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This volume presents results from three large, more contemporary prospective mortality studies and provides longer followup for two of the older studies dating from the 1950's. When observations from the more contemporary studies are compared with those from the 1950's, one important but disturbing conclusion is apparent - mortality risks among continuing smokers, both males and females, have increased. In fact, relative risks for smokers compared to never-smokers have increased for all major smoking-related diseases - coronary heart disease (CHD), lung cancer, other smoking-related cancers, stroke, and chronic obstructive pulmonary disease (COPD). This increase over time in the relative risks for smokers compared to never-smokers has occured despite a dramatic decline in cardiovascular disease (CVD) death rates in the U.S. population, suggesting that the decline in CVD death rates has been proportionately greater among never-smokers than among continuing smokers. The clearest message that is drawn from the enormous quantity of data presented in this monograph is that smoking prevention and cessation efforts are complementary, not alternative, solutions to the current epidemic of diseases caused by smoking.
This, the eighth monograph in the Smoking and Tobacco Control series published by the National Cancer Institute (NCI), is in many respects also the most significant. Contained in this volume are new results from five of the world's largest prospective epidemiological studies defining the magnitude of disease risks caused by cigarette smoking. Thirty years ago, in January 1966, NCI published a similar monograph titled Epidemiological Approaches to the Study of Cancer and Other Chronic Diseases. The report of the Surgeon General's Advisory Committee on Smoking and Health had been released in 1964 and had relied extensively on data from prospective mortality studies to delineate the relationship between cigarette smoking and various chronic diseases. The 1966 NCI monograph provided a detailed examination of the outcomes of several of the large prospective mortality studies presented in the 1964 advisory committee report. At that time, the outcomes available from these studies were based on 3 to 6 years of follow up; with the exception of the American Cancer Society's (ACS) Cancer Prevention Study I (CPS-I), studies in the 1966 NCI monograph did not include substantial numbers of females. This monograph includes three new prospective mortality studies (CPS-II, the Nurses' Health Study, and the Kaiser Permanente Prospective Mortality study, provides the outcomes of the CPS-I study after 12 years of follow up, and provides 26 years of follow up of the study of U.S. veterans. Data from these studies provide the most comprehensive description of the disease consequences produced by smoking available to date and are accompanied by a detailed description of the changes in smoking behaviors of the U.S. population over the past century. Prospective mortality studies continue to play a critical role in quantifying the relative mortality risks of smoking for the individual as well as in estimating the overall disease burden caused by cigarette smoking in our society. The goal of this monograph is to facilitate both these tasks by providing, in one volume, comprehensive descriptions of smoking behaviors and the disease risks that result from those behaviors.
The world is living dangerously - either because it has little choice or because it is making the wrong choices -- Dr Gro Harlem Brundtland WHO Director-General
This report considers the biological and behavioral mechanisms that may underlie the pathogenicity of tobacco smoke. Many Surgeon General's reports have considered research findings on mechanisms in assessing the biological plausibility of associations observed in epidemiologic studies. Mechanisms of disease are important because they may provide plausibility, which is one of the guideline criteria for assessing evidence on causation. This report specifically reviews the evidence on the potential mechanisms by which smoking causes diseases and considers whether a mechanism is likely to be operative in the production of human disease by tobacco smoke. This evidence is relevant to understanding how smoking causes disease, to identifying those who may be particularly susceptible, and to assessing the potential risks of tobacco products.
This booklet for schools, medical personnel, and parents contains highlights from the 2012 Surgeon General's report on tobacco use among youth and teens (ages 12 through 17) and young adults (ages 18 through 25). The report details the causes and the consequences of tobacco use among youth and young adults by focusing on the social, environmental, advertising, and marketing influences that encourage youth and young adults to initiate and sustain tobacco use. This is the first time tobacco data on young adults as a discrete population have been explored in detail. The report also highlights successful strategies to prevent young people from using tobacco.
The nation has made tremendous progress in reducing tobacco use during the past 40 years. Despite extensive knowledge about successful interventions, however, approximately one-quarter of American adults still smoke. Tobacco-related illnesses and death place a huge burden on our society. Ending the Tobacco Problem generates a blueprint for the nation in the struggle to reduce tobacco use. The report reviews effective prevention and treatment interventions and considers a set of new tobacco control policies for adoption by federal and state governments. Carefully constructed with two distinct parts, the book first provides background information on the history and nature of tobacco use, developing the context for the policy blueprint proposed in the second half of the report. The report documents the extraordinary growth of tobacco use during the first half of the 20th century as well as its subsequent reversal in the mid-1960s (in the wake of findings from the Surgeon General). It also reviews the addictive properties of nicotine, delving into the factors that make it so difficult for people to quit and examines recent trends in tobacco use. In addition, an overview of the development of governmental and nongovernmental tobacco control efforts is provided. After reviewing the ethical grounding of tobacco control, the second half of the book sets forth to present a blueprint for ending the tobacco problem. The book offers broad-reaching recommendations targeting federal, state, local, nonprofit and for-profit entities. This book also identifies the benefits to society when fully implementing effective tobacco control interventions and policies.
States have banned smoking in workplaces, restaurants, and bars. They have increased tobacco tax rates, extended "clean air" laws, and mounted dramatic antismoking campaigns. Yet tobacco use remains high among Americans, prompting many health professionals to seek bolder measures to reduce smoking rates, which has raised concerns about the social and economic consequences of these measures. Retail and hospitality businesses worry smoking bans and excise taxes will reduce profit, and with tobacco farming and cigarette manufacturing concentrated in southeastern states, policymakers fear the decline of regional economies. Such concerns are not necessarily unfounded, though until now, no comprehensive survey has responded to these beliefs by capturing the impact of tobacco control across the nation. This book, the result of research commissioned by Legacy and Columbia University's Institute for Social and Economic Research and Policy, considers the economic impact of reducing smoking rates on tobacco farmers, cigarette-factory workers, the southeastern regional economy, state governments, tobacco retailers, the hospitality industry, and nonprofit organizations that might benefit from the industry's philanthropy. It also measures the effect of smoking reduction on mortality rates, medical costs, and Social Security. Concluding essays consider the implications of more vigorous tobacco control policy for law enforcement, smokers who face social stigma, the mentally ill who may cope through tobacco, and disparities in health by race, social class, and gender.