smokers","volume":"3","author":"Rodu","year":"2006","journal-title":"Harm Reduct J"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1007\/BF00143739","article-title":"How safe is safe enough? A psychometric study of attitudes towards technological risks and benefits","volume":"9","author":"Fischhoff","year":"1978","journal-title":"Policy Sci"},{"volume-title":"Canadian tobacco, alcohol and drugs survey (CTADS) 2019","year":"2019","key":"ref34"},{"volume-title":"Canadian tobacco and nicotine survey 2019","year":"2019","key":"ref35"},{"key":"ref36","first-page":"35","article-title":"Social and cultural contexts of alcohol use: influences in a social\u2013ecological framework","volume":"38","author":"Sudhinaraset","year":"2016","journal-title":"Alcohol Res"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.socscimed.2018.05.051","article-title":"Denormalization, smoke-free air policy, and tobacco use among young adults","volume":"211","author":"Kelly","year":"2018","journal-title":"Soc Sci Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"V","DOI":"10.12816\/0024103","article-title":"Second-hand smoke\u2013ignored implications","volume":"9","author":"Naeem","year":"2015","journal-title":"Int J Health Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.lungcan.2007.11.013","article-title":"Second hand smoke, age of exposure and lung cancer risk","volume":"61","author":"Asomaning","year":"2008","journal-title":"Lung Cancer"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1016\/j.ypmed.2009.02.015","article-title":"Clustering of chronic disease behavioral risk factors in Canadian children and adolescents","volume":"48","author":"Alamian","year":"2009","journal-title":"Prev Med"},{"volume-title":"People with behavioral health conditions encounter barriers to quitting successfully","year":"2023","key":"ref41"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1093\/alcalc\/agac027","article-title":"Smoking as an outcome moderator in the treatment of alcohol use disorders","volume":"57","author":"van Amsterdam","year":"2022","journal-title":"Alcohol Alcohol"},{"volume-title":"GBD Results Tool","year":"2021","key":"ref43"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1017\/S0029665110001904","article-title":"Drinking pattern and socio-cultural aspects on immune response: an overview","volume":"69","author":"Romeo","year":"2010","journal-title":"Proc Nutr Soc"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1111\/acer.13071","article-title":"Alcohol use and breast cancer: a critical review","volume":"40","author":"Shield","year":"2016","journal-title":"Alcohol Clin Exp Res"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1186\/s12916-014-0182-6","article-title":"Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers","volume":"12","author":"Roerecke","year":"2014","journal-title":"BMC Med"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1007\/s00125-017-4359-3","article-title":"Alcohol drinking patterns and risk of diabetes: a cohort study of 70, 551 men and women from the general Danish population","volume":"60","author":"Holst","year":"2017","journal-title":"Diabetologia"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1111\/j.1528-1157.1993.tb02130.x","article-title":"Status epilepticus related to alcohol abuse","volume":"34","author":"Alldredge","year":"1993","journal-title":"Epilepsia"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.drugalcdep.2018.07.033","article-title":"A multi-level analysis of emergency department data on drinking patterns, alcohol policy and cause of injury in 28 countries","volume":"192","author":"Cherpitel","year":"2018","journal-title":"Drug Alcohol Depend"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.14309\/ajg.0000000000000340","article-title":"Alcohol consumption and risk of liver cirrhosis: a systematic review and meta-analysis","volume":"114","author":"Roerecke","year":"2019","journal-title":"Am J Gastroenterol"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"409","DOI":"10.7189\/jogh.08.020409","article-title":"A systematic review of associations between non-communicable diseases and socioeconomic status within low-and lower-middle-income countries","volume":"8","author":"Williams","year":"2018","journal-title":"J Glob Health"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1016\/j.jadohealth.2012.09.003","article-title":"Cohorts in low-and middle-income countries: from still photographs to full-length movies","volume":"51","author":"Victora","year":"2012","journal-title":"J Adolesc Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1331190\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T04:59:21Z","timestamp":1709009961000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1331190\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,27]]},"references-count":52,"alternative-id":["10.3389\/fpubh.2024.1331190"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1331190","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2024,2,27]]},"article-number":"1331190"}}