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This Surgeon General's report returns to the topic of the health effects of involuntary exposure to tobacco smoke. The last comprehensive review of this evidence by the Department of Health and Human Services (DHHS) was in the 1986 Surgeon General's report, The Health Consequences of Involuntary Smoking, published 20 years ago this year. This new report updates the evidence of the harmful effects of involuntary exposure to tobacco smoke. This large body of research findings is captured in an accompanying dynamic database that profiles key epidemiologic findings, and allows the evidence on health effects of exposure to tobacco smoke to be synthesized and updated (following the format of the 2004 report, The Health Consequences of Smoking). The database enables users to explore the data and studies supporting the conclusions in the report. The database is available on the Web site of the Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/tobacco.
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.
Tobacco use by adolescents and young adults poses serious concerns. Nearly all adults who have ever smoked daily first tried a cigarette before 26 years of age. Current cigarette use among adults is highest among persons aged 21 to 25 years. The parts of the brain most responsible for cognitive and psychosocial maturity continue to develop and change through young adulthood, and adolescent brains are uniquely vulnerable to the effects of nicotine. At the request of the U.S. Food and Drug Administration, Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products considers the likely public health impact of raising the minimum age for purchasing tobacco products. The report reviews the existing literature on tobacco use patterns, developmental biology and psychology, health effects of tobacco use, and the current landscape regarding youth access laws, including minimum age laws and their enforcement. Based on this literature, the report makes conclusions about the likely effect of raising the minimum age to 19, 21, and 25 years on tobacco use initiation. The report also quantifies the accompanying public health outcomes based on findings from two tobacco use simulation models. According to the report, raising the minimum age of legal access to tobacco products, particularly to ages 21 and 25, will lead to substantial reductions in tobacco use, improve the health of Americans across the lifespan, and save lives. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products will be a valuable reference for federal policy makers and state and local health departments and legislators.
Data suggest that exposure to secondhand smoke can result in heart disease in nonsmoking adults. Recently, progress has been made in reducing involuntary exposure to secondhand smoke through legislation banning smoking in workplaces, restaurants, and other public places. The effect of legislation to ban smoking and its effects on the cardiovascular health of nonsmoking adults, however, remains a question. Secondhand Smoke Exposure and Cardiovascular Effects reviews available scientific literature to assess the relationship between secondhand smoke exposure and acute coronary events. The authors, experts in secondhand smoke exposure and toxicology, clinical cardiology, epidemiology, and statistics, find that there is about a 25 to 30 percent increase in the risk of coronary heart disease from exposure to secondhand smoke. Their findings agree with the 2006 Surgeon General's Report conclusion that there are increased risks of coronary heart disease morbidity and mortality among men and women exposed to secondhand smoke. However, the authors note that the evidence for determining the magnitude of the relationship between chronic secondhand smoke exposure and coronary heart disease is not very strong. Public health professionals will rely upon Secondhand Smoke Exposure and Cardiovascular Effects for its survey of critical epidemiological studies on the effects of smoking bans and evidence of links between secondhand smoke exposure and cardiovascular events, as well as its findings and recommendations.
California and other wildfire-prone western states have experienced a substantial increase in the number and intensity of wildfires in recent years. Wildlands and climate experts expect these trends to continue and quite likely to worsen in coming years. Wildfires and other disasters can be particularly devastating for vulnerable communities. Members of these communities tend to experience worse health outcomes from disasters, have fewer resources for responding and rebuilding, and receive less assistance from state, local, and federal agencies. Because burning wood releases particulate matter and other toxicants, the health effects of wildfires extend well beyond burns. In addition, deposition of toxicants in soil and water can result in chronic as well as acute exposures. On June 4-5, 2019, four different entities within the National Academies of Sciences, Engineering, and Medicine held a workshop titled Implications of the California Wildfires for Health, Communities, and Preparedness at the Betty Irene Moore School of Nursing at the University of California, Davis. The workshop explored the population health, environmental health, emergency preparedness, and health equity consequences of increasingly strong and numerous wildfires, particularly in California. This publication is a summary of the presentations and discussion of the workshop.
Some people suffer from chronic, debilitating disorders for which no conventional treatment brings relief. Can marijuana ease their symptoms? Would it be breaking the law to turn to marijuana as a medication? There are few sources of objective, scientifically sound advice for people in this situation. Most books about marijuana and medicine attempt to promote the views of advocates or opponents. To fill the gap between these extremes, authors Alison Mack and Janet Joy have extracted critical findings from a recent Institute of Medicine study on this important issue, interpreting them for a general audience. Marijuana As Medicine? provides patientsâ€"as well as the people who care for themâ€"with a foundation for making decisions about their own health care. This empowering volume examines several key points, including: Whether marijuana can relieve a variety of symptoms, including pain, muscle spasticity, nausea, and appetite loss. The dangers of smoking marijuana, as well as the effects of its active chemical components on the immune system and on psychological health. The potential use of marijuana-based medications on symptoms of AIDS, cancer, multiple sclerosis, and several other specific disorders, in comparison with existing treatments. Marijuana As Medicine? introduces readers to the active compounds in marijuana. These include the principal ingredient in Marinol, a legal medication. The authors also discuss the prospects for developing other drugs derived from marijuana's active ingredients. In addition to providing an up-to-date review of the science behind the medical marijuana debate, Mack and Joy also answer common questions about the legal status of marijuana, explaining the conflict between state and federal law regarding its medical use. Intended primarily as an aid to patients and caregivers, this book objectively presents critical information so that it can be used to make responsible health care decisions. Marijuana As Medicine? will also be a valuable resource for policymakers, health care providers, patient counselors, medical faculty and studentsâ€"in short, anyone who wants to learn more about this important issue.
Millions of Americans use e-cigarettes. Despite their popularity, little is known about their health effects. Some suggest that e-cigarettes likely confer lower risk compared to combustible tobacco cigarettes, because they do not expose users to toxicants produced through combustion. Proponents of e-cigarette use also tout the potential benefits of e-cigarettes as devices that could help combustible tobacco cigarette smokers to quit and thereby reduce tobacco-related health risks. Others are concerned about the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals who have never used tobacco products such as youth and young adults. Given their relatively recent introduction, there has been little time for a scientific body of evidence to develop on the health effects of e-cigarettes. Public Health Consequences of E-Cigarettes reviews and critically assesses the state of the emerging evidence about e-cigarettes and health. This report makes recommendations for the improvement of this research and highlights gaps that are a priority for future research.
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.
"Science tends to generalize, and generaliza tions mean simplifications . . . . And generaliza tions are also more satisfying to the mind than details. Of course, details and generalizations must be in proper balance: Generalizations can be reached only from details, while it is the generalization which gives value and interest to the detail:' . . . (A. Szent-Gyorgy, Science 1964) The first edition of this book, published in German as Tabak abhiingigkeit in 2001, was prompted by the fact that no single volume was available in Germany or elsewhere summarising the adverse repercussions of cigarette smoking on human health. As far as my own research was able to ascertain, the last comprehensive work dealing with this subject was writ ten in Germany by the Dresden internist, F. Lickint, whose Tabak und Organismus was published in 1939 by the Hip pokrates-Verlag. All subsequent monographs in this field have tended to focus on detailed aspects, and there has been no shortage of publications on subjects such as how smokers can quit smoking, healthy eating for smokers etc. Friends and colleagues abroad have urged me to prepare an English language version of Tabakabhiingigkeit. In gladly complying with this suggestion, I have intentionally prepared an up dated and slightly enlarged new edition, taking account of the rapidly proliferating literature on the subject up to the start of 2002. The harmful sequelae of smoking are played down by politicians in many industrialised countries, including Ger many.
This comprehensive book examines the recent research investigating the characteristics and composition of different types of environmental tobacco smoke (ETS) and discusses possible health effects of ETS. The volume presents an overview of methods used to determine exposures to environmental smoke and reviews both chronic and acute health effects. Many recommendations are made for areas of further research, including the differences between smokers and nonsmokers in absorbing, metabolizing, and excreting the components of ETS, and the possible effects of ETS exposure during childhood and fetal life.