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In this chapter we review the epidemiology of lung cancer incidence and mortality among never smokers/nonsmokers and describe the never smoker lung cancer risk models used by the Cancer Intervention and Surveillance Network (CISNET) modelers. Our review focuses on those influences likely to have measurable population impact on never smoker risk, such as secondhand smoke, even though the individual‐level impact may be small. Occupational exposures may also contribute importantly to the population attributable risk of lung cancer. We examine the following risk factors in this chapter: age, environmental tobacco smoke, cooking fumes, ionizing radiation including radon gas, inherited genetic susceptibility, selected occupational exposures, preexisting lung disease, and oncogenic viruses. We also compare the prevalence of never smokers between the three CISNET smoking scenarios and present the corresponding lung cancer mortality estimates among never smokers as predicted by a typical CISNET model.

As a member of the Cancer Intervention and Surveillance Modeling Network (CISNET), the lung cancer (LC) group at Fred Hutchinson Cancer Research Center (FHCRC) developed a model for evaluating U.S. lung cancer mortality trends and the impact of changing tobacco consumption. Model components include a biologically based two‐stage clonal expansion (TSCE) model; a smoking simulator to generate smoking histories and other cause mortality; and adjustments for period and birth cohort to improve calibration to U.S. LC mortality. The TSCE model was first calibrated to five substantial cohorts: British doctors, American Cancer Society CPS‐I and CPS‐II, Health Professionals' Follow‐Up Study (HPFS), and Nurses' Health Study (NHS). The NHS and HPFS cohorts included the most detailed smoking histories and were chosen to represent the effects of smoking on U.S. LC mortality. The calibrated TSCE model and smoking simulator were used to simulate U.S. LC mortality. Further adjustments were necessary to account for unknown factors. This provided excellent fits between simulated and observed U.S. LC mortality for ages 30–84 and calendar years 1975–2000. The FHCRC LC model may be used to study the effects of public health information on U.S. LC trends and the impact of tobacco control policy. For example, we estimated that over 500,000 males and 200,000 females avoided LC death between 1975 and 2000 due to increasing awareness since the mid 1950s of the harmful effects of smoking. We estimated that 1.1 million male and 0.6 million female LC deaths were avoidable if smokers quit smoking in 1965.

The smoking history generator (SHG) developed by the National Cancer Institute simulates individual life/smoking histories that serve as inputs for the Cancer Intervention and Surveillance Modeling Network (CISNET) lung cancer models. In this chapter, we review the SHG inputs, describe its outputs, and outline the methodology behind it. As an example, we use the SHG to simulate individual life histories for individuals born between 1890 and 1984 for each of the CISNET smoking scenarios and use those simulated histories to compute the corresponding smoking prevalence over the period 1975–2000.

Purpose: To provide tobacco product use patterns for US adults by sociodemographic group. Design: A secondary analysis of Tobacco Use Supplement to the Current Population Survey (2014-15), National Health Interview Survey (2015), and Population Assessment of Tobacco and Health (2015-16). Setting: United States. Sample: Three nationally representative samples of adults (N = 28,070-155,067). Measures: All possible combinations of cigarette, Electronic Nicotine Delivery Systems (ENDS), other combustible product, and smokeless tobacco use, defined as current use every day or some days. Analysis: Weighted population prevalence and proportion among tobacco users of exclusive, dual, and polyuse patterns by sex, race/ethnicity, education, income, and age. Results: Exclusive cigarette use was the most prevalent pattern (10.9-12.8% of US population). Dual and polyuse were less prevalent at the population level (2.6-5.2% and 0.3-1.3%, respectively) but represented 16.7-25.5% of product use among tobacco users. Cigarette plus ENDS use was similar by sex, but men were more likely to be dual users of cigarettes plus other combustibles or smokeless tobacco. Among race/ethnic subgroups, non-Hispanic (NH) Whites were most likely to use cigarettes plus ENDS, while NH Blacks were most likely to use cigarettes plus other combustibles. Dual and polyuse were generally less common among adults with higher education, income, and age. Conclusion: Differences in product use patterns by sociodemographic group likely represent different risk profiles with important implications for resulting health disparities.