Brown & Williamson
the Health Consequences of Smoking, Cancer, A Reportof the Surgeon General
Fields
- Attachment
- 13168483
- Type
- SCRT REPORT, SCIENTIFIC BIBL BIBLIOGRAPHY CHAR CHART FOOT FOOTNOTES GRAP GRAPH
- LIST REPORT GRAPHIC
- Request
- Ca9
- D4.1/D4.2
- Sj1
- Sj2
- Sj3
- Sj16
- Ca5
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- D4.1/D4.2
- Date Loaded
- 07 Jan 1999
- Original File
- 820000 Surgeon General S Report
- Master End
- 690134905
- Characteristic
- OVER, OVERSIZE DOCUMENT
- Author
- X, U.S. Dept, O.F. Health And Human Services
- Litigation
- 10018363
- Master Begin
- 690134743
Document Images
,J
FIRST EOITION
Ttlil~ copy i5 issued a8 g lir~l cdilion prinl =
irl~J corllahlin(~ rio ~llb~(;r irl(f~'~ A ~cond
~dp(iOll Wlll~ index wirl bo ovall~ble DpDro;4 -
];I; t' TOG9
FOREWORD
'l'h~ I!)1{~! rep=~lt ()11 7*lit' Ih'fll//er (~.J~vlrlrnr'r'~ i~ ,*~nl.g'itt;! Ihl(.~;,,,llH
~l ~lpmllr~lu!n~ive t'vlllu;l(i,m ill ~]~e r~'[lJIi(lll~hill I~,Lw~,~,n ~.il~;~r~.(ll!
~ilkOe l!):~7. ~rln~er ~1~.~ ~ll,{ril Ill[! ~.~?~)ll~ i1~I ilnl~ll;llll i.:~tl~ r~l'
IICCUl rili[~ I~ll- iIL~tt~r• ~111.(11111! ili~f!:l.~l~ ~tl~:~l ~]~ IIbq, ~l{I i~=l.t f~l~l ~lr,i
liil~,
in tile c=l]~liqlvll~cullLr rli~en~ nll~rt~lIily rlLIl~ nl.I Ihl. ~qP ~pl'l~,,itl
ill~.'lJJle ill ~he c(~r~.llrllvn~4(ril~l~r ,Ij~t.;l~e rltc~rlt~l~l~ ill f(- i~h~.lv,,l~ ~,1¸
]iLIIt~ civet two d~culJe~ riutl IhuL chnll~l= h~ hl.~,tl ;i ~m;~ll. Irid.
~lle~l:~ll r~lhh2~ ill~l~]~(~, 1'11i~ inl:re~l.~e il~ I~1¢~r I;~li(y hJl~: t.!~lll i t,~l hi Ihe
I;~ elf i.t~rllrq,k~ll~l~ hllllr~lv~-iru~n~ i~1 .~urviv;tl ¢~lli'~ f~r¸ ~1111,, t.;lll~ ~,~.
)y~ ]lIIw~ver, L~lese Ill~vlllll!~ hl]ve ~]~lo~l ht ~r~t~n~el¸ Ih~ i~'lll;bt )l:1)1~,*
~llcr~-i~t~ in itHirll~lit~' friJnl ~]1111klnj~ i~l;lled i.~rlll.r ~. inllrly ~1 which
Ii~ly~ ~1 iio¢~r [irul~]]o~ [4~r ~(llll.r-Le r n] ~111 v~wll (~1. cut i.~
The Publlo Health $1gnl(loa,lce of this Report
(~i~:~r~||o Rllu}ltir, l~. i~l Ihe n:njc~r ~inl~te ~.llll~q! 4~f ,'ltnl.clt.
nl~l'Inlll}' in the Ui~ite.I .HL,Le~. ']%h~l'cll~ i'flrdrihH(i~rl ~l~ r~/I
Cnrlcer de~llh~ i~ e~(Jnl~lte(I Ii~ he. ;1(I ~ll.t'r'erlt~ rl'hl~ nlf!rtn~ w~. i=lln
onff~lll+eql wi~ll r~uil~lll~l~l~r~ (~i~],'(.[ll! ~l~lltkel:4 Ii~v(. I~l~l (.:lru~.l,
hll.~e~ iilllil~l~l'~ of ollr l~f:llll~llt~l~l dill ll~I ~lllr~ll(.. Ihl~ .:llnl.f.i¸ ,l,.llIh
r~de h~ th~ ¢otJ~t.ly cl~Jtll ~ll. i'~!(~ul:ef~ ~lnll ill~t i.~ril r~ I|~l" !~¢~1~111 I,II
cl~l)lhlued il~¢r('~e ill Ih¢! Irll~LI c~lrlccr dt~;lth irlh., the.re I.~lll~ Ill. :1
~.~l~.~ltlli~s~ ~l.~c~l~o. 'L'~I~I~ ~ till ~i~l~le L~q'(~l~ i~i~ itllt~.~Iil~tl~.~ll (~l~t!
Ill r(~;hl(:~. Ih.. riqk c)f CElllCC-I" tltljll~ el]~.c~iy(~ly t hllll iiiliI~ll)~ ~llll~llil~,
I ,,
I)l';ll lllltl li* I'yiit[t';I I Clill(l~l dL!il{h5 ~irl~ ~ i~L'tl)t~ i Li I ~,(I wJlh ~llll)kJlil~,
'l'lle,~
~L~l~'~,J~ ~lre ~Lr~lll~ly zl~l~i;ll~l wilh th~ u~ ill" ci~al~ and i~ij)~ il~
r~hltiv~ rich (Jl' zll h!;l~l Jiwl~d~l. 'l'hu iI~,~ o~' ~ll¢~hlJl Jn L:olljliilcLilll/
L'llll H H'~,
~sophli(~oa~ Cancer
"rhi~ yenr, 8,~lf)f) ¢h.;LIh~ IJLl(~ {O e~lil(!(~l' ill+ Ihe I.'~lillli~=Rll~ lll'e
p~L~iellL~ live 5 ye~l~' a[~l¸ di~q~rlt~i~ 4ill11 rl]l)~L die witllill (~ JnlJrllh~
U~ldLU,~e~il cllnc~r i~llll~, ~iilt~llel'~ ~l~lve nllll.l~il~ly r~LIjl)~ ~tlJlJ~l~xi-
iJiiltl:ly 4 I~ ~ t ~lne~ hi~hul Ill~rl IL~ll~ll]lJkel'~. 'J'hl~ ~l~e (Jl¸~l]cl~ll~Jl IJ~L~ n
~yllel~i~lic illt~rzlcl illn w Jib ~m~]k ill~ th~lL i~z ~ll~' ill~:l ~l~ Ihi~ li~k.
Bl,'lddor and Kidney Cancers
()vul' {I(),(X){) AI)]el'i~itJi~ Jill! exl~l:l~!=l I~ d<,viq~Jp I>hi¢ld¢~l" i~rld
JIhJl/L,y c~ulcL!l' Ihls ye~Lr. I~l~Jd~l¸ ~]nd hJ~hl~!y ~:~lll~:ul~ will ll(!
ru~l~(~rl~ihl~ li)i" ~J tl~t~41 ill" :]{~(llill II~LI h~ I hi~ yu~Ll'. 'l'h~ ~ yu~ll¸ ~l viw~[
~LiJ]l;4dL'll I~lllt ~L~tW(~i~tl :lfJ ~lll~l ~]~) II~l'l~'tl[ IjI¸ ~l;l~l~h,I ~lllt.q!l:~ lll~!
~l]ll~l~ilq~ r~hll~'~l, wiLh ~li~;llll~ hi~h~r l!~rinl:*l*.~ I~ll¸ i~h,~ I~l~ll lill"
J~!lnllh~.
P~ncreaiJc C311cef
Ihi~ y~.;ll ,'~Ln~ I hill ~ will h~ ~Ln l':it i nliLt e~l ~ L~,II~ )1] ~J~:ll h~. I,ihe c~nl~:J ~
(~l tll~ ILIIIF~ ~J llll I~ll{iJl~l~ t ~1, ~ ~lliC~l ol" I~lt~ Ii;Llll~t t~i~; i:, iJi~ll ~i~l ~ll,
wi[h
~lJll~ili~, il wlltlJll Illlll~l~l¸ t~ I~l~ ~ll~OllL ~l{I I}~J~:l~itl IJ;lll~t!~lli~ C;llll ~!J
~l~)~ll!~ll 5 Ll~ ~)~ ill(ll't!~l~ill~ ;ll ;I iil(~l'l~ i ~t Jli~l J~ll I! I h~ll illicit i~l I~l!l.
l~llH ~,1+
$1omaoh and Uterine CorvJx Cancer
A Ii[ll( ~lt~lwl~l~ll Hllll~l~ill~ ~lllEI ~*llllli~cJi c~lil~it~i• ~lJlll ~,~nl~l~r ~jl¸ Illt~
iih,iijl~ c.~z vi;~ i~ II(~t(~l I IliwL!v~i¸, tll~ jll~lj~lll~Jil{ l~lll Ill! Jl~;l~ hi,El l~lI ~llu
~¢~llil}u~UlCl~ i)l¸~lny ll~'~!i~l iu~l, ~)~¢~LL~U ~l¸ il ~L~ll~i~'Jlt ~:lt ~l
~l~ ~'VI!II( tll~l(Ll~, ttle ~'411~111~1~ ]llt'~.~. [~t~ ~tll~t£'l{ (t~t~ll,'~,l i~l (~1('
(rllllt iO;ell4y ol¸ whe] Ii(.l" ii:l~;~;ive ()r ~llW)llllllilly ~lll~killl~ cliIl~l~ Iiillf~
¢lLItet!r ill II~=rlqmol~ul~ 'll~lll,i• ellilielltl.h~lit'a[ ~ttlc[ie!; i.X~dlLinI'd Ihi~
J~.~ll{' ill Ihl~ Imsl y(!;¢t. I~]vi[h'llee Ill.iI Iwl~ ul" IIW ~(lldil!s 4ellloli-
sll~dUd II ~lali~li~:llly sil~l~ili[~u)l, ~Olll'l;llil~li ImLwet.ii illVll]Llrll:ll'~
~llll d{illl4 illlll IIII1~ I':lr lel'l" I'{ ~,l{ in IlOllStllol{ [111~ wivl~ ~)[ Ii[IS~}~lil~ls
whl)
~lllulced A H,i~4 Illded ;I pIIsitWe z,s~t,'ialiml, licit il. W~l~ I~lll
iIIlll.~lv{!ll, it dBes i':dsO lira ~(tl~Cer[I Ilml ill~{~]urll~[ry mnOklnr~ ,ll;~y
liege tl ~Zll~ilJtlgI'ltiC risk t~ tile lllln~lll~l{er Airy health risk J estllLilll~
~l I~111 [llYliilllllllly sr=J(Ne I~x [)(IHIIl'l~ J~ II ~ltl i{lUS I)tlllllc ht!alth {!(llll:l H ii
I)c#[ItlS~2 ~1[ I~lle Iiil,l[@ [lilllll?121H Ill II~IIISIIIIIII(!IS ill till! pOl)Ulll~k~ll y;I)@
;IH! Illdl!=lli~llly expIIse~[. Thel'elole. lilr the IlUll.6e i}[ Ilri!vultlivl~
IIIcllilzille. 11411¢[/.lllre dielale~ tl,tt llltll~;lllOllel~ llvilill L.~IIIIP;III'O (i)
s(!cotld-halld I~l[~al:l:~ ~llll~ke Ill Lhe I!'~l(!lll po~ilde. '.
Lower Tar Clgarelles
i:i~[~lt!lle~ hl~ve sl~lLi~lic~llly k)wltr ile~llll rld~H from lul]l~ C~lllCel¸ I~lurl
~hl ~i~l~(tltl~ ~ulldlel~ wll~l tl~e llorll}ller¢(] i)l¸ hil~her Lar I, nn(ls 'l')=i..t
rl!(lll(.(.i] i.i~ll w:l~; ;lifo ii(l((~(I.li)l" II~rylt~.lll CllllCer. Ilow~ver, ¢~11]c1!1¸
~11!;1111 i'~lll.~ I~,¸ ~=lll~k el~ ~Jl¸ Ic)wl.~ t:l]- ci~l~lLu~ were slill b[l~lliJican L]y
Ilil4her [ Jl~lil (]ll..Sl! n(dell I'l~r Ii(lll~ltlolll~lS.
I;essallorl el Srllollin9
Sill{e c]~ill/,ll~ P+llllll[Jl)l~ i, 11 CIZ~IS(~ (~1" Itllill~ Cilll('elS, (!11( lllllll~ill~
~kll~l id~*~ltl ~:l!ss;llil~l are ]~l+J~ell[(!d i=l tlli~ I~e~)Jt. (~lJiLtinK ~nlf)l{ir]l~
iJil~ ~lll~k~l+, even ;libel" tl]~Uty ye~ll.~ or ('il~at.eLtJE+ ~ll]llkillK rl'll+~ iIiot.l~
yt'r~l'~ one i;+ (~l]¸ (r~f~l rl+[ I +.~;, I.~le i~ J-e~ll er ( he i ~lluc|ioll ill eX ~+++F~l
I:IIIICI.I"
• ri~k. ]"ilL(!l!ll ye~ll'~ lll'iel" £Ll[I.l+ia~ cil+'~IH!IL~+ ~mokilI.E. 'Ehe ~Ol'mer
~ltlllker'l+ ]1]111~ (:lllleOl' lisk, I'()I. e~llrllllte, i~ i~dtJ~ell tie)so [o Ih:l|
(~h++~rvt.ll ill ilon~llll~kel~. "l']tj~ S~lt~e I~hlclil)n ill e~lncUr rJ~;k i$
ql[~t!l.vl!(I I~r |11~ ol]l(,J" c~lJiCer ~il (!~ tl~++l)cilll i,(I wJl~ ~m(iklrl~,
~llll(~llt~ arJill(.~ ~lnlJ illll)l(~co111~'l. In ~uIIIfllllly, I]lllny I)l(~nti~;ill,l~ Ii!l!h.
lli~lu(,'l iil~ I~wlihll~lll L(~ ~l]ll~lt(~lS who IIIIvl~ I)cell tin,lille tl~ qtlil f~ll
I ~leil" (iw111 JL i~+ ii~lll~l,ll(!ll.~=l ill~el'l~Lilll+r I1~ Ill)LI! L~UlI+ I]1~ vllP+(
Iil~ljllri~.y
t~[ Ic~rnl(!r Ri]l(~ll(,r~. illl)});ll)ly ¢lll~e |l) ~)~ i)l~leelll.~ iluil+ i~11 I+heil' ilwll~
'Ni I h~ lul Lh~ llill or r~lrl)l~ I ~l)l(ik i Jt~ ci,s~;i [i~ Jii [irlll~l~l Ills.
A~ lJ i~]lyl~iCi~lll, I i.nl!lJtllal~t~ ~lll Ilelifl,Ii car(! ilrovid~+l'S, i)llr|~(!tr]lll ly
t)l~l~r |lh~i~illrlt+. 14) c(lunsel Ci~[llroll~ ~lllllkt.r~ tl) (lull+ ~lrltJ Lo t~ivl~
Lll[~Jl~ ~1~ iiiLicll ~Ul)ll~rL ILS I~ible. /~s [his Itcl~or++ iloles, a low
,ili 91 & 2I:069
Trends Ill Smelling Prevalence
J zun L+rlcolllall~l'lJ bY (hi' II'l'PIl~ ill!¢lilll! ill t'il+:~If'llt! mrll41ini{ I:~h.s
hi Ihff= I'Olllll ry 'l'~.l~ly, ~llll~ m~e-I hild Ill ;llhlll ~ ~nzllh{., ii d~.l'ilnq, Ii~lrll
rqir ~. ll]SO lll~lle;ll ~ [i) he dl.l!li n ielf~.
~Vllil(. these fil+rUle~ ill(! ('l~('flLJr[]l~iJlrE. t]tl'II' ;Ire '<1ill .~:l lllilli,~l
C~Lr{'I.II! ~ltl(~l~el'~ itx I.~ I!~LtlLr~' ~1~11~ ~. ~l~t' i~ltl~ll~l¸ ~[
I"~ll t herllu)r er whil~ per ~'~lllil:~ tJ~l! I~[ t il!lll~'lll.~ h~.l dd~'lin~.d I~ ~r~
]<+lvest lever ~illce 1!~7. IJu.ll. h;l~ I/~urz ~l ~ll]l~lllli~ll iftl:H.;~, it1 I1~1~
++~llt~lll]lllliiizl I)f C]lelViltl~ I~l~lll+c(i iii1(] ~11111~ I~lrlh ii1~11 Iv Iiil~llr~ IhP
y(lllJl~. WhIiI i1111~l(t tim ir~q. ~f th~.~. [)rl~dll('r~ will h~vl. c.i I~lhn~.
('~ul col" iIiiii I~rily i~ ii nrrl.~ll ; kll(~wre~l~l~ t~l+ ihl. I~1~1~ Jlllll ~..~1 i.ill ~bl Ihq~
]teltltlt e[lecl~ o[ L)leso I(~hJ~c~'l) pl~lllucl~ i++ lill~ill'(I I!~ll H'III r.~i~h.lrr~.
illl]icaie~, hrtwe~r. Ih11~ Illeir tl~;~ i+] Jl,I wilh,)lll tlsll. ~hldil.~
(!rllll]lll'letl il] tJli~ Cq)tln~J~ ;inll (ll~ll!l~; Illl~.(• (l~.mr~ll~+h~h.ll lit1 ill
~1+4~1~ li~+I& (~y O~11 ~tl~M¥ ~1{ ~t.~l~'~ ~lltt£~ttl~t-l~ltlt4 ~t~/I tl~!~.~l..~
Ed,calional Eflorts
*l'hi~ I)el]~l),|lll0)t( i~ ¢(~lllllliltr,d to ~OlllJllUilq[ IhP in.Hillll~, ~r
el[I]e~llil~tl ~III(P itl[ornl~llillFi lill ~tl[ ollr ~i[i~llr~ r ~,Kllrdlnl~ ] h(. :t~l~i,r ~11
~ll,~l|ll con~eqtl~Jr]ceq ~)[ f;it~rlkill~. *J~Jlpr~. i~ ]lC) nl~}le illll~r I:~rlt :l!;[~(,l.I
i~ t}li~ tll;ll] 1,)1(! Ii~EiIL)l el]lll':lli~ll Ill (lilt y~llrt~. I~ cl~:lvi~l~ (. I [lel. rl~t
t~ ~l~lrt sl]l{~l~illl,~, or Lo qllJ( Ihe h[i]~iL be[ore i( Ilecllllll,~ ~lilllr =rll Iq~
triton Ihe rc~t, i)l' the Ii~,lll(~l (.lit0 ¢r~n~ltlllllit.y. Ih~ vl~lllllh~l~ Iil,~fll
this COUllt r~'s ir~lJ~L i)re&~irll~ J[ealtll I)1 ell[eJ~l~, Ill,d ul-il=~ ~lrll~rliltl~ will
le{l~lce |he i[~v~l~ll~(ill,q (i)J] IhllL cllll~l!r. ~t~ well fl~ ii[h(.i¸ ~;nl~l~(il~l!
I elil[ed {Ji~(!ll~=~. ex~lcL~¢ o]1 11iJ~ N~lLi~n'e~ Ile~lll h
]~lw~r.tl N. ]ll+u.ll,,ll, Mi)
F F FOG9
PREFACE
h~ July 1957, Dr, Lcroy ]~, Burney i~ued the Public Health
Servic~'a first stat~lnenJ, on clgure~e smoking: it identified sJiLuki=lg
~l~ ~ Cause o1" lun~ rqnc~r. E4~,~]l ~ll~ecd Jllg .'~tl~eol~ G~r~er;z J Ii:~i ~l~d
occ~*~iOl~ to ]~U~ LlddiLionlll ~zlld .~trorlger Wiirllillt.'~. 'J'[lese htlv~
|inked ~m0king with lung c~cer, wJt]l hear~ disease, with chronic
h~ng disease, with othur cancer~, a~d wiLh incre~se~ in overull
m~ Lality.
With this 1982 ~ate~n~l~t o=~ cigarett~ smokiJ~R and cancer, ] ~m
joiaiJ~g ~ny di~th~uish~d iir~d~e~sur~. Drs. Ilul'ney, Lut~e~¸ 'l'~=~,
WilJiuln ~t~w~rt, J~-~se Steillfeld, and Julius |~i¢]~m~ad, C~ig~lr~tt~
~mo[llng, as thi~ Report ~lJahl mat~e~ clear, i~ (h~ ehieJ~ ~ilq~l~,
• ~v~id~]~ Cau~ of d~LJ~ il~ our ~o~J~[y und ~.IL~ lu~t illl~ll~l~l~L
pu]~tie healLh issue o1" our tJlll,~,
h~v~ buen i~reparc~ by t]l~ Public l ]~alt]J ~t vi~ ullll~r the [~:~l,zl'a[
(Jigal~tte Lal~elli~g ~ld AdwJ tiaJng A~t a~d il~ ~u~or, Ihe Public
|lea[/.[~ (~igure~l~ Sin~kin~ ~.c~. ~r 196!~. Th~se rep~.'ls havu col~trib-
i~ted gl'e~[y to public uJldur~tandi=lg ol" the ha~Jrlh; Ih~L cig;~l'e~.l~
s~nokinl~ pos~ to tho h~u[th ~J Lhi~ N~ti~J~
ill ctJllL~t=~L wiLh prevJ~lJ~ I~Llllllc l[eahh ~eJ'ViC~ i~l~J~ uJi
~nllkiJ~g and health, th~ i~Je~!llL d~cl~JUel~t *:;~llbhh~ the lehhti~ll=
~JlilJ Jl~tw~ell smuJ~ing ~lld ~ ~iJigl~ c~uff~lJy ~1¸ ~li~a~. ¢~lnc~r. 'l'he
rl~hitil~r~,Jlip~ IIOLW~24211 ~n/~J]iillg liud [un~.r Cilllc,~r, i1~ W~][ .~ ~it n~l. ~f
ill~!lltl[ill~ cllrtliov~Jscll]~r d[~li~!, which ~1~ u L~r~[~r ~o[[ L]li~l~
~li~L~e t~ Jle |hilled with t~baccu use, and iLS a~llcil~tio~l wiL[~
~lllo[li~[[ IHi~ be~l~ Lh~ f~ll~Ji~¢:L ol¸ L]LI2 nll~.~t illL~l~t~ i~trc[i. Ml~[I Itf
~xa nliJl~tl h~ [[le de~ail [~r~s,:lLt e~l here,
A~ ill lll~vit~w~i y~'~, ~i~ I~l~ltrL hll~ )ll~[!ll jlr~l~lr~[ wil]t [h~ ~lil]
=u~d c~'itle~[ review of exl~lls t¥111n wilhhl ~ud l~l]l~i~e Ihe (~llverl~
Incur. On behalf of th~ Public Ile;Lltl~ ~e~'vi~:~, I ~xpL~s her~ lay
J ~l~Ct liar their ~pcrlisu a~ld gratitud~ ~r Ihldr help
xl
ACKNOWLEDGEMENTS
'l'hi~ ]{~,polt w~ts iPr~,p~lil.d hy IIm I)¢,l)=~rhlil,nl ()( Ih.ullh ll=.!
Illlrl~LIi ,HI~rViCI~S ~lillh,i¸ tll~" ~'l~f'*lLI ~ditlJl'~hip f~l¸ the, (~lflfl, ~*1
~m~d~ht~ ~llfl I h'~dlh..]f~;lllr~ f~.ol~. MI}., M I~ II , A. liJl~ })ill..t~.
()llic~'~", ()1 fi~'~ olt .gin~]lini! :~l=~l I I~';~11 h~
(~llrl~lJIt~ll~ ~;ci~lH i~ic i~l]ilLii ~ w~,lc. [)~s, lql Iv[. I h=rl~. M.I) ~ A~.i~l u~ll
A~v'~ll(~! J~r~',~:~lr¸ ill ]~ltl!H;tl Mt,lr~ci=~,~ IIrlivt~l'~it~' ol ~l:lh P.T~lli
c~11 Sl~l~r,(~l. N:dt I ,:~k*, (~ily. Ill,ill; ~r~fl EIh'n R I:1 i(~". I~}1 I). ~h.'~ I~.¸.
I~1 ;~: onl b~'r - M ~1 r lib), ~;lll( c'r i)l i,w!n t ilul I'lqp~= =lTll~ I livi~h.i ~f ( ~lll ~,r
(]t~ltrO], ~]ClIOS.'~)II (lq)]tqlr~'hl~n~iv~ (~llll'~'l (~l'ldl'l¸, [Inivl'r.~il~' ~tl
( hJlili~l Ili~1 Ill I,l~r A ill~,ll,:~~ I,¢1~ A i~i~l,h'~, ( ~:tlil~lr'n i~l
'['}1(, ('~lillJa~ iv~h I1~ ~l~:litl(iwh~lll~(, Ihl! ;i~:~;i:~l:ln~q. ~d Ih~, I~:11i~.1~11
(~nc(.r ITislill=l~'. ~l~lr'tiI!LIttlr ly f}l~. (~li~lic~ll I~lli~h,nlll~l!~r~y ITl~lll( Ii. I~1¸
fll:~killF~ ;i v[li[~tlli~. ~hl. COllllliT( (,I¸ ~i.n~,r ~11 [~] I }11 ~,~, i ~illll.ll,~id Jtl:t i
~l~lllr t~,
Oil]coon ,Smol;inl~ ~lnd I h,;dt h
P;~r L II. Bi~uJt~dt~l/'~.~,i~t~'~rr~./~Jrl~./~'~,~iuh~('~r~rm~/itl'
I{i~}lI~]d A. ]h~r~l~Jw. MI)., ~.':~f>~'i~" ])ir~'ctol¸ ~r IIf,~l)i~'~l.~ty M~,~li-
]rr~trlci~¢o, .~rl ]?r.~ i~c ~s(-o, f !l~lifi)t ni;i
Ahr~dmm M I,]liell~ld. M.D, MI~.I].. D.~c., Ihdw~l~ily I)i~r~ll.
i~li~ll!lJ S~'ivic~" F'r()l~!~!~(ll, .HI!IoIII~I ill Ilyp~ii~lo LIn~l Ih=}~lh" IIc'u~lh.
The Johns Hopkins Uniwt ,~ity. ]]ul~i=ll~)r~. ~l~lryl~Md
] )ic-t r ich I |ll~l'lllll]lll, P]I+~). A~ll~illt ~ J)il ~'clIli¸, bllly~llr¸ I )ll.ll rnsli~ll[L
N~w York
~J
L):~l. llldl'l~bill*l*, Ill~.~*r*.h {'*KJjdj~)~l¢,h N~lyld)r ;)~.1;i Irl:~lihll~, liH,
t'lillJ~+~l] I']l~lr~na(.Jot~y ihl~u~h, I)il'i~iOJl Ill¸ {~il~rUl" 'J'lu~Lhl.':lt,
~al il~iu~l ( '~LII(.*,I¸ I Jl~Lil [~lu, ~lul h~*l~, ~*l~ll~}.r~(I
I,~liz~d,~ll~ I~, WL~i~l~u~r, 1'111), A~ni~l~*t~l I~ilucl.r I~t' {~h~llli(~;ll
['d~'il~l~l]l~l~.~i~. Ilivi~i~lJ~ I~f (~IIIL~I¸ (?l~Jihol ~111~} ]~l'UVulili~Jr~, N;i-
li,lll~l ( ~ll~'~!l¸ JlI:H il[ll u, Ile[lle~*l~*, M~ryl~ul~l
I'~lH IV. h~uiJ/l.ll~ll:~.~.~l~.l~.lull.ll~(~lte(~:r
J'i[~i,h~bllJ(~ll)l~y, I)~l~lrlJllL!llL ot¸ J~l~vl~llive M'~(Ji~iJL'~ ~lllll Ili~lll~'l ly,
MiLhi.:J JI I,ub.wilz, I~h I)., l'rl~l~(.¸ ,~F h~l~rn~ll M~lli~:il~, (~Jlle~:~
J,: II l,'i~;h*~r, ,It, Phi), A~iale I~f~or r)l" l~ch~)l~l~V, A~oci~le
I)ilu~h~l¸ ~[ lhe Wll~hin,~h~ll |)lziv,~l~ily I)iulll~te~ I{u~.~LJx~}i ull(I
I.:lh~Ji II I:~il~, l*h.I), I)Jrcclor. M~l~omber-Mtlrj)ily (!~lJl~r' Pruw~n-
I'~,ll*~-i ('~:11~11 IJiiJv¢~iLy ol (~lil~Jll[ill ~L J,o~ Arll:c~(~, I,~,~
Iv .I (t~hl~.lli;i. l~s ~lll~:h~, (~*lil4~rt~i;~; ~lld I{~al.~Llch l'~ydlcllu
l~,t, V~I~.~~, A~l~i~li~l~i<~l M~i~d ('~L~¸, I~.~lt,~r~L, I~,~
IIL~dlJi II,'hllviol Ill'~'allh hl:4ihll~, IJnivl,l~il~ .I¸ H.lllh~'H]
'l'h,~ udil,~¢~ ~kL~l~l~ with ~L~dih~d~ Ih~ &~llowi[~l~ di~li~
i;ui~hl'd ~, i~.llli~l~, iihy~,ici~l~, ~lJld lll~l~l~ who I~111 I)iq,JJ¸ :~III~I~.H Itb
liL~Ji, ~ illllliblL[ilLl~ i li[i(~lI i~ Yi~w~, ill II~ Ill;lilll~ClilJl, iii¸ ~l~i~;lillF~ ill
J:lvi*i 1'i. Adams, M I), M 1'.11 , I' A, IJll~:l~lL'y M~lti~:ll AJ'I~ ('liJli~¸,
,~:ll~l I~ I~dli~,l~L, I'JI I), ~ul~il~r ,~lall I'l~ill~ll~(I,l(~L~iul, ~,rlhur I)
I li11~, lu,¸ , (~;ll~ll~d i,1~., ~ I;l~;~l:llkl:~ I I ~
J"H,d I; I1,~ L, I'1~ I). I)il'u~l~,~¸, (hu(~rd I~1. I~d~(~l(~,~i~.~, I~w,'ll
Vill¢l~nl T. I)(~Vi{~l, M 1), IJilut:lOl'. N~llilm~ll (~[li~u~r hl~lil~ltc'*
Ilall~ 1. Igdk, l~h [). A~.~fill(~ l)il'[c(IH, II¢~alth IIz~lll'(I Ass*'~.~lll~t,
(ieoll~i~l
Io[~, Vi:'~inia
,'4ucticln, A~alylical (h,zuli~tly [)ivi~il)11, ()H~ IIil]~I" N~li.~l~l
.[O((~J~ ~ [[~lHi~., MI)~ I~1~ I). As*~l~:i~lle [>ll)[bn~m', J)/ll;llllHt:nl ¢1]
J,~('(llll)nlic~, M~*s~'hu~!Ll~ hl~tilolo or 'l'e~'lulu]lll~y, ('mlllH'illl:u,
~l'lhlll' llll]l Ihwes, Jl', M 1)., (~olllrllj~iul~Ul, I~olld an,I I)ltll~
Ill WIJnlH;It; km, ~,;{ It h!, W;Inliilll~l(m
~1~11(! I hliw,rsiI?~, A nl(.~, b~s;~
i~,}~x J,~lJlKl~iuil, M L) , {~llillll[~H~, M:~s;[l:hllsPll~
l,~llw;llll J,il:J]h~ll.~h'i¢l. PI~ I), I)k'l~nllJIl*LIII ~JI J*:~vrJ~r~h~r!~', (IIIJV¢'I~ilY
AbHdu~m M I,iliunhqd. ~.1 IL MI~1~, l)~;l!. Ihdw:~ily {)islill-
Aulhi~l~y Jl Millul, M I), lJi~loJ', l']pidu~liol~)lZ~ (III~L, N~llii)nal
{ ildl~llll
l{mllle,t}i M. Mos~,I.' M~), ~.l,i~I~,,~l~. id M~.,~[icittt! ~L~(I l)il'I:i!lill,
I )ivi:d~n id" l)~lJl~IIll)~ll Y mid (:ill i*:il[ { !;ll'U I~ h~di[ i~l,~, I )*:p~iz hll(~l)[ (I~
Nolriuhl I)l!pal'lll~e~ll r~l" (~tini('~ll MIdich,~. I~,~lillu hllhl,al)',
( Ixlill ~1. I,'.11~ k~lld
Ilich~l'd I). II{:~dilglllll, Phi), Jh'all, ,~C~.lId od Pqbli(: Ilu~lilll,
I hlivm.~ily ld" M h hii~l~l, A II~l A ~ I)ol. M ich i~;lll
x~
l](,iflhy P [{hi'. IPilt'vh,. Natiolmf Uriil1.# lor lli.~illlh .'gl;ili~lh'~i.
I lyal l~Ivill~., M;iryllli,l
Mc.i[ii!ilw. l)ii~i:l~li¸ I)l (~llrii!~.i' ITon11~iI. Mennlliilil .~ih)mi-l(~llclhlg
lh.~illh. (~im.ll Ifnivei~>iiv ~dirfil ( 'i,ll~.~.. New York. N~.w 'lq~n II
M~r~hl #%. ~ hlltfi~l~rli~ni~, l~ll I).. I li.l llt~lll, lili~rT# li~li~l
llvii~l~ .I ~e]il(ol]~ MI).. l'iol~.~or ~I¸ C~,lllnullily Medi~hle Inld
~i~t'~l~:ini~>, and i)hi'r41pn¸, l**.llviri~illni!lil;ll .~'iences i~il~ipl:iloly. ~II.
Siillli Srh~ml ~ff l%ledicille+ Cily L hlivi'i~ily iff N,~w ¥~.i h. Niaw Y,~i k,
~luil ~hillililili. l'h I), #'i~.qislaeil. PIInl~'!~!;ilr. /~l~lil0nl.nl i~[¸ P~.rhnhl.
i~Y, (~,lhq~e of S,cilll lilld IIehavlon~il St'iellrt>s, IJliivc't silJ. ~I ~llilll
["h)rida. TiUlilla. Fhll ida
Mich;l~l II. Shiniliin. MI). llroPe.'i~ol¸ ]~ni~.iitu~. llel~ilrhlll.nl Ill¸
(~(lllmlunity mid F[illl]ly l%Ii.dirme. ~cli(ll)l i~l¸ l~Ii!liil!hle. [hliver~ily
.hl~.~ I.. Sl~fiiili~hl. I%1.I ).> I )~;ul. ~¢hool ol¸ M edicllii!. M eqlii:lil C .'~llcge ~ff
Virllini~n. l(i( h mrlli,l. Vilgillia
~l'he i)dil~li~; ~il~o ni:kllowl~ll;e Llle r~mlrlhuiioli~ ill lllc" Ii~lIIiwill.q
~[lill illemllt!Is illi~[ IJl]l(.l~i who u.~i~Ii~d ill l]ic inl~I~ll~l[illll ill¸ ~h~
l'~lh'll W. Adluii~. (~oliy l~ilil~Jr. (?J~alhii~hlJu~e Sel~'ice~i ]Jlvi~iilli~
hll~ll ni;d h ~ Incon l~Oral~iL I Iiicl~ viII(.. ~]iu Ly htiiil
llirhm'd II An!;ll hi!n¸. I)hei!1¢Ir. CIi.inrinl4hi~u~le Project~ l)cllalLinil.lil.
hilhl mal h~ hlrol ptllaled, l{(tl~h villi,, l%~inn~llilld
.li~lui ] .. I llil~ i il.'iky. A ~.~li~:i~l i! llh~i'I hlr l~il¸ l'Itil¢lllnl Ollel~iti~In~, Of]ire
on ~,,Ir~l( illi~ mid I h~all h. l~ockvill~'. M;llylluill
Ricllnl~l ¢I llnsl. Mi.¢lh~al Tllni:~lali~n (~rlli~lili[llil. l~li.'~i*inl~1~illSl'
~i.rvile~ llivi~i~in, hil~)rliiEilics hlcrlnllor~ilrd. Rot:llvilh.. M~il~land
.lllrqtli.lili.~ ~) Illlui~llilld. ~cre~my. Ol~i~e oll ~lli~khlg llliil l le~ilili.
l~,ch vilh~. Manylni,]
liivi~hm, hili)rlnlilir~ hi'~(pFporlnted, l{ivi!riltn]e. Mai~Izlnll
~lllailli~i II. Cr~chliii~. (~llq$, i~lit~ll¸, lill~l'IiulLilt~ lllld 'l~rllil~tl~igy
'rrllli~ler l~palhlil.rnl, hlF~rlliiitl~ [ncoillOi~iLed, l~o~.~vilh.. M~uy-
I k'lii~ M. ( ~i~. l)ala Eiltly M~li~,14ei'. Pul~li~liiiig Ser vi¢+_.s l)ivlsilm,
Mmllnl I~ Davi~i. 'rechnie~il IllllsLrlltol¸, lli~rlllliti~p hi~OUl~llliled,
IIt~cll~ille+ i~llrylmlll
~Li.lJlilln,i/. |) I)eVoe. i)zlill Entl'y Ol~el'alOl', (}l~,ndnlllioil~ St.l'viresl
I)ivifllln. lllhlrinatles |lie01 lllil lltl~d. II,d~ville. MIIlylOml
/lildleii L. [)ykslrtl. ~¢~lliOi" Tec}llliciil Edilor. Ilifmlllleri~ Incllrl~elllll-
~d, Ill~ville. ~liliylalill . •
O A&I TOG9
~11~41111 Ii J'l'llh,ll, I'id~l. I IIlIPI, I'llllli!illllij', !;t'llli':, IIIVIJili'll. IIIITM
in;nllr~ Irll't)n ii~lllll(*~t. I~i~l.ncr~lh.. Pdl~r ~.lilli~l
chldy I"erllllndt~. Wlill.r-I.~dihllTM, (.ll~icl! llll ~qnil~hhll~ ~lnd Ih'~tllh.
R.rl(vilS,, I%1~,ryl~l~d
~illlCI) (i]11"4(1ll. (Tiilly Edilol. (]]i.ill'iillgltlll~e lllojpl!ll [h'llnrlliwIII.
I lifllrinilllf.~; I rlCOl lll)rlil ~,ll. Ilol kvill(.. ~lil "¢llil It I
"~'¢t.illly ~ (~l~l(liil. ~(.ell.l(liy. Illl~lllli~llillli llllll 'rl'rlllilll~ll[~ 'rlllil~li'r
I )l>lllll I Jill!ill. hiliil llilll il.~i I lirlll plirlil i~l~ Rllcll vl Ill.. I~¢]ill yllllld
IIt.l~'a C. Ili%llli~lll. [~l~llli~g('l. (ll'lllllliet Ihdl. (Th'alitl~hlqtl~l" ~('1" "
vires I)ivi~ion. hll]il mill h~ liil!o0 llOl'ill eli. I1~1~ ville. M IiI ylllilll
Ib.ginald 7, llll~.ldn~. 1~4 ILII. I%11)11~ ll~.~llll ~lllll~b.I. IIIIi~v i~11
~illilll i 117 ttilll I h.llll h. R~.lt ville. ~¢1111 yhlnll
I)OUl!lli~i Ilnyl..% ]llllllil:lilillli~ ~lJl~lllll~/q", llllllilllalil)li lillii I l~illl~ ~t"i'-
vil:l.~i I)iviSlOli. lllfill'llllllir~l hirllilnlltllll.ll. I{ivl'l~lall'. MIIlylliild
I'¢lliiri:l I'] IIt.;dy. 'rf!chiih'ill Ilnlilr lililliOli Ch,ik. I)llirl. Illi ~rllrlllhil!
aiid IIt.lillh. II~,~vill... ~vllnl) lltiul
I~.<~lie ,L ll~.alllre. InlTllliullhm ~l~'~inli~L, (~lelirilll(Imll~l' l'lctircl~
[)t.l~nillllL.inl. Infl)iliulllc~ Inl ill imrlih<nl, II¢lrllville. Ptllilylinllll
Shh h'y I{. IIillllliall. lJlllii Elilry (ll~l'ilnllll. (~le'iUillTholil' '¢ll!lVil'l'~;
I )ivi~ioll. hil~lli In nl i~ ] ilcoi I,H ull'~l. Illiekvilll'. I~1 Ill 'ililllll
Ilolil.l{ ~. Ilulc'hhll~ll, A~l~llrillll~ Ililel:llll" I'lll hll]ll'lllillillll lliill F~III
IZl'~lnl I)(w~-IOllliil2111, OIIit'l! till ~llll~llilll( llfill il~'allll, llu¢l/ville.
I~lill y Illll II
I.lqi~ A I(~(z. (il~lllhle AltlII, (]lOill'itll(hl>ll~l' ~t'lvlrl'~ IIk'i~ioll<
I ill'lit ni~ll ic~i Ill f'ol illlial~(l. Iblck ville, M tu'yllll)d
I~.ll~lgill~.l I~, I¢~11~1 iIII~11. I'ulllic [llftll'llllt(illl~ ~ll~( I~ldll{l'illillll~ A~-~I~-
I~illl. O[Ih'(, llll ~lillJ]{ ill~ IIIId I [l~lll~ll. llnl+kvilh', I~1 Ill ) I;in,I
~Ollll ~> I{ lllil'illl, ~enlttl" IiIItli'llllll lira Anlll~l > ( ll~rhll[lloll~l, ~t~vil'~!~
I)ivi~ioll. lllflli'rlllil i~ Illl Ol polilll'd, Illll'hvilli!. [V~al'J Ilill+l
.hllle I~.llu'~. Ihlillhk" AiIi~l. I!l~lllhll411~lli~l. Si.Ivicl.~ liiti~i¢lll, hihlr
inllli~<f lii~l)i'lllllllll~il. I{i}clt villi!. I~llyl;liill
Willililil II. I.~ZIIII. I)llllll'tllII l)lJOIlllillll~i 'l'(~llniC¢ll #~iflllll(e I)llilTl'l,
{Ill'lee Oll ~llllllliiijf lilill I lelnllh. II~'l~vilh'. i%lliiyllillil
IMal'il.tnli II. ll¢ll'iill(t', (~Ol~y I+.'llilor~ (TIl'lll hll~lioI1~12 I>i~Liel~l~ II('llall-
ili(!nl. I itlbl inlilil.l I ill:ill llOllll i.iI, I{ot'l[ ville. I~l Ill yllllill
¢lliCqlil.li.iiP I~llllll.ll~!k. T(.l:hnillll Illil~ill'tlllll'. IlilOllllalil~4 llil.nil i~lilil-
ilOlllllln~ I~', p~.l,in+ ~lllli!lllc;~l Alllll~]~l, (!h'lllilll[hOll~;l' I'l~jl.rl~ I1~..
i)lll I iilelll, hilill inil I il'q hlrlll tl~/I ill I'd > Riir h villi.. Mill) lillul
Ililylillliid I( Poole. ]llo(lllrlillli (Joollllnlllllr. (~h'illilij(llllllNe I~l'l!il'cl~l
I It.lla~l ii/elil' lllfiil lllal il ~4 li1¢ llrllorlll i!d~ II~lr I~ villl!~ I%1 ai'vlilild
Illsht,llli A. Jlill~ltl!l'. ~1~1'91,11117. (111.lil'illl41illll~.l. I~ll{if.rl~; Ilt.l)allinl>ill.
I l/l~ll Iiiill it.~. I llclil lllll iiI ell. Ilor I~ ~ilk.. {vlltl'~lillttl
Lindli II. ~t'XlOll. lillTIIIliillillll Sllr(i;lli.~l. (~[('lllilll~litllln(' Pl~til'cls
I )l.[llll I i)1 olll.. I nl~li'lllillil's llll~ll i)lll'lll i'll. I/l~ k~ilh.. ~illll )'lllllll
(~atol A .%hvrJ'cr, Tc~hltk'uJ (~on~tdl~ml, (~hauqngbolt~e pr,J~evt~
M~CYI~uld
TABLE OF CONTENTS
[Por~wDrd ..,~,,, .................... , ............... ,.,,~, .............. v
Prefue~ ................................................................... xi
Ackn owledge~lmlt~ ................................................. ~iii
2. ]~iomedical Evidonce for ])e~mminil~g f~aul~alily ......... 13
3, M~c]laJ]i~]l]~ of Oarcin~lg~nc~i~ .............................. 171
6. C~atinn ~f ~m~iking ...................................... ~:I
F'ART I. INTRODUCTION AND
CONCLUSIONS
~CLF~TOG9
Inlroduction
Dcvcli)ptitvllt and Orgazzizat[on of the 1982 ]lcport
The content el" t]tj~ ]~el~it i~ "the wolll of nulncrotl$ ~icntisLB
within tht~ I)l~l~lrtlllellt ill" I]cltllh arid IJurlt~ln ~t'rvicL+s, tL$ WeLl ~
~civatifi¢ expeit~ oulaidc tile oiguitiz~lLion, hldividuJzl m;intisci'i0ts
wci'e reviewed by eXliOr(~, birth out~ide lintl within the Pub[it llc~hh
~ci vice, lind I]lc CliLil v I~f~lltll t wll~ i.cvjew~d by u [iroiid Ililscd ]lallt~[
of 12 di~tllzguished scieliti~t~. M;my of tile~e ~ciell/ists life, or Ilave
broil, dil'ectly involved ill re~c;ll¢:h on the health el'fw'ts of sillolling.
't'llc 19~2 l~epl~rt consists of a Preface ily the Surlfo~n (~caoi'~l, a
Foicword hy t}le A~si~l ailt .~ucrctzzry ~lc | [/.ll[Z]l el I hc [)e]ltti lllleiit ill"
I le~l~ll end I Itlln~fl St~rv[cc~, zlnd live P~trls, tl~ fill h)w~:
~p pt~l.t [ [ritrolitlc[ioll ~nd Conclusio/l~
¢~ Palt II. llioliledic~ll Evidc ac'e f~l l)eter mirliilg (?;itlmd ity
Pitrt III. Mechaili~ilt~of(~alcinogeltesia
• l~alt IV., lnvolwiLtil y ,~Hiokitll: luld I,u al~ ( !ltllec r
4~ P~rL V. (~ILJoIt el Slnuklng
I lislocie.I Perspccl(vo
'l'obilcco use wzis li~sociatvd willl I]l~ po~ible d~velop~ie,,t ,,f
eaileer as early us 1761. Acc(~rdhlg to oily mvdical hisloriall, I)c. Johll
[Ill] (17167 17751 ~ht~uld lle credited with th,~ lii~L rep~, L d~Icii,ileiit
ill{~ lltl tt~ociation between ~lbacco I1~0 ~lld C~IICCl loll" lii~ iVtll k
()lJicrs ere, lit SI~UIIIIILCI'IiII{~ Ill 17!)5 li,{" il~>liil{~ ;i Itl;lliOll~[lill
all ll~ociidio!l b~Lween lie;ivy ~llitil¢ [ 1114 lind CiuIcu r ill {,<cii~ i ;11. Mllilel
;,lld ~¢haircr ((iOll,llany) iii i!);;O aild 191,l ,cspvctivcly, a,l~l |)oitvr
i~lll{Itl~ ]tln[~ Callt~'~.*l" puliell{~ Ilkuli ~tiliOrig 13Oll(fOl~, TIle ]ilB~ In~lj()l"
,l~vvlolilileni~ in the tli(~dut'll lii~ t~i'y ill iilve~tig~aLioa id Lllo ell'uvl~ ~*l"
~ltil~l[iill~ lll~ he~iltll llt!t~al'r'i:d ill l!lFl¢l wilh Ihe llul)li(rliiltlil ~)l" de,Ill"
ictiOSllO~tiyv ~tudlc~ oil ~illoliilig {l~il~il~ (;f lulig c;lil(er llLIlielll~ alid
¢',~llilOlS in the [Jliitcll .~lat,~ hy ~iiruk eL al., I~1i11~ ;lrld I'lliler,
]Ar~ill Ct Ill , alld Wyllder lind (]l'{ihalll Hath ill tilt:SO lll3[(:d il
cl)li~i~tviit~ ~taLi~ti(:ally ~it~liil~caliL a~iicial tioii bcLweuil Ulilldlilig aild
¢'aiicur ,,I the luilg, el llor ill ve~til~l [ll[~ [ll~lccuded Lll [ul liiel ex;itilinv
Ihe ruJ;ilil~/IshiD J~y initi~lliillf lli'aspeciJvc ~Liidii~s ill whi(!h llirl41!
Iliinl]lel~ Ill [l(!illLliy II[!l~(itl:; %~t~lo ll~ll()wod livl,i lilll(~ illld llildl"
~ll ll~.qllerl L ill[)l.t ;lliC~d ii{l((~ll.
hli: ill:4 ll,~tll~l I,IL,.I,.~II~. :,iiiii, t11,~,+lll,.t:.SJlll~ lig(;il ;irlq4 1:111 ~
spec'Llit+ ,ulpllalHy iv+is i,dl+:th,d hi Oclol~t'r l!II~l by t)l)]l tlltll llill +u
/In+ thfited l~h~d~.n zuntm+; 40IO(X) JhiG~h phy~iciali~, lhinm+o,+d
m,I }loin [olhp,.+.t+d II+++.t)tlt) nmhm Ippp++tlrllll~ +ii .)nlltlttt+y ~!)~'1~ III I~i+]
lJniled ~l:llt.3 rrIH,~O +111d 15tlbP+t'41LII!Ii[ Itl+n:q.~cLive ~;[tldiPm COlldLlt'It!t~
in the UnihM .~lidt.s. ,Swotlen, ('ilrIildtt, ~ilitI JHIiiin, ~()I)lld llIl~ l)ril~
that ~+lnl)llt!rB IlIIVt+ mfl~,~tJmlial]'/elevMed cancer lllOitJlJi~y I+llt~, hut
I'+iIi,~;
t]++l+e+zr Ira+ beerl lhe t;uumnd l+tlliJtirl~ 4!,'llim~ or ~[qtl.h im f.he |Jniled
Hlnlrs sinee 19;17. Provi+i<mal vital ~lnliMic~ tltlLa fro' Iti+l() intlietlte
~:tllt~',t,l ILCet+Lltdetl ft~r tllm¢lsL ~1 pe~c+l+L oF all d~u~hP+ i+t the /hfit~!d
~I~+t~'s. Tliim cmnTm~es to ]? percer,L ol nIl de+ill+ in 19711 t, nd 14.R
pmcent ++f ull doMhm iv+ 195(). Vnrh+w+ invo+li~alo~ Imve +ilg~vsled
+lilI~. ~2 (O ~l~ pPrCell+ ~f theme death~ can he atLribtJted to smokhtg,
and l~lI+l'+ for P. Iil4~ polenH~ll~ "n v~firlable" if smoking did not exisL t~s
II hulllIIII hi, HI tlVioP. Sil+c~ I ~51), the nlTe ~ll[it Iml ~d ore I't+] I vtlllCer death
llll~ hn~ chilllJ!('d li~l?, wil/.ri];iR 111~ I1111,I~ C~III;OF de[ith lille }Iris
IIICl L+llmt+d di illnltlienll3, I'~r both illil]l~s +ltl[I I~,llltl lull.
'l'ilO lU[lh~ tq~t:+mljslMed lllnl~ ettllt,tH" l'ii[e Jll~i'+.+I1,~'~+] ]~2 permen+
dtith+g Ihe i+eiiod It150=1952 lhrtl I+Y]~ J[}r~8. Female lung etmeer
tl+'Ii(tl I+ll(~ ihllinl~ ~]li~ 5IIlIl~ p~tir.I hlel'~ll~l~d evei~ m01e: ~(~3
ciltlC~l th++llh JllllO+ll! /lltlIP$~ i11 Ihe lllliled ~t,'ltt~s, nnd if pl%*Sellt
ll<:lllI+ COlll+lllU', will b+cI+111o the 14~RIIIJII+t cmu~4~ of c[InC+l" dealh in
fi+tmlle~ dutirlg this tlec~tle; the age atliusled fenmle lung cancer
deitt[I I~lt/" i~ i+l'~jeeled to p+~mibly +tlrpnss +lie deilLh pIl~ flip I}~eil+~
I-+IIIC4~F n~,~l ~G+tll'. 'J'od+l~, i]01~th+ I'1~111 t:tlllCeF or ~ll~ Iuil~ ~-~pi(,~PliL
+lilly Oil+ qtmrL+r ¢1~ IIII ~l~t+kh+ <ltle to c+ui~er ill Lh+ Uniled ,~tatc+.
In ]!)G~, Lhe year whon tim ~uigotm (] t'nerai'8 Advisory Colnmitlee
on ~ln,>l[in~ +lud I hmlLh lipid++ n deliber~ntin~ the e'Hdence pi'csen led in
Jim hmdmnrk t(!pot L, sllglitry mote Lhtut 4 l,OI)O lie~3ons died of rung
t::si+c~r Imlttmll~, +m+ll~,ir~ t+ IP,,3t~ll Itul~. ctlm!+~ de~ths ill I~3F+O, 1;+
] 9tL2, I be Americarl C:In¢~I' ~ocieLy es tilu;itv++ I l I ,P~ )f) ~lneliCimm will
+]i+~ O[ ]Un[; tiIllt:e~, ncnrly tt Ihree-fohl irlcro~ ill Lh+ nliltlh/'r ol
denlhs in a 2(I-y~itr Lint+ sl+ttl
The Advlsuty (klttllXdtLee'+ Rel~+rl of I!)G4 ju(h~ed tim enusal
sigriil]cancv of the association of t:igilrelle smoking ttnd di+.'nse by
Iigitl ctJrtqitl, iio Olle Of whieil tllOllO Wits Su~eiollL fop .51 cat/sal
jttdgrnenL The el+idemiologic criteria ilmluded:
n, The eonslstency of the association
b, The mtreng Lh of the +e+sociation
e The spceificily of the associatimt
d, The teml+m al relatieilship or" t he amociaLion, and
e, '['h+ coh~+enct~ of ihe tt~+~+<:itxti+m
I' LI;P.TO 9
4
,I
IIIIIIIIipI~ Itlili t'llllt'l h lit,ill Ii I t,lil< [i,ii( f!+
~iltllilil'ii+ll. lill+liliolilil p~l,il,lllil]L, ovitIPnl.o lillllhiff +iillllltllilt In
"~ttl~t!l'l , I1+t ~'+t'll 11~ I<~ tll her I ~ll i:~t't'~l-t +,l~l t,~l tli~t!n!~t<~, lla'~ ltvt
xllnllhlh,~l
~ilit,l! Ilif: i[llllilit'l+ +t[ Ih:l# Ail+iSOly (~llillilliltl,i,'+ [IOllilil iu 19i;t
Mulh of Lhls hnF+ lgt!l!ll t'lJlh,vli'd, It!ViPl'4Pl]+ III1<1 litlbli~;hod hi IIIiiiiiii1
iel~>l,l+++ liy IIi1~ ] )l,lulll UlOlll of I IP+lllh ltlU[ I ]lliltilii ~l,llSil:l,l,
The" Iltllll+++o nl" Ilil~ lil'liill{ l'i III It+vi~'w ili IhLpih Iho IIl~ltl'i~ ~IIIII(I'R
Ill P+l:il!nllPli+ pvill+!liCO Idilllul~ cil~llit,ttt+ ~,nllllliiil+ Io t,iwh +,itlll,l,i liy
n lilll olni(" +iIo, lUld to IwII hlllt P I lliPi evilh!il< p by t lip ~4filll r, i,l'il t,I ill f}l
gl
e+hillli+hell by tile Advimlny (Inllililillt!l! lit i1+ 19GI Ih!l~lll, in~ lliclilqt
ex pt,i iintqllil[ Cll i't i Ill lift' Ill'+ i~i lilid h iiillil n e iii< h>ln il>lol[i<: ~t
liillt,,~,
Conclt~slons of the 1982 Report
Overnll (~nneer iMm.tnlilv
, I. (~igiu'oll~" ~llu~kel~ have nvel(ill illur hllily t+ll<,~ muh~hlllti;lllv
,~rolllOl. Ih3rl till>m(! ill¸ ilnll.qlrloller~+ I)vPinll ci,tlcPr. +h,;it h i:~l~,:~
irr inll[~- Ritlltt<(!l~ ~l.p ilrllllOKil)lill(,iy <r4111111t* lilt~!+(, tll lie}lib;ill+ill
o1+~; ovora[I cllnc~l¸ d(,ll~l /lllf!R (If" J'l?nilll~ ~lllO[ll!l~ illt! lll)Vll(l~l
tu;ll(!iy 30 pereenL ]llh'h(,v I hlli} nnnsluok0r~, lulq[ nil, iilt, r +.~t!~il~l~
I )w,Fll[I (,iii1('~ t. itlol lll[il V I lllt!H ii111o11~ Rnlcll~l, f.~ flip 41<1~+~ 14,111h ql
ll~ rlll!~l~tJr~,d hy Ihe ilqllllllPr Or ciglllt,llt,~ Z;tll+~hr,l~ pi,i ehly.
Ile~lvy muokers (~Jver +~irv ll~lell [~r' dllyl h~lve iuole Ill:ill Ihl<:l!
llnte~ |llo OVel llll clJ iic~i¸ lh~lLh rnl 0.ol i] (ill,ill,lit el ~,
~. ()Vel~ll cnricer devil il lilies d~c]ille wil ]1 Ih<! lllllllher +lr vl~llr.!: olr
¢il~atelle~, llllpr(llichilll[ the ile+lLll I~lle +If rllm!;ut<ll<ei'~ wilh
ir tcI eil~inl{ dtlr~lLion ill¸ t~l.~+ll ir ~rl.
Sile-Spe¢if[e Cnllcer Ml~rlllllLy
l,lt tl~ C¢lttl~!t
l.(~ignlel,to mnokhlg i~ Ihe In+~or ~nuse rlF Itlitl~ ~lltr~<.r" hi fht'
Ilnii.d Rhde~.
2, Itllll~ CllnCel" lllOll~llil~' [ller~,ll~,~ wilil ilXCi.l*~i11~ (Jql~tll~r~ uf
filnolte ~XllOsIIr(~ lit~ II~¢!;IRIIrl,II by lll~ iilUiIT~(,r" ()l¸ c[iT~lr<!lll.~
~ln(iklnl dnily, Ih~' .hllnLioll rlf Sl]lokinlL llrl(] inhnlnihlll I~+l-
tpi tiF,) nnd i~ ilIve rsely v/~hlllyd |rl ~tl~e ~1 lu (p<l hi !;inqlll<. ~UlOl~l!r ,~
wiln c~,l~Ulne Iwr~ rll¸ lill~rl* i~lck~q oF eil~;ir i,(fe~ dllily II:lVl! lulll~
i~llll ['(!1- lllnl ~lliity i ~tl~,~ I,~ Io ~,,~ [illle~ iuonll!r Ihllrl nllll~lnohr~r S
3. (~i~il" llill] llille ~nl+l~ ill/! n i.e Illmo ¢~lll~til ~lClOl ~ ~n¸ Iiirll~ (.jttl (.(,l.
}h~wever. t|le I~liOrillt v t~ In~ ellu~,r int~lltl~ily hi Ilie ~llllt~,<l
~1 ~tl [,B i~ (Iu~ I r) (:iglir4~l Ii. ~nlllkirll[.
4, (~+~al h>n ill ~ul+lklrll~ reduces +lie li~;k ill lunf~ ~lrle(,r" nlol f illily
crllnll~UOd to t]ln[ i+[ Ihl, (!tlllLillllillg Rltlllkl!l¸ I~nlril~!r ~illt~ltr,l~;
rllI ~s {}lIly ~lighl]y J]bov~ thine flJr I LQIIIjl) tlJl[u~+lt la j)[lll L L%q/o Lizlle~
g~uutul L 'j'h~ [u~idual ri~l~ of d~w:l~qfi.g hulg clmC~r is directly
jjl41jldll'liIHild ~ll overall lifo -lilllu ~){P()~(lle l(j cj~l.~|l~) ~;lllok(].
|"illul'ud Inw~r lar Cig~l'l~l~ ~u]uIluln huvu a lower lunl~ ~'~u~(ur
libll Ctili)lHli~d ILl Iliiilfhl[L]rt~d, hjl~ti~r {Izr Cil~IJl'C~o ~l]Xol{d~l~.
clev~fl~d zig JoV~ Ih~ I-i~k of nonsn](lliu£ ~
g ~ine~ lhc ~:i~lly ](JS(l~, lung cancel ]~a~ been iho leadiag cause
I~malc~, IIm lung cancer deaLh tale i~ accelerating and will
likuly ~ll'p~zl llml of bl'em;l ~ancul in LIra ] (JB()~.
ah]~ II i~ c~timated that in 1975, lung canccr coat f~3 8 billion
h~ lull umnml~, $3795 milli~ln in ~hoi't-L~rm hospital c~at~,
~md $78 millh.I in pby~i~ian fuc~.
Illat ~,~ I~le~lit I~f iUlI~ calIcO¢ nlo/l~iity ~OtlZd |lave b~url
~wdd~d ff imlividual~ newt look up ~liulkjng. Furthermore.
z~uIp~/IlIIIizll l~dtlC~il~l~S ilX i, he IIIillib~l" el" del]th~ fr4~lll ILltlg
ezn~:er ¢t~lhl b(~ uclxiev~d if ~ Ilidj{il [z~zlioll (~[" Ihl] ~l]]ll~ii]g
lmlmlaLhnl [pro Licularly young P~r~on~) could bc p~rauaded m~L
h) ~01[4J]{~,
],lz/~)lll~l~ld| (~lll('d'l'
!) ( 'ig4 Idol [~ ~Jllui(ilt~ i8 the major catl~e ~1" laryllgeld Ca slc~i" irz I1~o
Ihlilc~l ~11~1~, (~igal¸ and I)i[)~ ~llll~k(~z~ e×l)el.ietle~ a I,i~k ~)r
ILae yi]g~n J c~ll~z" ~iali[~l Io thliL Id" z* i:iga r~l(t] z~lnl)l[er.
JO 'l'litt ri~ll ,,I devi:lopg)g I~l'yll~U~l c~lllc¢r ~lll:lU[l~s with in-
~,n~d~e~s havu huynguul CUIICUJ IIIIII hdity ,i~l~s 2() ~) ~[{I /ilil~
] [ (~¢~iJ(i(ll] OI ~lZl()ltill~ I'12dllC~ II)~ i'i~]{ (g" I~lyjiguai CallCOl
Ilalll~dily (~mlpm~d h~ LlizlL ~)~ Ilu! HIIllhillhl[[ ~nud{t!r 'l'llu
hJlll:t:l ~l iglJIl~r Slllokur is ofl cig~lutlu~ the iL~w~!I" tii~ ri;g~
lar yilge~ll (:illlUU [" I isl~ Ihmi IIm~' whu u~v tinl~lte~t~d highl~¢ tan
IB 'i'gt: ~t~ (If ~tll:lilir~] in conlhiil~flilu] w[lh {:igUlt:tlu ~lllllllglg
~lnJn:;us {i' art ~YJ~Ul'gi~(icaily I~ I~iually hll:tea~ Ih~ Ji:~l~ ripr
C~II)G{~I UI Ihu lill yllx,
I}llll I'LIcL(I*I"
~ ( 'ii:U HI I(! ~nudljilg is a major czuJs~ ~X (:nncers I)f I h~. (Iral cIWity
T:9 TOG9
experience a risk fvr oral ¢liitcc r ~imilar to tlmt of the cigarette
~Liiokul*,
|5, Morttdity ratios for oral ~uncer'iimrease with lira numher ~f
eigar~tte~ ~,noked daily uml dimiJ,i~h will, cu~slltion of ~nmk
i[,g.
]1] (]igaretle smokillg and alcohol uso act ~yner~istically Lo
inl~rea~ Ihe r~k of I~ra] ~uvgy cu ne~r~.
17, ]~Jllg term tl~e of 611tt[f ~l)[)ear~ to Im a f~zclor ill IhrJ
d t!v~lODJllell ~ ~ ~tlnct~rs Of |h(! oriel cavity, i)ar[icii]Ul'ly (.zlllcel ~
of th~ cheek and gum.
E~ot~hageal Cancer
18, Cigur~t Lv ~molling ia a [z][zj~r cause of e~q)hag~a] caill!er il~ the
[hlitwl Sta~e~. Cigar and pipe ~,nokvr~ e×[)et'i~lL¢~ a ri~k of
esuphageal ~ancer similar tt~ Lhat af cigar~ttv ~m~k~Js
)9 The risk ~f e~ph~geal caaccr increases with increased s,nukc
~Xl)n:i~zr~, IIs me85tlr~d I)y t]l~ n~mg~r t)f ~it{~lrt~Ll~u siiioJ~ed
daily, and is dimini~}md by ~lisc~ll tir~L, ing the habil.
20. The u~e of a]~oiloi ill ~o,]lbhLa tiu[i wiLh ~ m[ll[ing aet!~ aynl!rgi~,Li
c~illy to gl~uLly incleil~ I][e risk I~*r e~o[~hag~ll c[Jn,~r
mortality.
Bh~hler Cuucer
21. Cigarette ~moking is a ¢oJ,t]ibdt~y I~mh~r i,~ lira devtd~qmu~nt
~f bladder canccr in the Uniiud Stat~. '/'hi~ i c*hltio~lMlilJ is n(~t
1~ lstrong ~s LJlat noted I~)r [ht~ zl~s(~l:i~liil~ll I~l~twl,(~ll ~lllolliiLl[
arul cancer's (}f t he lung, l~ryn×, (~lal ~ J*Vily, and ~l)i~a~t~l~. The
t~rnl "ctmLrihlJ~ry li~l~l~lJ¸'' bY tit) l,luan~ exchi~h~ the. i]d~Mbili
ty ~l¸ a cz) ~1~ I rol~ Igr ~nltlkinl~ ill (!lillc~!J s id¸ I his ~;it~
Khh.?, (~rm~er
22 (;iga[~ite sm~ki[ig ia a e~mLilhuhlry I'm:tier in Lhe d~velopnmnL
ol¸ll hh]t}y ca]lcer in I he Urldud ~lat es.
l'~xlrcl¢,zli¢ (_~(llll'¢l'
2;l Cigale[t{~ glll()killg iS li ~(mh'ihuLI)ry Jhteti)r ill Iht: th~vehllullt!lll
of i~:~ZlCl uali~: cancer in Lhe I JJui~d .%ta Les.
,~;t.m{~ch (:am'er
2'1. I':l}idenli(doglcal sLudies have nmed ;Ill usst,ci~*tion I)vlwe~m
Ci~JI t d][ 1~2 hil]iilIcing lJnii hh)l ii iicg Cil ~11:(~, Pl)h{! ~lNSlhL~i~ i~ ilill i~
~llli[]~
iii l'l,lllJl[lll~lll WIIII lhill llll11"d Jill ~lllllI~ill~ ~lllil ~IHIII, iiI11~,I
Illerirrt! ('i'ttrix (~tt,'i'r
2~'~ "l'heI~' :~te ~,nllicl inf." rt~lllls in sl ud i~.~ pllblish(~l Io dnU. fill I11~
c~islurlce oF ~] rt.l~dionship h~lweq.lt sla]oking 111~II c~.rvic.~11
~illee'l'; fllllJlcr ii.~e~ll~Jl i~ ni.¢(.~ll.)' [o d(!line wJlolJli!1¸ Zlll
t1~o{'kdion e×i~l'~ nnd. if l]o. wht~lh~.r lh~iL ZlSso¢iILLioJl i~ irireel.
t)r¸ i1111it c.ct
~|echlmisrtts (ff (~nr(:ino~engsis
'~'11~ ov(!l-,Cit!w III.L,~(!I11.~I eVill(ql(N) ]ln(] o~l,%f~lyHl~illll~l 011 I(I1)II('P()
emn21t~l)l~en esls pliall~Lrily rh,velnlJl~l ,~inc~" 1~)TB.
I. 'rio(! Ili(Jl~lj~ic~ll ~lclivily of wh~le (,ij~l i,iI ~ srnolle iind ilt~ hit iii]11
I~lr tl.acliol)S c;ul Ii(iw ]~t~ inl!~l!~lllt,d I~y irnptoved ill])zlJ~lLil~ll
~lS,,~It~,t~ irl ~ll~lliJi~lll io 1#2b(~ ft~l¸ qtlJil~ll..illili~l~ir~g~ [Llnlo~lJionloL*
ir i1~, l~nil (,ot,~l t ei noip211ic ~lq:l i ','ilil'~ Iltl itlr;llS~2 ~kin
2. !~[udi~ urt srnlflle irthllhltiorl w~lh IJ]e Ii~lllts[er now tel>peal'
~iil~lhle fi~J r:sliril~]t~n~ Ihe ieh~llve Imnori~llie IioLer]Lk~l ill"
Ltamor il)dtlcLi~ln in [he a'e~l)iralltty Itlt~L is bes~ a~hleve~l b~
J'l~ll!lilm;l(iqlr]~ rlf Itlr ~md I)y ~i~;lly'; ilrl iiiotJ~e ei~ilh,i nlis ~JI(IL
~,lel illitl~ Ih(. I~1~ ~lrld ]l(llent'y ()t' f.lli~ ~3 rci 11o1~21]t~, Itl Clllll~Jirl~l.
lira1 wiLh blo(:henlical le~l~, n]ilu~e ~kitl ~l~.~lyS sk1~i]d ak-o aid
ir~ t!vlllllldjll~ (Jlc: ~>os~,il~lf~ roJ~ ol¸ rliel)tlne ~1~ ~ ~l~calC~llO/~eii,
;].'J'JtL! idl!nlilil!~lrion, fo~'nll~tiOl~, ~l]]ql itlu~llJ[~lic tlt!livlllion or
oli~zll~..,qJ~ciJi¢ (~ll~'illOl~erl~ Ji~tve ))l,4!n sLudied wJl~¢Jl hl!Jp ex-
i~J:tin lite ilit~l(!it~ed risk Lo cil~llrt,l~e ~l)lokeltl OF ¢l~ncer ol Ihe
t!~Ol)~i~ll~ll~, i)~ln~r.~tls, kidll~y, iIIIr~ ilrirlliry I)lllri(Jt,t', Jn ~111dJLion
h~ Cl~ll:tiri tll'om~lLi~ iiit1111~.% (oll~lCCt3-SllUcific ]~.lliLrosIiillirll,:~
~lr~l~(~ll¸ [o ]~e 1111 ~ll~por[[inL I~ro11]) o[¸ o1~1 Sl~Ci/]~ c111~i11¢)t~,l~
hi tol~ilCCO [lltd (nl)~lcu~ t;rllolge. Li[~le i~ ktlOWll of t.ht~ il~ i~ll!t~
J~ll iil[iLil~ll o~ or~,t~ln.~l)l~i [i~ Carpi illtl,'t!n~ Iron1 Ili~oLirl~ Jlnd o~ller
ll~:liv~l~iOrl Lo uJl in~ll(e czlrcitto~elliC i~1"111~ i~t!lts [o I~ explore*l
ItS/eJl~nlopl~.v~llLive a[tprolleJle~.
(:ig~lr~'(It. slnokirlff sh0u[d be inw,~li~nLud more firlly, rL h~s
bl~l~n known [~r ~orne Lime ~Fl~lt iilli~ll~l(,iOll o[ llll),'leCO ~ln(ik(!
~lc(ivnJes enzyJties in ~)le l)lllcl!lll~t altd fol.tJ~ and I~L~ Cllll:~e-
i(ll(,~c~s of ~;iJ t~ h cJl~l rlb~L.s ile'et I |o Jl(! s~lJ (Jied
5, TJ~e (~l~llnuit~ modificaLit~n of US. cil~arell~s luls letl L(~
chamois it~ Lh~ q~al~LilaLiv~ atttl p~.lhal~3 tll~ Lhe quaUtat~v*~
(~llrlllJo~i(il)ll ijJ" |~le sln(]ke, 'J~hi~; on/~oillj~ tt(!veJoprnl!nl, ii.qllir~,~
H
, t,llhlirl~q J iiitlrllh ,* irll~ ~,1 rrlt. i~1~ r( ~lllll i ;~ii Ii~o!~l nl(' i,li, lit ~;iJ rd
G The i:h;llff~i's in t'i~at i.l[i. ('imlllI]si[iml h.nd l;i.m.l~dly [o l(.dlll l.iI
(,1111~:si~lll o[ lll~liOl II):~iI lllllill~Jll!Hlll ~lll[llIl' l,or1~Jihl(lllS :i~
111l'Jl~llt1'~I ill 11tlrIlvii~:ll lld~nntmi~'~; lllHh'l Iil~lhirlI'~m~dlil~r!
c~i~diliims. ~illl~ ~lllO1{(q.g ini(.r)~iry pull villmnl. I~lld ,h.Ilt~.~..d
ildl~d:illorl whnl~ Sllmliirll! zs h~wtr yi~.Id ril~;, I'll('. Tlff.~(.li~.. il
~l~I~Idd I~! ((el~'t'tl~ill(,<l "~lll~l, ~f~,¢( ilil(,II'Id li'~'lllli(lllI'!I zl( ~I
dil~lli,n ~llIl i]IftI~lilm h:tvI' in eomlri!iIulilq~ lhl. im~i.;u~d
~.rlli~hI! e;~llO~lll (. lh;ll i ~.s~dl~l floln infe11'.ilivd ~;nl~IiirlI~
|nvoJlllll~ll-), ~11141tlilll~ ~llll l~lllll,~ (~Illll'l!l"
L ~3ill~treFlltl lind ~itll'slrI'111Jl ci~i1relle ~111iil((! ('olllnill ~hllilllr
chcnli~ ~I eIln~liUlerd:~. I JMair~slteam slnldII~ i~ ~im~ke which llm
~;llJokol" illhld!s Ilitet:ll.v d~lliIl~ imllinl~ .~.ilb'slti.~Irn '~nlt~ke i!~
~It~i~Iie enlillo~l (Ioln a ~moltle.rlil.~ ci,~ati!Iti! inlil lhl. ~mlhh.td
ilir.) ~rhl!~e l:flll~til?11*lll~; illl:llI(~(' kl1(l~n lY~lll'illol~I!ll!~, ~(Jlll4" IPI
whkh ~u~ p~I'sellt in ll~gl1~.r ~.Xlm:i.iltt111ion~ il~ sid,,~ih~.m~ lhlm
ill lll[lillF~(.l.l.[llll ~tIlllke. pllsrive or illvOliiill:ll~ SlIHIIIilII[ dflliq~:
I'r(llll "~olulllllr~ CiI[IIII~II[, ~lllr)kill~ Wiltl te~lll'(:(. Ill II1~' ( II151"1,11
[tIlJi[~ll I~f ~lttOJce ('o111(Io11('11l~ inhalell, tJ~, dllNlliOll I1111~ Ill'
[llll!11('~ 11[ Sllloke @x jlO~4lll ~,, 11nd I lm p~lll 1,iii (i[ illJ1~iIlll iotl
2. Two ~!llilh!miIllo[!ie shldie~ l~0ve [ou ml 1111 irlcl e~l~I'rl I i:~k ,l ht~iT
cii[I¢~r in lll)I}~]nTIllli111~ ~/~Ve~ of Rt1111kill~ J111~Tl~111ri~ In l]it.~.~.
~ludles. the nI~nsttlIllclrll[ wi[e'~ rirk ol rurlt! I:an(:~.r bli't i.~i.d in
r(,l~iliotl to L}IO I!xlI']]l (~r i)le Ilti~l]nlld'~ ~,rilnllh~l~. lli ~t tlfir,I
fitlldy* the risk ~f ]ll/ll~ I:1111/'1!r ;Irllorlf~ Itrtrl~Hu)rlhql wlve~ 111'
snlokilll{ hll~hnlld~ WlI,~ (i~[lI irIqreilsed, blll lh(. dilllql.llcF. WII~
noL slalisl ic~*lly silli~ilicanl.
3. AllhIlu~h lh~ cllr/elllly llVlliJ;Ible evfik.m'i, i~ rl.f sllllJ
('ienL i~ I~OIIC1111](! Illll1- prl~'~ive I)r IIIV/IIuDIIII~ ~ItlOkilll~ l~lll~l's
hlrl~ ~llll~'er ill ndlrl~411ll)k~r's, the. evidt.u,~ d~.s rliise ('lllli(.lll
IIIHHIt U pil~ ild e: ~I!r i~Ir p,hlie hI'n II h Itrrdlh'nl.
4..~es~alJon I~l ~nlo|ttnl~
I. J~irlely five lff.r~'erd ~if i hllr.~ who Ii~i'.'~ (llliL SlllO]linf.~ b;ive lJil?l~.
~Ii Wil~)011l LII¢~ llld Ill till tlp/~lrlized ~111oili11~ ['l,S~llklll J>101~111711,
[llill I110~[ ~'llrrl,lll, ~in(lIil,IR (tllJic11([' rl 1)r'(~[i,rl,rli¢• r.l qllillili~
r~otl lfl t, lllpr nrl o1 llillllzi,d, l,~ ii1 lllr (,11 [,t l~liv4~ pl Ill!r ~ii11,
2 ll1'.'.elir¢]l ew/hl~llh)lt~ or ~ellLi~elp nid~ h~lve 14'Jllllll'r] ~;lll'l'l'~
III~('~ llp h) .~() peri'e111 ('~.~:lliilll al i.xh.niIi!d roJhi~qll)~ {(i In l!i
t11r~11111~). ~IIsL eslirni~h.~. Jli]w~ver', Fall bI'h~w lhir. lttmlml ~ In
~0 llercl.rlL.
15, ~IIC('(~ Ill qtlitting incJ caavd with the inlmber cJI elloll~ ii/;idc:
tdl~ut 455 I~errent of ~h~le~c~nltt who k~pt tiyillg ~¢v~ntLmlly
~tlcc~edct], with alJ¢}~tt hair Ill" the su~c.~es tlcc~JI t illg ~it ~1" lh~
t,~t~ot id tly.
|(J,~lllokin~ IllOv01ttioll II~OlJlillll~ tLr~ t]~iluble ~llt~ln~lljvl!s to
fichool [RL~I], ]I~t.U~J~ ]IIIVC t;]lown ~1 ~f) i)~tt;oll~ or iJll~l~
i~dtlct[~r~ itl stiiokil]~ oll~L.
PART II.
BIOMEDICAL EVIDENCE FOR
DETERMINING CAUSALITY
13
,I
IN'rI{ODUCT[ON
Pruvi~iaJlal mortality d~llii t'or J980 indicate tirol cancer was
r.+~l)on~ible for approximalely ,lI2,fl<)0 deaths in tlw t/aiLed Statc~
(199). It is estimated that ia i982 t her.. will be ,13{).(l{l{) deaths due h)
cllncur, ~33,00() Ilnlong Inert alnl ]~?,0~l(I alllOllg wozll~n {~). Various
inve~tigatol~ (70. 78. 106) imve mLqgesled that 2~ t~) 38 pelceut i~f
tllv~u de;~tll~ can b~ attributed to ~m~king, and Ihotulbte llJo
(x~tentiully "avoidable" if ~m(~king (lid not exist as a hunlml
hehavh~r' -
A relatianship betwven smoking and cancer was IiJbt stig~csted for
neoplasm~ of tho lung in scientilie reports floJn thl. 192lJ~ and emly
1930:~ (203, 266). Muller (19D m 1935 and Schah'er aml Schou]ligel
(237) in 1943 reported that allot hlng cancer patients were snlolier~.
Snhs~qutmtly. 18 nmj~r prl~spcdive studle~ and zt~ot~ tinm .rd)
t~'t~OSl~tive studies tlave exumlned this r~latioru~ilip lit 1!)61, Lhe
Advlso~y C~mmittee to tl~e Surgeon Gcncrtd of tim L].S l%hli¢
lleulth Service (272) pub]i~hed a cuulpr,.hensive Jeview of the Ihen
availuble data. They concluded IImL "t:i/~arelt.e ~loltint! is eau~a]ly
,elat~l to lung cancer in me,i; tl.. iilagllitud~ (~l th~ eil~:ct of
cll~dt'etto ~nloking I~l' nuLwei~;h~ all (Itilec factol~. Ilala r(ll. ivon]eJl,
though le~ exten~,ive, pomt iu the smue directhm. The risl¢ ill"
develolfing lung elul/.~r illcl.e~ WiLJI ~he dui.atil~n ()l ~lllflkif)l~ ~l]~tl
the i]tmlhcr of clgaretle~ ~m0|tulf pet d~ly trod i~; dimilli~hcd by
di~contiauing ~mokingY
river Ihe h~t 17 ye~lrs, thous;nlds of ~:ienliric inw.~*i~;iti,ns Imvu
ctmiirmod tile Conlmittcc'~ clmclm;ion ml,I i/iovid~,l ~,hlili~nlni
evidence callc~vniug the i~.l~lilm.~hiP o~ cigal.t:lle mHd, i~lH i~ hlll~
h~ynx, lind cavity, and (:~aldnlgns, iuld a~ovin h~d willl t~;nlct~ td liln
II[il)aty lliudd~!r, kidney, nnd I,am~l'eas. This is tht~ lil~t t~pul't
devoted I!xl:[tlSivuly to ~l corail~Ji~herl~iv~ ll~!s~lln!lll of lh~ :*~;.ci;I-
tioo~s rel~ot.led b~tweou ~mokillg ~hild w~zhms emlcvt~, hn the I~dh~w-
in/~ ~*etion~ ifl" this J~ait ~t Ille IL,,l~(,it, Llte natule ol" Ihes~
as~l)cialions is llllln~ised in Iht~ li~,,ht i)l" eurrl.rltly uwiihddc Itiit)wJ
6 Lt' T069
15
|,]|'|I)I,]I~II(;'I.I.}(;IL~ ~.#Li I~I,;ILi/% I*(.miL L~ALI~L\I.II ~.
The ~¢lneqPpL i~i-+~lmsi~lily h11~ beoi~ ill.b+tl~[~ I~ ~LtliIl'nt~ of Ilhilo~l+-
I~l+y sil+ce IILe dElyS ~F ArisLolle. I)n'~id Tlqltne {1711-177(i) +m,I +b~hn
~ttlaiL Mill (1~1r;-1~7;I} ~,tt~ ct+.~lilc, I wi+h t+mj++r cc~tlLl'illl]tiolts to
cl)ntt.lnllc+mPy inl~ip~llL ;toni til('ory ol` c~lus:lllLy. Mor~ re~u~llly, niPitl
I~lS +~l¸ <Ira Aslvi~+,l~y (kJnllnlillec to Ibe ~;lln~t~ul (~nerlll 1~721, Ibll
.'.,'ielll'e~;. 'l`~l~! ~ll+illty to IolnL]iy cr*lllt,~l Ihe exi;erinu!t+lal etlvinlll~-
Ill(:llt+ ~(i i~lild<mLi~ t!llttl~ur~, lind It) iil(.~l~tlrl] Ili..-eetel~ i~lj(i?<~illt+~
lllhtw~ II cb.lll¸ ex[>~.l.inl~nlli] d~lllOllslr+lli~tn ill Cllll~.'lliLy. llowev.2r,
Ibe ++l~l}li~t~i+~n <~f lhese r'i~kl ]+ll~ol~lltl~y lecllniqlm~ ~t' eslal~lishing
c;itls~lbly Ii~ ~i(! ~;lll(ly ~r czlnec~r In ]lllnlllnS i~ c]etlriy irnlltl~.q~hle The
ilb!tl oi" i]ximsin~ hLitll~lll ~tli~l!l'l#] |{~ l~+~t<!tlti~llly cni+c~l'-i+loc}ll~iil~
il~unf~ ill t~iller Io e~Lzibtish c~llns+tlily i~ mllrally iltl+l eLhic~nliy
un+lt:<:c~l~l~lble+ Tht!n'Pl`~a'e. i]lher cril~ii~l h~v~ i~e~.rt dl,vel+~l>l.tl L<)
t~ln~l~llsh c~tu~aFity wilh +L "~en3* hif~h ~lt~l~t~e of" ~clenLific prl~l~lbiliiy
(~ 11~ 15'#. 2#;¢#. 272. 281~F.
Trs ii+lnt:l ict+, el~ill+.llli~ll<+i~ic nleth(}ql~ biiv~ ~n[!(!n e.lllllt>yed to sttidy
~111<~1. ~ii Ill;Ill. rl'h/-a~! ~tll{ri~ I'esulL ill <~h~;el vlt~ion~][ d.-ita ~ll~lL iIiny
(..sl;llglis]l ii ...~l~Lislb'?llly b~nifiClllll, a~socktLiOll ]}~.w~.c.r} ...J~rlilble~ (}r
'l'ht. pl+~.ilgibl~ (~1 till ~lrLil`~ltllll {or ~ltllrio~ls) rl#~ulL Cil/l be el~llllntlL+
• 211 il¸ Iht+ ~h!~tl ~llld clgnl~llCL of the ~l~l<lil!s tirE, Jltl~qltgll.e. [11111 if
F;I titli[!~ ~'<~litblcll~cl ill dil{~r~tlL L[t~l~r;119}~ic~+~ tlrcti~ DIId allll~ll~ iI~f~el.-
enL i+l~l>lllllLitlll ~ttlUl;S igi~l(Itict" Lh~ F.;llllt! or I~bllilzir' ~lilLi~llt'.'l~
tbt i.t!l (~lnl~lll) phi!
Jbm<l<~mi~llitm i~ aul atLempL to +~limbmte the ~rfeet of nil
vliliplhl(!~ i~lilt!l¸ Lil~lrl Lhe one Ilnller Slil<ly. [Io'..~t]v~r. ii l~lz~]lllll
i:h+~i~ I~t!li~lvi~Ji. ~lrch li~ slnoking is inll]{l~$ihl~ IT. rl/lld~rlliz~ li.o.. LI1
~li~l~tle ~nll~lltit~i~ beh~vior). Ther~h~re. il~ i)n<ler L~ esl~lhlisll t}ltlL an
t i'¢~q~(.~;~l i~lll it~!l xvl2t!n ~]liol(in~T I~n<l I1 di.~l~a~l] i~ IlOt i~llO Lo tl coil
figtltltl
in~ v:ln.i~,i,le. +m elltlte belly of ~l~tn mn~l e~ist to ~'~;~ ~pecific
jml~mt~t~L 'l'l~t]s, when a ~clentific jud(gnl~llL i~ 0]n[ttJ~ LImL u]l
l~btusiblc~ ccmlbllndltlg wlrlahlc'a Im~e heel1 cotlsidered, ~in a'~s~l¢iu Liorl
Innly I>e .:llilS~{ll~rt~li to ~ge d ] i.L.~l..
Fn Ilni~ I{t~i~orl, lbe slime dofinil`io~ of Ihe Lerm "cmns~" tlll,L was
t~sed ill t)~e ~t~l)Ot.L or i~to Advisory (~ommil.tee Lo t~lo ~l]r~.'eon
(ieneml ill J!AI;4 Im~ been n~lollLed. "The wol'd cause is the one Jn
.genl!rtli tlgllF[I] bl c0nlleCLiiin w]t]l IrnTILLet~ ~'onsidereLi in Lbi~l ~lll(ly.
~llld it i~ CI~l~l+te t~; cotlve~.it~g lhe n~timl ~f a sllgtliFiC~l~aL, efl`~cltml
rl]ln(ilmsbiI) ~gq!lwo~ll 4in itl~ll~ Illld £111 ll~OCklt~d iI~ml)l~]er Or (ti~le~i~{+
in Ihe JI~+~L" (2721.¸'1'11o lerm "calme" ~;hotild nmL be constrll(*d Lo
O } F TOG9
~"{c'lald~' lllht'l" ~ll!C'lll~ :i'~ ('lllll;,'~; I;ILhq!r, il i~ m;r,,I bi Itlll ll,4'll~liiliotl
bl thi~ Ib,llell t~ tl~ ~l~ lhl! elan lil~r oll,', tht' Zll ( I iblllillll Ill' "{ ~lll~ll ~il V"
Ill II cli~c;,~e-IISSllckl(~'d wlpi~qhll' {tit;, ~nll~llilll!) bll'h]dl'~ l`llll tt,~ iif!lli
I~l'~lllll, ~, IHIII1Flf,r of el ilel i~ p9111!;I hi! Illilizell, illl imp, ~F wbkl~ ~ im
[I. Th(! COIl:~i!;I e fll~ llf I b~, ~l~ill,kll il)~l
I 'rhr~ (!l~betence nf tile ass~¢:i~f i,lll"
'l'be~' ct'ileria tire utilized hi, rein for evllrllllli,)rl lie Ihe It'llr,/r('rl
bl htlm1111~
'l'l~is crit~rilm illnl~|i~,s Ibllt cllw!r~e ?nelblll}~ of ;}l~ltrllal:)l ill Ibt,
/¢'qlliri!~ lllnt Iho ~ockllk~ll }r~!.l'l!jle;~t~ll~ ilb3elvl,d l)y inlullil,le
ill ~'~liiIIIl(It~, bl dlfFt'r t'tal I~,l tlilntl~ and ~iL/ml iltllS, ~1 diffbH~nl ri m~"~,
lllI.~hIl<II+l+ll~y I~t" t~lll~iecL sele~!li<tll, ~i+1<I lhlll it is +rot imli+I<l ~hI+, h+
~ml [<~llllllin~ 'mrial)les such l~s dlf,I, <~tl[llll it)el, t~l ~PIIl,I it7~
~lr~m~lh of the ~.~oclnlioui
r+,Lio of cancer rate~ [or ~11149114~r~ to Ih0 I'1~o$ ~of I~(mS/ll[~]<l'l=~ 'rh<!
rc!lllliVe risk ratio yields evid~nc~, on tbe ~i~,¢ (~r Lhe e[l~l'! nf a l`n~ t~r
OI1 d~l~ll[;~ oc~tlrre~l~e ii/itl whk!h, even ill the ~lr<!~nl:¢, 19( ~lrmlber
tls~;ocin tel~ l`n ~tm' wilhllLll cml~ll I el`[~cL bill eol]lcilleel t wilk Ihe ['ml ~lll
ii~erlt, will 11o~ be obscured Ily LbC~ iir~rl~ c)l` LII~ firm cl/ll~l l~ellt
A rcb~tive li~k r+~li(~ nle#lglll (!~ tile t~l"rent~th +~1 ntn ~:4s<~ri:~llon ttllll
pi~lvirb,~ tm t'vnllmli<ln or Iht~ iillltortanco ill" tblll I~lill>r bl Ill+~
I~rodtnctioi~ ofn disettse.
II Ilia CI~Se~ O~ [h~ tllseil~e initial" ~lJdy, bLIL nolle fPf ~h¢? Cr)lill'4)]~,
]l~l','e n ili~ory t)r ~IpO~llre ill the ~u~pected eti+,l,~i,,i~' ;tl~elll i)r
chtll'ttet~ii~ti¢ (~Iiii]1}~ lh~l~ LIII ll+lequnl~ mlmlter {I~ etl~t,~ itt~i
C[]l~l i'lll~ exisI Jn Lhe 11Olgt¢ Ill I.k)ll IJ rld(~r @till]y), g o11(! I (} retiE! C[~l.rec{p()ll
hyl~oi hl:~is wmlht }1~ credible. I~l*~L digerl~es are inl]~letlc~'(I I,~ I~l:my
ftl/lor~, h{)w~v~r, alld tJHqt.~foro it ullu to oll~ celrl.t~lx);idullc~ wotl]d
tl0t i~o exiluctud, tJ'iiL~ Ml'l!ll~[ll lit" ilia lis~oeiulion i~ llIciinurud i~y
let.live li~k ratlo~, incidenc~ rati(~, t); nlol taliLy ratioa. The greater
Ihu i~l.lliv~ link ratiu or th~ nmrlalily r.tio, Ihe t.tlonger the
i~Jzd hm~.hip b~lwuen tile ~tiuloglc ugunL amJ tile ,liseuae. P~ oapective
ht.diLa haw zdiUWll tila[ [hIJ dea{]l rldu ~ioni cancer (d" the ]ling
lttlt{ill,~ cJgultdlt~ ~lnukers i~ Upl)i.xiJnalely tO fairies t}lC t~tl~ ill
IlUlt~tilnkel~, m.l the rate in h~avy cigarette fil]lUkt~r~ i3 2{) It; g{)
lime~ glulllcl" than ill nouamukura. 'l'o a¢COLLnt fi)r micll high lelative
rink it~ tcrlna of all indirect a~oclutiun would require that an
IIIli{nliwiI cauaal factor bY preseltt at leaat ID tillt~b nl{n~ I'rt!ClllCli~lg
ill th~ ~laokula and 20 to 30 tilnes lllOl'U frequently umuJig he,ivy
t~Lnulit=r~ Lllan unloJig rlonSlllOk~ro. ~llell a ¢onfoutlding facLor ~hotlhl
be curtly d~Lcctabl~, and iJ" ~L Callllg~t ~a detecled or I~a~olmbly
il d'ut t cd, the fiading of ~uch a l~t/ung u~sociation makes a conclusion.
eUllC~lning can~ulity more probable. Importunt to tile strellgth, as
well au to tim e.herenee of the associution, is the preamlce {ff u d{~se-
ic~pllli~u i~hunonmllon in which a I~'~ilive gradient between degree af
t~x[Jo3tll~ tu tll~ a~ellt and incidence oz' I1501 tz~lily raLes of the diaeuse
¢'UlI lie d~lllOll~tl utcd.
Hp~cificlty of tile A~soclaiion
'rhi~ c(incel)t calinoL bu entirely di~uclaLed from th~ conc~llt
itll~:lt~llL in the t, ll'en~th of file us~u¢iati~m. IL inlplie~ the iwecisi.n
wilh wtiit:li (ilia ci)nlpun4~nt of an ll~(lc~ult~d pfiir cun b~ utlliLt~d Ltl
i~i udit:L liit~ occllr i'ellee of tiLt~ triller, i t~.~ li41w Ii ~:{lll(:llLly th~ lll'u~211¢e
ill¸ ti[i~ wllilil~le will llr~dicL, ill tile ~ilin~ hldlvldual, the In'u~llee tg>
ilnl)l ht~r
~;1~ iliciLy iulldie~ ihaL u cauual ug~nL invaliubly leud~ Lo a ~illgiu
~l~:lilic lli~t~il~e, lin ~vent rululy uil~clv~d, A lllit:-Ll~ ulit~ iclaLhiJl~ldll
J,ci II i~il t I~l: ill t~(:llCt~ ill arl eli(ihl.q ic ul4uliL UL/d di~eu~v w~nLhl ll:ltl~l:L
il (:illl:.it I i t:lu Iillu~ hill, I hlwvvet¸, ~V~li~l ll~iill ts Lnlt~.L i~ IlupL in nlilld
ill illlt:il~lt:tql[~ ~l~t~il'ici£y ill ld(dlqlicld ~y~tulll~. FII~L, Uli zl~nl Jll;iy
ht~ ll~(Iciuled wiLli ILiulLildt~ di:~en~l:a ~et:olld. inilny le~.p(lllsu.~
{:tJli~iti~l'l~d ttl iu~ disease ~l~ltt~; h;iv~ illillLilllt~ CallS~H. t!(~lll{elliLill
tli[iilillliiu{ion:~, I~I, (~.~Ullllll~, r~itlt I~tllli lli~nld~l lltdizdioil ii~ well
ii~ Jtlml Niliie drllgfl ~ldlllii~isturud dUliJig ]n~gllUlll!y lnld olliel"
llu hll~ Vuiillli(lil~ in the re]ttLive I'i~k id dlne~l~U may he Jn~ldtJl:t~d lly
vat inl illlla hi liit~ n~liubcr (if eu u~ill zlt~t~ll{~ .i~ wvil un hy tlzv nlll~t!ilieil ~'
i,I¸ ii i~JVt!li I:illi~Id al~l~nL Third, i~ ~iliHl~ lllll~ nidl.~t~lllt.l~ hi tllt~
t:JIVililUlilt:ht Jll~ty lllt~llJt:C zl ntlJnht~l. (if dillS:reid, di~:~l~t!~.. 'i'h~!
ux I~L~l ilUuiil~d llr(idilr Liuli ill ,'1 V~l i.ic I y t)l¸lii~eu~t:~ ill adl:t3 I~y ex i )41~t
ii.t~
Ill X i'uy~ i~ il i~(md ~xuJnllJu (if Ihi~ I,'~l[ll Lit, U ~illgle I~ici~ll" iiuiy I)l! Ihl!
inixluJ~ .I ~uvelid Lhou~und indlvilhllll cllJl~lit ~lOiLI ~, lind tJiul t.l~ll ~: iL
WtlLihl lllit lie mll'pl'i~hlg to I]ild t hal I hi!~l! divl:l ~t~ sLdlst~lllcl~ ale ll[llu
19L T069
L ,.
to Illl~ltlc~ IIIO[1~ lllun I]11e ildvel'~e biologic lOal~lll~l~. It ill al~O 11Ol
I~Uil)ii~hlg IliaI. tlie~u~ coll~titnelil~ Intly have pos~ihle additive,
~ynergJsti~, or ¢onipeLiLive uction~ with each other and with oLli~r
ullenl~ in Ihe onvirtinnient, Aiid Ill'Ill, lllere i~ no i'eii~ll to u~Ull/e
ihui iil~ rclation~llill.q b~ lxJ#ei~ i i Olle 171clu f filld dil]{,ren L ili~nu~et lillY()
~indlllr /.XlllunatiOll~. The as~ocJatilm between ~inokhig ullil hlllg
~illiCOl+t fur eXfillllileI is ~onnldeled dilect lllld Cail~ini> wheFeil~ that
bet wt'~ll cigarette smok big and cilillo~i8 of tile liver 19 t Ilol~gllt to i)o
illdlr~ct, i'~fiecLing the ~oso¢iatlon nf cigarelL~ I~n/o]{illg alid li~nl'y
a]culi(d tl~e by ~OIIlO scglnt~rt t.~ Ill tlio pOliulathln.
Ill ~tlnlmary, despite tile [act that the denlon~itriitJoll ~[ speeificily
iD lilt IISS~Iu lion nlakea tl causal ]tyl)utllesis iilUl'e acci, llizlblo, lack {d"
Sll~eii]ciiy does not negate ~llCll all liypolhe~i~, l~iiice iliilny lliol~gie
lllld cllhl~nli~logic llspects of the a~aclalioli nln~t ll~ ~ll Ji~i[lerl.d
'l'~iilllllrl~l lletattonship of lira As~ocillthln
In chronic di~asea, in~Jdhiil*~ lill~l~L lnld llie hick of ICllowil~dg~ uf
pl'~¢is~ induction perials auloJll~iticaliy llre~eilt llrol)l~nm oil wiiicii
l'ali/t~ fh'st--tils suspected ugt~liL ill tilt! discus/, IiI ally i!vuhl~itiojI of
tile sJgilil]eance of an assocla li~/i~ eXl*~Ul'O to all Ligln i t ilrenilnied Lo
lie causal Inu~t precede, ll~lnlioi ally~ tile on~eL of a diseii~ wllicli [L is
[lln'llol'ted tO p rodlike.
Tile erJiei'iOll of telniloral reialiiln~llijl requires Ill;it UXlliiSili'~ to
the ~ll~lleCl etiologic factor i]ll~[lll~ Lilt! di:~ell~, Tenillorulily i~ iiiofo
dirficuli to e~ilibli~h [llr dis~un/,~ ~villi hlilg hlli, nt'y ilelilnt.~, ~llC]l 14~;
I~ali('t~l', lq'ospc~tiw studies iilJldinizl~ tlq~ dilticully, al[ilOUl¢h t:Vl~ll
In'o~il~ctive ~Ludie~i do illlt ~;{clll(l~ lile iill~dlililv ililll Ih~ lii~t~i~o
Wll~ iii,l~st./it. ill tin tllidoll~ci~d lllllU [liiUl I~1 t,l~llil~lZl/• lit iht! illllnl
IIi~l.lrlgic evidence delllllU~lllilillg iil,l!illlilil~lllllll rhilill~l~~ iiltlOilll
itidividilldS oxllu~etl |o the iil~Olii, bill illll Hiillllll{ Iiill!Tllfl~l~il { lUlhlll~'
lii'liviil~/~vldellce limt leinllol~llily i~ lli~,~OliL Iglllll~liiill~lll;ll ~liiilit:~
illily ~ilsli ll~lilOll~i rule li I~ lillllil id zinnocllilillli,
(~o]loi'~liCe of tli~ A~so~iatlon
q31t! i]nui criLeriiln l{Ir tile Ulllirai~al of culi~iil signil]t!ance lif {111
ii~litilitiOll ]~ it~ c~llelellf:e wiili I{liown fucl.~ hi llln li~tul~d hi~liny
lind IIiuhJgy Id" tin! dint!il~e,
(~{)h{!l/~ilcl' leflllil'n~ tilal di!~il!rilllivn ellid~liii(lhil!h! i,l!~llll~ eli
IIi~ii~ {l~CUl-lUiic~ corr/qaLe wilh Illt!ll~illl'l~ ill I.XltO~tlle [O lile
nU:illl!¢lld iigeilL Pel'l]ail~ Liilt iiill~l= JlilllUllitzlL coll~Jd(~l-;iLiilll hl:l,t! i~
lilt. i)h~efvaliUll lif ~l dllHl~-ri~lliiil~t! leluLion~hill Isl!lw(!t~ll ii~l~ll[ illlll
Ilia'list5 tllUl i~, the In'ogl'~iveiy i lllll i~U~Jllll~ Ill ('tl rl i~liCt! lit tli~i~a~ iu
Jiicit:UniliEly Ileavily expo~d iflOUll~>, hi ~iUlll~ {!filet!h, liligiilli/, illl!~l
~>UlL'~ III ll~ige arc i~viiJlnldl: Tile IlZltlll;ll hi~hll'y llf llJnisll~ WnLltd
JIwlllde tlllSl~l'Vll{iOll~t on Iile liltlt~lIX'~.~iinl uf dJneiln~ wilh /'lllliJlillilil~
d iscqlzt tln ued
In oe(ler (o (!sluhli~h the cnherence IJr Ji slleciFic ~s~ocillLion, iHher
pl~i[)i~ explamilhln~ ~r the Nssaci~ltkm inusl. ~Jc J~stelnfllic~il]y
~nnsidcr~i luui excluded or I~llt ell into a(:coll tit. (~kere ll,~p is c[e~lrly
e.~l~lb]ishetJ wlmn Ihc actmd mPeilllni.~m oF di~eas~ iJrl~Jltction is
d(!rint!nl (~l~hvrt.nee ex~sl.% nt~ll~the]e.n.% idt[iough or a le~er ma~]li.
IncJ(!, wiltm I J~erl! i~ ~non~h ~vhlE!rlee ]o :~tll)POlL ii plau~il~ie mech~l-
ni~m, LI~IL sol ~l (l(!ildred iznder~tanl]inl~, qlf t!,'lch ~[ep ill the chail~ of
evenls Ily wlli~ll a ~iveJt eLi(d(~i¢ sgeJit lU (eh4(:(!s diseaso.
Causality for Specific Forms of Cancer
"Jlt~ Catlstl~ Sigldficclnce 01" l~ll a~oci=[llotl is ~ matter of judgnteg](,
which ~oes beyond any stateln[,nt ¢~f sl~ti.tical probability,
[11 Iltu ft)llowi01g sectitm, tJ=e relaLioushlp I)etween smoking mid
H(!v~r~d ('a nc(!r~¢ iH I e=l pJ)nlised. ~Cpid~nl ~(l~o~ic~ |gBt hulogic, lind ~Xlgoli.
IIIOlll~d d;tl;l ]i)lrll I[IO DJl~i~ f(3r reviuw, When a ~i~,rli~i~+#]ll[ ll$SOCi~.
Lion I)utlw!~n t:iffurt'tte ~nl°kill~ find I~ ~9('[~][ic C~IICCF is ~ti)tO~, the
Ilalur., ill" Ihe ~ls~ociaLion wns at~es~(~i hy nppiy~g the jadgme.t
cJih.ria noted Idmvo. If all epidemioh~l!i¢ criteria were jUdl~'ed to be
sntislied luld i,nllmlop~ical nnd expeeinlrHl~] data are supportive, the
~(!rll] r'e~ltlSUI'= i~ applJed to the associltikm. '['lne desi~naLion "major
czu4se" is use,d whes tim relntive r~sll for the cnncer in cigarette
smt~ke=~ is hilt'it "rke term "contributory factor" is used when time
bedy or eviden(~ is less compe]lhll~L the relative risk Js Iower~ or the
~lnt~i]l;tr)' evldea(e {]lath~h]gic and (~xller.hlleltt~d dala) ~ not Stlffi.
cieall for a j,dgm~.nt of causality. 'rile tt~rnl "contribLd.ory fllctor" by
lit) ~l~etHIS eYX('ILI(i('~ ~he pnssibility of a Call,el loll, fur sTr~okir~ ilI
C;III~jIH (>[" Ihl~. sites. The /~rnt "as~o~:iati(]n" i~ 115~d Whell ~t
reh~li~,llsJ:ip ])ut We(Sl ~l~ln~ill[~ ~nd a c~] ncer ~i~e ex i~L% but Ihe data
III'C inl~lk~Illltt(e ~or ~tll ~O~.~tllen~ Or thl~ character of that i'(.~ld.if}n
ship
9 PCT069
2t)
L~Id(H{II~(;II{I,~I,ATI~i) C/\i.~L~I,;li,'; II~, ,~;11 II;
Ltall~) Cancer .'.
lihirO(]tl('(]l~ll
~ince lile e~lrly 1!l~, llml[ c~ntrer h~ls I'~en Ihl. i~.:ldin~ ~'llqisq. r~f
c~lll{!~l, ilcalh tll)~tln~ mlde~ in (h(, T.Iidll~(] ,~(~110~; I~rilonj! li.ni;li~.~, l ile
hJni~ runner (]Path rnle is n~'r.eln,rrdinl! ~f,!r LImn Idl ~lt]u.r i'~1111'~,l¸
de~lll~ lares Imd. if lira,sea t Ii i.n(l~ e~lrl~inll]e, will ]iht!ly ~nnl i~as~ II1:11 ,~
I~,~mst eluu:er I~ the ~nid I !}~Os I?J(Fil~urn II.
ILclween 1!150 and 1977 inl 1be IIuiLed ~tate~,' 1he Iot:d rsunll~,r t>f
hlnll~ cm~cer deaLhs increused ft.m 1~,;113 in 1!)5(~ I~ !}O.~H i,~ 1!)77
(Ihe hf~ure for 1977 hlchndes I(~1) (Iniernnlltm~l (~ln~ifica~i~m ~lf
Illl!r~ wiH he l~9,tH)O new i~il~l~ cancer c~i~es di~tl~lnlsL.d iln 1!~12 ~md
l I1.(1(}~) dealhs¸ Of rids nund,0r, flf),(~}l) will I,e men r,l~l 31,1}110
wouuen, rl'h~ al~e adiListed hm/~ ennl:er uru)rlnlil'/ r=]ll, fur ilu. Ii,l~ll
p~q~ndatinn r~early tripled, ri~h~p~ Irmnl Ill l~ 327. f/~ll ~11~' =ldimd,.d
,deal]l i.a[~, tJille~ sllded othel wi~.e, wnl~! dt~iiv(.IS I}.y nitl~lyiqiI~ IJn,'
ell~]liler~tul] in ]!}~q).l Overnil hml[ cIl?leer nlml~t]ily I~IllL~ iti~.e~.;l~,,~l
over Lhis I~riq.I nt a d[.~deualia~ price Thus, in ihe 1!)Sf) I!)!W
Jntf'rvrd. ~he ~verI~,~ Einnu~l increase iFi ihe ~l~[l!.ntljllS( ~.d ~ll.;nl In e ;,f~
w~ I) 2 pereel~t; over t]ie next ld ycllr~, idle ilvl~r~l~f~ Ilnnu:d il~cle=lm.
was 40 I,errent; and in the fined ](I-)'ear interval, I!~q~t.1977, ~l,e
rain of increase was 3 1 Fercenll.
'J'hes0 ~px ii~reF[a~ed ~tlr(.~ [lltle di[feren¢l~ il~ Ih~ Iunl~ #:[im.l.i
mnrtali~ { rem]s o[ msles ~nd ~emtdes {Figures 2. 3. =lnd 4 ) ]t~ qh~. ~tq
year ileria(r from ]!]5() L~} 1!177, th~ nf~ adju~te.d Innl~ q'lmrcr r~l~
increas('d ahn~t ~()0 ilere(.llt ~l>r ln~ll alld itver ~54) [~t,rel.qlt [e~l¸
wmuenl+ The nt~t stz'ikitll~ aSl~!~l of Lids tlel~d is Ih~. ~ll:('q.l(.e~lt iflr~ h~
] un~ ca nt!er mortnlily a IIl~)lil~ feut~tles The nF.'e-ntlin~h~d deal h 1 ~lt~ ~d¸
while ~lTm]es illcl~aSed [ly rll} nvorn~ of l(I ilerreld per yf,m¸
],eLween 195/I and 1957~ 5.5 p~tcenL per year Ilelw~ein I!158 ~ntd 1!91;7.
am] 6 7 percent per year between 1!)(;~] and 1977, ']']le c~rl~'~l~l~Lli]=l~
increrlses For all O~Fler ~lfl le~ wele ~ O. ~. I. lind I~(] 1x,rcPn( I~n,r y(.~ll¸
(The t~rll) '~Borlwhi~e" re]}rl!sents Ii1[ race.~ olhPr Ih~11 whi(e m~d ix
u~ed in most ~raphics throughout this i~ei~iI [~>r th~ sr,ke~,l F,it.viiy )
]rl c{m Lrast la 11ds (r~nd irl ~emldc~, [he r~l e ~i" incI c+~l~e slowed d,~lVil
ill lult]e~ Annr (!iinlbiTi]~ nB avel'Bl~ of~.l ix~l(!eil] a yt.~lr¸ fillln [[1~!)
to ~9,b71 Lift. rtite nlnoTl~ w]lilf! nl~di.fl ro~e 4t) ileicelll iinntg~llly fl ~lm
]!]58 to ]9~7, and 2.1 percent n year IYmn I!P(;8 to 1977 The I:~1~, ~d¸
~ncrease amllng Jill other nudes fell frtlm 87 h~ (;~ ill 3.6 I1~,1 el.nil l~l,,"
yenr aver ihese inLervais Even wil]l this dec~l~ralillnl hn 110(! ~isinll~
~ "~,*rl~l,~v F.,,~, I~i~ ~ ~.,,~i,,d~ Wilh H,,,,,t I,,n I h,in, ,I ~n,,t, ~ n~ ~7.¸ i:,~ F.,, ,i ,~
,~i~.1,1~ ,, ~.. ,,r
in,~.,la~j, ,~ w, II ,,. ~,, ~,]~ G~r ,~h,~ .n~ ,,~ • ,, 1.1,,~ ~,, .,,~ ~,,,~ el,,¸ ,, ,,,5, ~,
,~.,,,n., rl,,~. ,,i,,,,.,
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dim i h:~. This sl udy IIrovid~[ I}1~" tiltirltit! Olbp,~r tu nlty to exmnine Ihe
i't!lltlloll~hiI) t~ t.~l~nl IJ[le ~lnok[ng to iI~,Jl[ h i tl~es [11 o ]ln[lu [ll~ ii~ll with
i~t, llt!li~, t]il.ll]ry, ~111~] clJllurltl i[ilh!lt!llt:l!~ [loin ill'ev[llllsly e×~lllilll~l[
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t}l~ nla}n tll~ly or p~lblislaetl IhlLa is basc~[ iJn 5 tn ~ yenl~ ol ftlll~wup.
"Fhe ( "r¢llcrdi~lll V¢!IIw=IIs ,~llll~y
I~cl!innhig in [!)$5. the (]anl~dian I)l~pnrllnent oF Nati~nHI I {ealth
t~nd Wella~e ~t~d[~d '~,(1(1(I tx~elx mid t4.q(l/I ~ux~ in a ~lkidy ~t"
slnflllhlg-lel[dulJ mllrttdiLy (2C~. 271 ]rll~rlnrtti~n wns illll[ii~o~l Oll o,q~,
~lehdled slelr~llillI! hislory, i~e~iflence, nnll oCCUlm[inn, l)urJng Lhc first
(i y~tr'~ t~l' l~lh~wul~, 9,4!)1 nl~dL~ ~lr~l 1.79¸| females died, I~o nl~re
it!ct!l~l [}l]]OWUll Ii~s [1,2(.11 t t![7orlPI),
"l'hc Amvriloll ('~lt*t'cl ,~;~mi*ty Nine Hlllte ,~;tll~l~
h~ Ihe ArncHcnn Cancer ~oci,~ly NineStnLe Sh]dy (YO~ II~L
I B7.7~1 ~hile i~l~ll~ wet~ fM h~we,I I}~t¸ un averol.'e or 44 mont h~, q'hi~
sl ii,ly Ft,'I~LI] in e;trly [952. There were I |,~7[} de~lhs in Ihe nge .50 [0
7t) I~d~imhtli!ln. 'rhc JnsL Innillr lepott ~tf Lhls ~tl]l]y wn~ ptlb]i~he[I in
I!JSl~.
This ,~llt~ly (~ ~,q0) exnmioed lhe morl.~diky exl~rienc~ of G1~.15,'1
men. :15 Io G4 yeass ~f ng~, over a i~,lilb~l of 4~2,650 Iler~nn-yenr~ ol¸
nhle ~ct:ll[*~tl, il~lL~11 gl'oups. T]~¢ InsL pnbli~he(] reporL fi'orn Lhis stagily
• ,~ts in 1!170
"]he .S'rr,t~l~h .~t~,dv
A nali~elal pl~bahili~ santp]e 142} or 55,0~i) ~werlish Inen anl]
• .~ttnl~n~ wns stu ~e~6 in l~.q b~ nmlh,iI q~s~tionnaires, to '~lticl~ '6~
II(!lt:eltt Of Ill~ Banll)le resl~onded. [nforlnllLil)l~ wn8 col]t!ctell t)ll
I~llll~Jlirlg l~tllltlS nt I.he Lime of tht! i+tilJal qtlel'y tlrlt] fill" specific
~tllt!rvt~l~ IJlll'il~ Lhe previous 9 ytJ:~rs 4Jlx~)r~ill~ Lo tylm ~1111] 11111111111[*
or sm~king tJll~l tleglee ol" irihahLtJOrl. The questlonrtah.o i(lentif]c~]
tlgl!, vex, I{~[llJOlt Itl)[~lln, IHIrtll[']~lll~. hlcotne. ~lnd ot2txlJlllll}on {)f
slJbjet:l.m. A ]l) yotw followup Orl ~nl*~lllngreln|ed mottnlity was
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~llldieB IT[dd(! ~) Tile I~lor|ali[y miles f~ll Ill,re 8111[1~{1~1~ I-IIn~-(~d []'(1111
37(~ lill" Ihl: Jzll~zllll,e;c: ,~Lildy Io 14.2 for the (~zlrt[tdia n Veleritns t~Lttdy.
Ill l~(,11{1~1], I(l~,~f}I. inllrL~l[i(y iL~[io9 wele i!xp~rleFiced by [~'F]l~lle
'~n ,Idll!l ~. The II~oll~lily rlltJl~ flit f.'nl~les ral~ged from sligll[ly iTio) e
Lhl~l120 I'llr llle d~ll)~llll,,~e LO ,~{] for llle I~rili~h len~l~xle plly~ic~ari~.
t~l}lllldlii111~ Ihe d~lf:l r~-Olll 1he ]~ro,~peclJvt~ e;t~ld]e~ £tllow9 Lhe eonelLi-
d@v(']l~]} h]n~ ~;[~liCl!r ItS iir~ ilorlsrl'lek~rs, whHfi, th~ lisk ['l}r hl!tlvlel,
uimd(ers considered ultme is su bstt~l] tit, lly higher (272L
'rh~ sLl'~ll~]t I~[ Iht3 IIF~ocilll.iol] ~){!Lw(!cII ~l[Iokillg ~IId ]Llll~ Ctlll~[~l
iB [11TLher t2tlllBnced hy Ck'ar [[¢~c, i~sil{l[l~ r~[l~]orlBlllps, The
~[t'oll~f- l](lBc I'P~l~l}llSO measured in t~lost epidemiologieal sLttdies
WIt~ i'Ol L]1~2 n ii i]lb(!~" or ci~r@t~c~ slnollt:d per d~ly JJt th(~ tinl~ ~r Oli[r~¢
iIILO tllr~ ~;Llldy, 1J~wl!v(!r, other ilT] porl [inl tneLisU i-~s of do~a~ includ~
the ~]ge t~t whi(h st]lokitlg began, the dlll'atioll or smoking, and
inllr~l~lli~lt lJr~leLice, ~cveral of tile pt'o~peetive ~ttldJe~ have ussessu~J
Lhp~L~ I {da [il}llsl~ip~,
The d~JLa, I)te~ented in TaMe B, ~ndicate that as Lhv number of
¢[gareLtc~ ~]noked per day incl'e0ses Lh~le is a gradient of risk ftlr
]lln~ cancer nlorLt~liLy. This grmlletlt inere~lse w~n obset'ved in eu('l]
~r the eighL major prosl~ective studies. Male smokers who emoked
inole titan 20 cigarettes daily Ilad lung c:mecr morl~x]ity ratios 15 to
O&LF TO 9
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inllldt,d ll~t cOiilp~lr ¢.d Io Sllll,lle¢ ~i wllo ~iiitl (lt~ di~l nlll in hille: lllil 41il.
l (] Vl~ I'~(• WIIH fl)lllld ~lir il~,~lvil~r sll14dc~l.~t ( > ~ cil[~l i (!1 ( uH Ii~!r 4iny)
Arl~llh(,r Ill(!]l~lil.(~ (~F ~llllek{, ~.xlHISUTo ~ I('ll(~C[l!d by (11(* I~11' tlltd
,, nilllliilt'lT/N)clml~ntiIFill(~l:il~i,rl'tlesmolII,d. ]"illel ci~llel,lll,~vl,ll,
i1111odtl,:ed ill []11~ mid 1!~Sfln fllld ~{!i.ii quh'hSy adrlpti,d Iiv ,~liit~lll,ts,
I1:~1 ¢~:llhlrly WIIIIlell. (;l!ncl~]lly, I Illllsy's [ilt~,rl,li CIfTIItl I It,m htlw! Io~v(,r
~lr illld ~ic(l[illO vlllll~ C(ll[Ipill('d I0 IlillllilJl!/In[ CIJ!tlll!ll(~ (~111 fly
l!~lll, !):1 lIOr¢'t~ilL or tile lnoit~ lilzln (ill[) llillinll e'ii!liil:ltt'r riilcllil,iI in
hllve (,xllitllned the telatlorlsliip of Illl}[~ ~'ill~C(!l illilll~llily lly T/N
eorlll~nt or by I~fllllinill~ I]lliyl'~d V~1~115 nllllril[l!ll!ll (:}l~illl'llq'~
rl]lllk~d. For the Anlericvll )1~;1111~ FoUIIdllti{lll. ~*~ylldcl. find ~h,ll
Ill'in COrldtl~'li!d II relili~p~tiVl' Sllldy of ihe eff(,c(s of lilt~!l~!d vein~i~
r~otifiltcred clg~lreLlu~ (.'12{0. I¢~,11~1 ire rink .'atior fi~r s.~ok (,l'n r~f lilt.'l
Cit~;l~-I!l (¢.~ (WhiCh Wl~]e Ilgwu IIIt?d Ill h(~ leave21, ill lilt' 8rid Idl:lll hi('1 l'd~,l ~,
I{~ Ihilll I(IO~4~ [Ol ~Zll(llll~lS i)1 ilimlillt, i cig:llCtli,r ([.'il~i//.i,~ 7 :llld Ilt
]{tlllZ(! niid VITtIIC (/4!lJ lind I{~lllinl~l ¢1/i (21!1) i I![iril If!d ~inliltil rl:tl:l ill
Atl~Lti;In and IIIjti~ll sllldi(!s, ]I,!~llecLi~dy. '['hI! Illll~¢.~l ~[ Ih(,
prrl~l~e!~:i,lv~ ~hitllcr> Ihe AlilollCllll (~alicOl' ~oci(![y ~.rl ~l/ili! ~lully
(155), sll,~wed ~ dt, cie[l~c ill ri~lt for IIin~ CIIIII'CF nilltllllT lilill(, lind
fi'elllllc slnl)kl!l ~ of lower TIN rril~llrl'll~ tls toni Ii~l 1"42d wilh ~liliilipi ~ or
cil~llrt'[I(! ~;nlil]/~'lr were slill I'oll~idt!rllbly hil~hc, r Ihlin lhq liil(,~ 1ill
r)ot}~]1111k(q ~
, 'llet'i[~r'l'lv Ill le A+¢~ a I
TIIblIC{:l} ~mok~ i~ al I~Orllpll,~ mi~ll31"~ Corl$i~|jt~l! IJl" SeV~rlll fho~t
~and chl.nlic~ll ~ldj.~fance~ (2t;!l+ 2}'/I '['ht,~o divei,~e ~lrll~lilllt:e~ +lie
CZlllllld¢' (it lll~rllJci~lg inorc Ihllll II ~drli~]e Ili+ll+ll~it,al lerl~lll~f!. 'J'hi!
(]vid[:li~oil I1~ COlllllarisiln id Ih(! lil~]~ltitlldO or ~lllll~ c/inc(,r rllllli;llilV
rll~tl~i Lii lilll~c llf (itller di~Pil~(!~, as hlIs b(!cll ll,)ll(! ill i~l(l!~ i}l 1he
IllIJ~ll~'e:liw slmlio~ [s0o Al~l~l'n~li~" Talll0s A ~1111~ Ill. TII~' Illl,rl~dily
:17
TAIII,E IL--|amg cancec llltu+LaHty rtltloa I'oi" nlcn llll([
wilni~ll+ [Jy CUrrl~ll[ IILIIIIIJ~I" OI+ ¢21~ar~+i|l~l
++nloIL~d p~r Jay--pro~ll¢+t~liv+J ul+IJili~
~iL.kcd ImC J+y r++l*~ *a*m~c~ i,++ d+y rnt+J+h
L •
lhil~+h
&qh,,,r~ ~L~+dX
All ,q£+~
It) ~) I,', ~
+,h.,L+l i *I+ i,~ tJ~++
. -.-- + ~+
l;nlJo~ ~)l hlllg +:~Irl(!~l" Jlr~ V~I'~ high when (+6+ltlI);LI'IPC~ wilh {hl)GU q)f
'+'+""++'""+'+
TAI]LI~ 7.--Lung cancer mo~+tality ratios fur lualcs, by ng¢+
b~ga~a umnking--])ro+ipt~t~|ivtl ~tu(li~+.
iJJid~ r 15 1677
I', pJ 1141~
~ II,LIL r i~ LHTqJ
t h,,ic, ~6 t+~
TABI,I,~ 8.--Ltlng cancer tool LalJty r+~L[~)s+ by ill!h'r~+e i+l"
In ha ]atioi~--pt t J~l~eCiive ~tullics
~llll~ ildk,,hiJ.¢l M,~I~ • h ,l,;,l, .
I'..... hh
"reurl,+u+ll Relt+ti+mship ++]' tlw A+s+~czati+,n
The cr[t~rlon or temp~a'ali~y r~(iL~il~ thut ~igal~tte sn~ohing
~nl~ll~t ~ Lhc ntl~eL 0[ t~tJ tl~l'. ~UplJor t libr [ll~i clJl ~r [+)n i~ i)r ilvi¢l~l hy
i~itJa[[y di~e-fr~e subje~l~ wcl'e iollow~d <~v~l+ va~?/hll.+ tlm~
illt~rvult+.
<
I, U~IG C#% lICE rl I> MALES
~IfJN F NF F ~F F NF F lIF
F rlF
S~OI~EFt i IO • 11--20 21 30 31~O
411
~tO OF CIG AttE T | I'S :T.M O K F D PER DAy
FI(H]|IE ?,--I[l!hsiiv(~ rich or lu.l~ (!;ulcer for m.le~. I)~,
1111mI)~r of" c]~nre{t(~~ SlllOii~d i)~,1- [lay ;lll(I
h)nl,~-I~rm ,he ~f filtt~r (1:) or l]O.filter (NI~)
I.~lir(.~l. ~tllllll}l[ I'(ir the t~i,l~ndiLy of Ihe li~soc]liti~n i~ provided
I~y olher ~hidi~ (57. 70). Oile sLu(ly (.57j e×tuuiiled the i~hltil)u~hil~
IJe~w~n I~l~l" Cllllil~ tol~llcco c~)nsulullihm ill 1.~:~0 ~lld ,l:lle lull~
c~ilc~r iI~;iLh r~te~ i~ 195(I ill |] di[~l~ill ~untri~s (l~iKurc (a~. 'l'hi~
~ludy ~ll~l)llll~l~.qc~l the ~i prhlr to Ihe lldve,t (if Glint ciK:ir~U(.s.
A~ullliul~ I lull th~ Ilii~Ol i~y of ~ll)~c('o (!llll~ll III I)tlO]l in ]~1) i}l:cu rr~
(l~vt!J(lllmer]L of hln~ ~[~il(~r~ ~h~r~ wll~ n ~lrrJr]~ i'~lsitjv~ ('(lll~l,~li~l]
]~'~t wl!e ii I llb~l~¢ll (~orl~;tlltiill~io[i in 19~(] lind lullg conccF d~tli liil ~ irl
25
IS
: m
l0
LtlNG CANCE ~ I, r EMAI.~S
C~SE$
H
C~N r Fl(ll S
NO, t'lF CIIIAII~ ';~ll SMOt~ l D pEI~ O*',¥
F r~l
FlfiUilI~: 8,--llt~lnlt~e flail (if lillil~ ~:iliil:l,i" f.r I'(,lll:lll!~. I)v
I"luln}~r Of cil~lll~>llt.~i Illilol((!ll i)l!r (]~i~, ~llltl
hllll!-ll!rl, u~(! ill [ilh~r (I~) illld ii(itlfilll~r (1~!1,')
A I~1[f_.1" fJ~ll(]y (7()) e:l.+llnill(,ll Illo ri, l<~tioll~hil) hi!t,~/l,l.n illllllll~lll]
t ill ~.d ¢i~rlTet~ coll~llnll)~ion p~i' llllll] 1: ill l~f)(I lltlll I lllll~ ~ilil.l~l iI(!lll tl
rtlt, l~ ill rllil]t,~ ll]ld ~llllll~ WIil~ ~v(:l'~ in ~ll~ ~15~ {r) ~1'i y~lll (lid Ill:l,
Kri)tlp ill tli~ mid-lft?0~ {wl,~ ll.d i!lll~i'l, iI lidlil{ Iil'~. ill Ifl~fl) 'l'hl,lt.
Wil~ ii COll~iS101il, 1:4irr~lnl illn I )ph.¢l~f.n Cil(0 r~l If. 1~Oll ~11 iii ill ion llllrl hllll!
i~lilll:l!l II('iilh llll~'l lit ilifl~rl'lll cl)llllll ll!~l (]eil(lil'(~ 11)), il Iillllilil!
I';lli(~ll
~ll~ '+[l~Ll~l" {htlll.,,~:~i)l!Gll.(t in view (If Ihl! I~o~illlt• illll?llllllillll:ll
t il)ii, hiltl I~: nlllh, i~litlil, hln,~ I i1~(~ ill ii lil111111 ii ii lll('hll i!ll ~>ll~ll t~l!l
I i?~I {mill
olhl'r ~l)l"lll~i Ill t~l~co). Illld lllllinn~ll t'llil~llilIpli(In li[ c'ilfill~,ll(~i in
illll~+Vl~liililf ~(.lirt h~l,/(~ n I!l~f) iiiirl I flT~,"
'I'AIjI.I~ V,--Allo-adju~led liillg cu,l,:uv +lulrluliiy rl,Ltos fo."
lliill~ ~ll(I f~iLlalu~, hy i~r ll.id lli~oihlo ill
I
I, •
~l,,llu,,I I H ~$ 0'1,~
~.,hlilion~l +vial+..++ for tIle l+ml~+l'a]ity of t|fi+ ~oeiatioJI im
flevelill~ hi~l+)h,gic chn.ge~ illierllletecl by nu~t piithlfiogi~[~ ~
Illl:.lidillllllrz[ le~iml~ it+ bro.ehhfl epithelium in iiitlcll greater
IjlOIllll~illll~ [h~ln n(~nslllo~l'~, l~lld [hlk| Illes~ chlllltle8 Ilrogl'~
lllWiJiiI i'llliCl~l" ill C~llllillLliZll~ l~ll]131tl/l~ btll+ rl~vei-~e ill ~-BilllJl(el'~ (~J,
I1, /.~)('l'iible 14k
The: fililll i:lilt~litln i~ lh~ (!lih0rt~llC~ nf Lli~ il~0~illlioll IJ~[w~ell
~ilildJli~ ~llld ]iilll~ ~lnll~l:r with hlil~wll I~i~ iti [h~ IJiohll~y lliiJ
lufl I~lld ili:+tlil'y ~d¸ ]liit~ ¢lllicel+. (~ltht.i i~ilc~ ill t]l~ ~lu:illtilnl lul~ hl~eli
.ol~:d wii h Ilia: I~fl hlwiilt~ Ih~l~:
Moilliflly
'l'he iilulillg ill il ilo~-li~lloli~e l't!l;ilioli~hill hi!twt!i:ll ci~il'i!ll(!
~ili,Jl(ilil[ lilid llllil~ (:~lii~r lil~)vitl~ b~ri~ill ¢:ll}il~i~li¢0 ~.ilJl l]i~ l~lllilVll
. i~li:i~ ill ihi! di~li~lJ lIi~£ii.tll~ ill¸ I h~ lii~ii~lli'l# Ill¸ l~ili~l¢~(i ¢lili~illlill-
I i~ii elti]illlyi:il 4i,~,, lilllilli~r ~fl" eJ~liri~lli:~ ~tii(llted. ilihltlltLion
lli'~icli(,t~.
lhli~iillll ~fi ~llilil~ hlg, llg~ when snloldli~ ht~li~in, llr LYl,U ill" ~il~ll el I~:~
.~i~ilil.i:d I. lllt:li~ wii~ Ii ~lli~li~liL llf ,iil;i!ii:~i~ coli~i~Li!ill wil h iII Fl~e lh~
i'i:;~l ~+li~>i: i.~liilioli~,hiI) ill ~wly ~Lildy+
~3~Jx llillol~ii(:es in Lunfl Cmlce~ Moil~ilily C(~rolalin~] Wilh .....
(hJilu~liiilidili0 l)iil~rCllCO~ ill Smoliili!l ll~JbJl~
~l~il~ :i ]i.lve hllll hill h,:i¸ hilil~ ,~lli~t:r ~h~ill h i'ill ~ I lillll l~ili~ilw, 'l~hi~J
4+Jl:ii~Iv~llllili ~iil~ i~i!i~ll ililtJl[il[~[l#d fly ~i)iiII# ~i~ (~lilil+lilllii~iory l(i lh4~
(~lli~;~il li~h~ or +iill~illhil~ ill ]illil] ¢~ilit:i,i I~ I~ lhIwusri~i", ~i ~lii't!lill
~i~lilili~ll i,~il ol¸ ~lli~i]~ hi~ li~lILel li~ illid ;illi: ~ lli'~ilii: lil(il L~il{ly (l~itli
h~i:~
:I
ICEJ kHD
FII~L ~ICB /
7-
P]{ lllll~. 9.--{,r re ililtll! I~i i,liii~ foi. llUll~ ~illll~i!l. ill 19~ii)
lilill per i:£illil~i i:Oll~linlllliOli i)l cil~ilil~lll!~i ill
19BII ill vllrlllii~ iouilll,ii,~
illllll i~ li,ii i ~ ~i
lll'°ll inlerlll'l'led liy II1°~[ obsl!l'vel'~ il~ l+lllllUll'l I~)r Ihe t!;lll~llily ill"
~llull~ illt~ ill hinl~ cllnc~r. 1 li~ hll'ii!lilly, lll~il~!.~ llel41il/ tl~ ~llll~l~ ~ in I;irlll!
lilliilhers ill Lhl# World Wilt I pelil~d, illi(I nllil!)l or Ihe in~iell~t:li
I~lllli~ ol¸ Iob~l~cll IIL~., ~ilnoll~l~ Lol~lc~:lt~+ ilil1(!14, ~lllil t!il~ll'~) iu
Oil~ilil~l te~, l+'t:xll~l ll~ b~llll |o ~llllllll~ hi llil i~l~l, lllllllht:l ~ ill)(~llL ~ll Ill
~,~
Yl~ill~ lllti~l', ill IJie Wolhl Will' II el'li (~71~)I ill Ihill. liiiil:> ii :tnllilh:r
lil'l)lit ii'l J(lll ol'l~nillles i~llllll{ i!{I (,Olllllill i~d ill ii i~1 li~:i' lllill i i
lll~ll) v¢l.i did,
I~/'nl i'ii] ]y ~lilUlii!d I'ul.¢l,I, l, it{lil,Olll:~ ilei illi,4, hili~iloll ll!~, t, lll i I t:d
I~lllPi,
in lilts, illld xvl~l'e lliOlt! Iil~ely Ill .~lliilf(i: liiwl:i. I~il, lilill liil.llllill! iulll
Iill(!l'~nl cig~ll ul h~a, 'l'li/,~e 111117r/'lU I:~ hi lililllic ilil( li~llli I.~ ill" lililh~i
£1iid
Iit^Ly CAtI^II~ •
plot I ^r ~/~~ ~ w~t~ ~ list,s has~l ~
~ I r~ ~
{~FIILI~N~ ~1 ~$ II1~1 ~ Styli #lilt ~lU a I~ ~1~ t~.l~,
•JAPAN
VI(IUI(I'I I{l.--hlh~tlmUm~d ¢l~erel~(i~n bet~c-el~
IIIllllllfll(!llll"~lJ I!il,~llrl!l~~ ~on~lllltl]~lUon I~lJf Illllll~
hi I!ttlfl while IHle ItllrlJeulni" lfr~xmr~iion lil~[l~
exlleritlg Hdull life (in f~.~ll)+ and lUrZlf emll:~r
¥;Itl~i ill lhi~it l~l,,lll!rnlioIi zl~ |t elil~.rll I~lilhlll~
Ilge (ill tim mi(l*l!PTO~ll
fel~ulle~ c~rrel~l~t well wiih tile nbsei~ed £el~ dil'fel~ee~ in lung
cllueer morf~llity rili~s, In Net, II1~ rlse in feiil~le lung ca.cer
inul hllily rnte~ oll~rved in the I~t{~ I ~lSlhl and enrly 19NN nppeuls to
lie ri!plo(lueing the llhenonmn~ llu/ud nillong nmles 20 to 3#1 yellrl
~llrller. II une subttn~/~ ~5 yenr~ frllnl the feinnle enncer death rnle.
lis iml~d i)revh)usiy hi Figure l, Ih~ rules for women nre ouiy sl}glltly
I~h~w the I'i~l ~ Igr Inch, 'l'hu~, ~lo~e ~cr~ltlny ~f tke~e tripods i'evexll~
I, I'L I: 2TOG9
,t
i(I ~llhstllnltiil difreielle~ in IIll! rlnl/'llf (invl!hll~hil~ hmlf ('liitr~'l
)r ~lll(~(,ll iIIt'll [i llll WOliI#'II, ..,
_urlg (:~rr~er Morl~lily ~t~il Cossnllorl OI ~mokirl~
~iiIc(! ~ill/ire.ll~ ~lllOlli~ is ~if~llllil,Ulllly ii~l~ilih.ll ~iih )llnl~
~11 iic(!r, il i~ h,gi~ll hi I'I lira2{ Ililil I ~,I liiilil ill" ~lllmi¢- illll ~mlhl I('illl hI
II th,l!ll!(l~l! hi Ili(llllll{l!/ ll~l(~, (rllltl Itlill4 ('ullr'l!l lllllnlll[ IIIlilhl~
Cflllillni t, tl Io 11%,1 ~(llll who ClllililllIO tn llllllll0 I'il~lil ('I I I'~I, hi 171('I. Jill
ill
the IllUjn f ~llidh!~ which #.~lllliillprl I!t'l~ll£iull Ihlltl?i I Illi~ It{'('11>llf41' iu
I ii Ill~ rll ii~e f liDh. Ihll~ I"l'U I I1 lill I f elr Ilil" I Ulljlil" llrll~llPl!l i Ve
~lil~lil'~ lill'
llreselilea ill 'l'Uble ll) [or ilhl~l rnllnn, hfil~r I.~ I~ ~II ye;ll~, Itll~ l'x
Blillll(~-~'~ ri~Ik Ill ~t~il~ I'l~llil hllll( cOllfl~r I~llilhlllll~ rlr'('ll'/l~l(>~ lu ¢I
lluill i, ~lll!llTM il, illoro i Io~ely ulllll nx ililltlel (ll~ ii~lh or i hi! noliHIlil~l¢i'r
ff;~/, .~741)~ wher~li~ fill" the conlillllin~ ~ignrelle SiIlllkl'l. IhlI hiillT
cllilcl~r rill~ iN illUre ~hllll I(I illlll,~l lh~ll rll IIm ilmi/lUlU~l!l, 'lhl,
/llli~ili i,illle (1~ I~l(. rr+~tii~l ii~k lbut I~1 tll~ll~ ~I 1 o~i I~!l i¢'lll f! i~ hu I(elY
ih~lt.l, ll%ill~ll hy (ll~ Clilltlllllf-i7I~ I~ilII1~1110 (IJ Illllli(!l:ll IIliOP Ill ~ltlllIlilll~
~uiion (i,e~ hlllil IIiIlOlln[ Ill~ hulividluil tlllnlll.d. II1',1' IlhI'n
~illink big b~lUil~' nild tl(!lgief, nf iuhilllll ion). lind vn r i~,~i wil h rllilill q'i ill
yt~ ll~I iilnl:~ flllil {hil[ ~ lUllllinlf' ll~ w,}l nt wiIh Lho I f!ll~(lll~ for Illlllll)lll
iii1(11¢1 ii~ h' I~., flllll I illt Ihl~ II) ~,~ llllll lllll~ (ll'lli~x~(l~),
Dillorences In Lllrl[l C~n¢~r ~ollalil¥ tly ~i1~ of rlo~id#rlc~ (IJihari
Versus 13urol} ' ~ ,"
hml ~{~ llxort~llil7 ll~' silo ~f re~iden~ filth:Ill 111 I'111 nil llrid Illl
qimlily of ~ ~onlnitlllilY- 1~i~hl Ill+ Ih(' ~:lrlittr ~tu(lle~ Wl'l i~ li'vh'wl"l hi
the IFJTI llo0ull uf Ilie ~tir/~l~Uli (IOll~ltll (~Tfjj ]Vhlre II!C°lil llUb}i~.
[iuli~ i ile|Udl~ "].]pll~eniiolUl!ie~l I"t~vh!w ill I,tlll~ ( ~lmt'l~l hi ~1111" { I # II
ni~l lhr. r~l~tt t~f II tn~k i~TI3llll, "Air Plllhlthlil Imd (~U/I('I!I" I'll1.
.rhl!r~ hlw~ it~ll tl, lidi(.I in |~li/~lllll(I illlll {Vnlefl (6!lh hi Ill cllUlih i(~
~lrlililn0d (~0, ~glJ. n~ well ~ Ill Ihe lhlJl~(I ~lnte~ (lol. 17(;. Ilil,
~/tL The Innjoriiy of Ilio~ ~hlrlh'~ hntl I~OUllll llmt, hill[[ CUll¢or
nloll,nlily i~l mule COlllliIOII in IllllHII th~n/lll~l 111"~t. 'l'hlg tiih~m h~
loml gri~lle~t i~ pl'iml~ril~, hll~ n°{ e~luslvel~, fnunll Illill~li/~
~lllokol'~, ~ili~e ci~,relle celt~llUlllLif)ll il ~Olleflliiy t~ll'lllel' ill III IIllli
llfelll lhlin in furlll ~r~g, i{ ifl IIillit, tllL io ih'line c(liil~lilli~t,l# wlilil
i~rlJlitlrtlun, if Illl~. uf t,h/, e~re~l hlnl~ ~lio~r limilillily tu .ily
rllwller~ ~lin b~ lIoe~lll~l~ll I~lll ll'~ IITI}l~l*l IiVll~g iilih'lllllh'lll. ~d"
~mokllq~.
One ~lilClV (1~/) ex~lnlti~ell llm fi~k of loyal'hi Cl~ll(:Plll II~ r~liffilul
al~(I I)ln~e of i'e~idll~ in 70.:177 en~(~ in Lhl! ~ [lil/~ o1" I lhlh, ~lll! I i i I ll,i ~l
~f tile (,~iurch of +lt2fllli Chli~t ill I,llll~r-I)ny ~liinl~ ll%~ml~mll~l
eOml)l~d i~ ilpio)tlnllll r~l7 70 pt.l'e~il( iff Ih~ ~1 i1 {t.'~l lilllluhithlu ill I !tTII.
q['lll~ iit eJf £ohuccII uud lih!r)hol IFI lllnhil#ih~l] by r~lll~ioll~l Ii.ri~l~, ¢illrl
il IS (hl~lllll['lil~ thul MOilUUllf Ilnv~ fl ¥¢'1~ hJw I)l'llllllfllliil of
i
nn~ n~
TABLE 12.--Epidemiolog~cnl and experimental e~rlclence for carctaogenicity of indas:rial inhalants
r
or~
2="9~
L~ a~ ~ur~/~7 ;~, :o~ ~# a~em~*
~ risk ~I l~i~ who n~:~e~ ~m~xtd
---
, r • .
!
rgl0
(10~loilln~ llirll~ eltlirt'f I)11¢0 lOliil!llno nl'llilll[), Mtlll~ Sllliil~illlf,
eOlllllZITe(I to per~oil9 wito eol]tilltle It) ~illoke ci~llreLlo~. ITow~vl,l'. ill
tile yilungest lllZll~ blrlh colllill~ 0firlh yo~l~ 1931 ]!M0 Illill |!)41
19~II), there is a slJl~l~nLi~tlly hiwer i~ilr% lltl~vlliellcl, of milulllnl~
which ~llolllCl I~iil[ irl fl I~wer IIIllg Cllll~er rnollalily ~xpl~lil!tl((!
Ii'roin tile mlloklng pl~vl~l~ll~e qlli[ll ilrlll Fil~llro 12, (lrl0 w¢)llll] f, liIH,['l
tO see thi9 declining mortnlity exr.,r iollce ill thrlsl! hil~h od.lrl~i bill ii
liner l!)~l(}, nnd/h~ dnLn in Fillull' I~ f.r 19:15 nnd II).lll birth erll.~tl~
stlgge~L tJlnt ~l d~line in niorlnlliy eXl~!riellce is i~:¢llrrllii~ 'l'hi~
trerld ce~ be vislloli~ed enrily irl Figure 16, which llhds the nl~e-
~pecific luilg enncer mort~liiy i~lle~ for 5-yenr nge gl'lillll~ over Linlo,
arid revenls tJmt kite nixie rl~tl~ for tile yotlilgt~st i1~Ir~ ~lllllllS till
apllenr to be declinillg, No RUCll IrPII(i Cirri Ill~ NeOII ill IIl~ fl!ltllllO
rlml'tniily e~l~ri~nee, rind thi.% toil, i.~ consisl~,lll, wilh Ihe ~nloking
~r~ilreil~e iJfl~ll lirtNell[e([ ill Itil~tlr~• I4+
!;Jl
Y
Fll~lJll~ 15. A~,~l~C~llic mor~aliiy r~lt~ fL~l¸ ~ jt,ll~L~,. ~r Ihd~
G&~O~TOG9
TAI~Lll 13 LLIB~ ~n~ol" nior~lity rullns fop m~lo and
!i e
\
li
|
C~
'I~AIILI'] lS.--PerccllLa~e of seeth~na with each of several
cnLegln'ies o[ hislologic ~:hange, c[nssilled
ll[2corL[illl~ [O 8[[IO1[[11,~ |lEt[t~[#"
A II A I~ 3 /) ,t S
61 r,,~ I~1 21 114 57 O5
II0 ql~
T.Inl 5~ t2 13,'1¸ HM gZ5 I011
~3 It7
Ir yl.i, .I m,,h4
~-~ (~41~ ~:llh 0 I00 2~ 2]9 GO
:)03 ,
• 1,1,,, ,,~.~,. ,,l~,,,i.,~ ~ .~. u, II. ,t ~1 ,~1,~, r~ ~,..I ,t,..ll, •~' .11 i~l,~,~,r ~ In I~
'1,,@ ~ A. ~ ,k,~,~
Service in 1973 and 1979 (~tT~, ~781 A hrief sunmmry follows, fo
c~ntra~t wilh cigarette smokers, ~11f~st pipe and ci~lr smvke~
i'¢l~rte~l Ihey did not ilnfolle the smohe, luld ~s a cDnsequenc~, the
tolal exl~s~rv ~" the lul~g to tol~acc~ ~ke w~s re[~ti~e[y fow~r.
Thcr~ was little evi(Icnce that lung c~lnccr is assnci~tcd wHh the ll~
~J[ chewing t~bacco o¢ '~snull~" ~ever~l prosp~ctlvc ~pidcmioJogi,~nl
6t~ldies have delnonstr~tetl higher tung c~llcor morta]i~ rntios for
plpe ~nd cigar snmkcrs than for nonsmvllers, but t}le risk or"
developing lung cnncer for pipe ~nd cigar smokers i~ less than for
clgnl'e~le muo]iers. 'l~b[e 1G presents a stzmmary of these prospective
~tudles. Two studies 1~4, 131) Imvc wportod (Tvb]~ 171 thnt hmg
c~ncer mortality r~lt[os for pi1~ ~nd cigar ~mokcrs e~hibitcd ii (l~se-
gS .t' l:O( 9
TAIII,E 16.--]%~orhdily raLi(~ G*r I,HIg e~nc~,¢ tit tnlth~
~UI.F(!TI[ ~nl()Ii~l~, A ~ i ~ry of llrO~p('(!(iVl!
'I'AIILI~ 17.--l,u~Ig eallcer im~t'lallly rzdios for (Ignr ~,tid
S~,~1.p[ ~l~. M,it 9 ~lily t~l~
N,,,,d • r ~[ ,I, aqh~
response refotio~lship; however, the rolatiot~shlp is :ml its s~r~mg ]~s
thllt lln{~'d for' cil.'a re(l(' Slnotlin,if
1o iil[ow llll i,xnll~71n[iorl ol'(IfkqC.l't'~l~On~(~ re[rtlilllg4]lill~ [lulw(.(!t~ iPlp,"
~lnd cigur slnc~lllng nn~l hlng C~ll~Cl't¸ II. 161. 215, 231J) An illct'(':~'(I
rlsl~ for ~[(,vt'fo[liltg fong c211111'er Clot tt.[~llell wilh 1he ~lli!l ~l~.r,~ 119(. IIF
[I~h;Ihl(i(m.
I:!l
.ll!qM -"!10ll~J ~;1!1,11onl IInl~iIl[pl!-.];h! ~,11 'LLfil Trim {F;(H u;xlh~lnll
irl ~,~li!.l ~l!ll!l.mUl '.la;llll!~ ~lliq IIl!~ il~O~ S! ~V "['i~. ol ()~ IllO~l
It/I ~.l n ~!.,I I (lO(l'l~l I ,a~l g'l ~ 1 "I
'llqqnlql ~Zlli!:~n lllnl nril~l!l ~!111 *I, LI~[ #:II +~ll~Jl!l °Ill ill ')°;llll~[I .I~l
>IZ[I +~rl!o~!p ~!111 Ill orip ~lllI~ll I~l~<l', pllll s,lSl~l ,~oII IIDG'OI oq II!~
.l~lllll)!;) JII IU*I;II~Ill I Ino(ll! I().l Oifl!~tlllllq~;I ~ll~& XU.I~JII[ .-ilrl F() .l;l;lull~
tXllll~iil)~.llul
",~1 Ill II I1~ (l~
IIIII II.llll~ll~l;l~l ;~11 pIIIlJl ~11o~.1,)11 lillllfl~ ~1 II~IIID!I.IIIIII IIl)!'ll!ln(hi(I
~lunI tlm.II ~ql~!:lp .l~l J~ei[lllZll ~/J~ !1/ ~lrll!l~*nll~l ll~!lUlVl~llU~
:DIOIU.IOIIIIII,l "~ll!l[OUl~ 4In ~[(~11 1~1~]11 ~[TIIll)!A!~)IJ! J! PaP!OATI
(171Oq D~ITI[ II~IIIKI 7(1!11!],1Oill JO;)tll!,l ~flJIIl JO 111.'J3+!12il] ~ ll1(ll
lhllltnv .S;lllll.~ [iOl!li['l mll u! ~rqi!tll [lllOtull titianp I~tll~;~ JO
~.t~llOUl~ aalnz+a%l .aoll~ul~ ~q!nu!luo~ nq:l Jo ~l~ttl v/I ll~xmhu~l~
p~l!li[~ ~tll it! ,~l!l~lJOlU ,i,~ltll~ ~llnI ,l~ $:l!lo~l~tu o111 '.l,~t^;1,~Ol [
i,
i m
6901347S3
~l+lillnll~ll~lli IIInll rZlll!;ll~t ~Olil!l !~ OI I~I ~ll!.l ~l!ln!l llllll I;~nTll!l
~.1 t!lOlil~ rlllellll~ oI flail ll?l~ rip'i! o I ll~ )l!l~.l A'I ;~%l;l~lll! ~! [hilt! ImP ill
-li!d Inll!li!li!lill! lllr~ '~nr!!lrllli~ Irl llri!ll!xnll orll '~l!!!p Iz;*!lmll~
~lI~.lll]f!~ .ill J:llliilrlll mll ~,~i ll~lIll~l!~lll ~r!) ~lll~lldx,I ~l!lOlirn
~.lliH~ I~;H!nl I
Olll lU! .l~lll!: ~hlnI jll ~llil:l .r~*ri!lll ,'ill) ~i! ~ll!~lOlll~ ~II~II!H!LI l
~lh~n[ Ol p~ll!AOlo olllo~,I n;l:nil!;i ~lrrlI .io ~ll!l It!ill ~:*llr:~!pll! r/)
~;) ll!l~ FIll!ill 1 ~lll in! oll ~l~Juni~ Imill oo.l~l~ ~Oll!n gl I! iiI n![rnn~ It!lf!;i
lhl!llllnl~ a~li~l~!:l nI mill "~in:*~o ir ,!llr~
llnll ill, ill o!jolll~ dil~t!9 11111~ ,~l!l] l)) ~tll?~Jo JOiilrl 2~jij!~,l,ii illlll ~TrlllJ
aq I JO ~lorlm)rl ~.'l .u,~<t4~I I~ oq iiI ~llr~dihi ~.amll illl~i~.i i! ~l~ pinl! 'l~;*ll!nl~l!
lllll ,flllli~Linll ~! ~uiffl!9 plni~ end!d UlO.[I ll~^!,T,'lll ~llrnil~ oilill!!lpI
~ll,I, ~l)Olil~!~ piill IgDr]!tl I~.iitTl!:l ill ~IIOiIl~l Oll~ Itl ~ril!lili;i ii~qlirJy;I
~ll!lllJgi*lirl;1 o~i?{joI ~ll!d pliil .ltl~!*~ ~l?lil I~OD~ll~l I!tlli) [lllll~ltlll.i;~ll~l
o~Otl,l, "(17E;,£" 'I~i~ "h'~l '£gl '#..G-'rF,,) ~i~npo.ld O~mll iiT i,.i.!l ~tlV.~ld~lI
~ll!lll~l!ll Jo IrO!la.iluo~uo~l ii~l!lI roll UlOlJ polJii'~J ll~xll ~1:*~.[l~ n!xoI
Im Im pO!llldn A'llllnsrl ~ll~ ~lln.lli~!~ Ipuil '~l!ll '~.l~!~ lilo i~ ~l~,l' +.lit I
J~; 1oo!]~l~!ldde ~lll .ioj o~!lll JO ~r!~lS p~^l~il~ o111 pa~n l~liul pinl 'lrl'~l*
~ll! JO ~llUlS~J roll g~inui Ol llhlu~lln lle u! p~z!p~lrputq~ o]n~ e~l!pnlr
o~alll Jo Iso|41 '~ad!d plan '~l]l~,'l!a '~llOjn~!a Um,U llOli[~lqO ~ali!~
-llapuo~* g~loul~l ~l~a~qol JO ~l!a!lOn ~!ua~!Joulnl ~h!ll!la.i o111 mn![inl~o
ol p~l~npuoa llg~I ~^nq giill!ln~!1~llu! illlUOlu!mllx~ le.ioan~
• ($,t:g "ll.I)~.!lnnj
all1 llaIl~oid(ll~ sa!JO~aln.~ ~uro~l u! 1nil1 l~n~Llell~ llla!~qoqlml
JO n~oltl uao~loq a)li!paulJalu! ol~ lmli ~O!l!lmll.loull~ imq ~lnq,i,~
Jl~'l!,~ Dllil [:,l]h| "~JO~Otllg il~lolll.¢l!~l pIll~ ~i,lo~olll~llrlll lut llllill!l ~nlrll
IIl!~ po.iT~huo~ ~ o~ll s,la~lour~ jli.'l!o plln ~l!iI JO uln!lall¥!d~ i,!~1 m~,l
mll u! ~,gtl!pu!] in~!~OlOlllnd fn ~lI~l plln n,mqulilu all.i, ~llnll,r
~1!I['~ ~"t tu~l.Ij llatU!nlqO mlo!~I la
t Ul
x.
+ ~ ~3 El
b~
I~TES/J00.0fJ0
FIGUIIE 18.--A~e-sdjusted* morl.lity rates for cRnct!r of
tile Inrynx. by race nnd sex. United .~lnies.
195~1977
]~q P~q I. tm~Y~ u*~ .qr~,l,qq~* lu t tt* ~,jdat Jtl~ .~ ~num~a nd4q[ i~b i~t ~1
fClillIl~*~ ~tlt"i'l';l~t'll frIlnl (12 II~ ft;I $,~!1" ] ~ ~ )i~ [I )~ ), whlh, Ill:ll ill
lirll*,l
(~l~rlq'J~llry. tilelC wn~ Ii ii~ltt~,lal ill i11~:ec~l~irll~ illnl~llily :~lf,i¸
1!)77 t]llll~ in I!}GI) ftll~llril~ (~tlar,e¸ Ih~tn witite nl:llc~, I~li~ ~lrl~,r~l w~
~vi~lq~ll f~Ji Illl~e ~ y~,Jli~ i~[ ~l~t~ lit illl]l,iI, ]tf~ll w~lilf, nlll~ ~l~ll.t¸
h~ ~'~11trz~t t~ IttTig C[lll~efi 1hi! .~yl!~lr ~lel.v~vl~] ~r. ¢*nltct•l~ fll qlll.
ovel¸ Llic ~l~t~t 1.5 yelt r~t. ~ Jl r~i~lt It. t he Ilend o v r.i" ~illtl, i Ji ch,~l h r~Ii.~
Ill~lTi t-lliicee¸ ~lf L~le I~tlyetx i~ ntd iin nccul.~l~e i~fll!cli~lll nl¸ t~lt,
il~t'hlence of L]lJ~ (]i~l~l~e,
tlfln ]l¢~twt,i!el ~4111ollir~ iiitiI [.liner!r" ~r [hl~ I~kl'ytll{ ()rl¢. i~t~ll(~ ~pf
~it~ll~i~l~ ('2,~)f;I con~lticlr.~l i~ i~tl.t~silf~cl~v(• SIUi]y ~[" :~,!~| i~:llil,tll~
C~tu~al ~l]~nific[tnce of Ih~ As~)cinti~tl
Mnr~ Lh~tl ~,~ retro~pccllv¢* ~ttldlOs hllvO ~xnlll~ll~.d Ihe ~[~l~r~n
clrll~iI~yel] diver ~ i~leth~l~h:lTy ~nfl hltve hccn ~lee'~rllll,~[ iel Ili[[( t ~rll
tip I~ ] !lf~ ~']'~lll~. 181 were c~lel~i~ll!llt iy ~;l~lve '2.II. ~lh~l.qllcrlt ~llt~li~,'~
~h~w ~irlliI~lr I~r~iI~lg~ I31~ ~';. 44, .~. II;~. 114. I;~ Y.~ 2t~ Y,%I, ~!ll~
~ 31~ .727). The TNC~ ~lql~ly 12,~.~71 ~lld the | ]~w~ii~ul ,%t II~ly ¢1F Five
I~lllnic f~t~ulis (II3) ]lrtv¢. Idyll lell~rL~l II Ilil~iliw! Jl!~lleiIllifll~ I)~ltll
M~rtnor~ ( I~,~. 16'G. 994] nn~] ~.venth I)uy Adve~li~t ~ I~?U) ~ll~w ~,~w
]~tlyll[~l~l ¢~llc~.t.i.iltt-~..~i~ ~i[ L~II! rip.jilt prn~]~f~cIJv{• ~ful]i~,~ h:~vc
('X~llt~inel] tit~ to]ttti(~liS[l~l~ ]~t!Lwl![!n sIIlll~clra[r IIIlll I[~tVtl~t] i!~111.i¸
L~SE~ILSI~ ~
\ .- .
1~ ~
I~ z~
$~-~
.!
/
/
/
J
'rMII,E H+.--.'++.mnmry .It remH+.+ td" r~dro+i+ectlve +ludit+s of
lollacco use llnd EtBIM!(+r of ~h4~ ]~sr~llX
. C,,.,I.~kL4 m ,, ~,lh,l: I,, ~I~ ,,~ ll,t.i,+Li i ~ + hr,,Lh ~++
'I'AI+I,E 19.--Morfalify ratios for ('nncct Of lho lur:.'zlx--
pt'i)specli*#0 ~lllll}e++
Nt0~d~g
~hN ,p Sly,h.
~r hlrynl
~CIll fog i*l
Ilno~erl
omcer e[
I~ry]~ Bpld
t~ hl.f upf~t
~les
r~ur ~rd m
'~'I'~IH,I", ~11+ Ih,lallvl' ;~:+1I ol I:lrylll!('al (!~iill'l'l h,I niah"~
lllld ~n141h,n Ity llimOUlll snitdl~ll per did'+
i.,, D+,~ NI+,+,I~., Ih.~
I ,,,,i~
K1+,1,~ fN *'l:l~
~1 Iii ~; 17;i
+iii i17
4h 41 rr44
i:~1 ~H:I
t~ ,,,:,11 ~ IN I~l
t ~l 19 44
"t i z~l 2~ 2
• II, ~ +.L,,,,+ I,, I " (,~ ~m~,..I ,r,
,(;fI+'I+gfh o/ lhe Am~o<lr+/irm
In lhe +{,lrt+l+~Clive ++tllt+iem. th++ lelative rimk or lar '~] ~,:~I ra.r+,r
(Tnld. 8}'t[tn~i++l.fi<} t 7, O in +i mludy ++I"73 U ,~ vt+leHie]m (7,111 l++ ,lli
ill +l I't+limh SI tll]~ O[ ~07 nliltt+, nd+il+lled lo rl +hrola+e d i++('n~-I+ ll~mT~+l++l
{2,++2}. Twa +.ih[.r shldi+'+l (+'P0, ,H'f~p fouud +mlmlunHal hlvH.;,~,s in
rel+tti.~t~ I +~1~ IIIIiO12~ S1'11oltt+l'm n~ (,imlp:ll'(~ll with llOli~./11<ll+el ~ ~i,++.iI~I
~,hl(li(,+ Imvm rel+rirlcd n t+tl'ol+~ dO~;t+-IIPSIK)IISE+ l('iaLiou+;h+l+ br'lwl'p+1
the ntlmber lif l~+~iir+tle~ mtmlI+'d per day lllld l;iryelJt,'nl t';+lll('l
mortality (~99, .?lfi). ']'lle mmfnlily rnti++ for Iil+d~p ;furl h,n,+dv
+i{{~lre[{e +Illt+I{erS l+roll+ one {)~ these +Lutlies (316") hie m m+lU+~ ri~+'d IW
daJ]ycom+timldionhl,rnbh+2(i ' ,,
One shldy {327} examined tlu+ hnpaet of ]nng-lerm (]llf,r c++Clll(.tl(.
U~£~+ orl }~r~llr~eO{ ~fICer r]slt+ ~l'+pr ndjtlstln(,l+t for ({tll+ll+{+ll 1~1
sitioking, inhulntiml, aml butt h.ll+l h, Lilt rellll ire rich f~,' devPl<)ld~+++
I:llyll+{t, ltl ~+'lftCpl" 'Wit+ II~C[+tlB+~(~ +11 II1+11~ all<~ r+lllll}e ii~otR OI 1liter
ci~<'ire{{++ ~itlll:it'~d I.o USeI~ or orlf+ll?rctl ei~+Irell+'+, nllh++ll+!]i 1]I+~
rimk Wnm elill +;ul+s/mltially gl'matel (]l£sli llml hw lliill:++llr+l+r'Im
(]ril:ures ~1 null ~) II e An • n C Ccr ~mJcLy :~.S-,~hlie ~hld),
t tn tlS+l aisl) sl wea I~ le~+llCl+ll r+++lt of }FITyl+~l'ril I;inrtw il+ll~lll}~
Bil1(llt{+r++ {)f 14]~'pr lilt gnd 11+c++linl~ 4:i~i~re[{~. litl~ |ills ledut:liml l'~lim
not stati~iicnlly significant.
[II I.he i n~ io+'tivc. ~i+tiTlil+~. {hn mortalily fiil.il)ll top +tllo+lPlm illlll+(.t]
inal~m nnd llriLish inale Iff;y~l~inns ('l'+dde 19i. h+ Iwo ++r Ihe
proml)~ ve stl es, mortal ty n t+scould not beaccIl/" lt~Ty rllltlddl
I+(1 br~c~ltl+l.* all the deaths ol~Ctlllell ill miHiltPl'3. ~(+V(+lill fir Ih+,+e
~n'~ml~t>cLiv+ mltid{e++ Iliwe ~xlxfittt~e(t t.~le +Lrtinl~ tl+ ip~l,itl~(! It.ltt
to ,~1 • nrtel n leretr s ¢1 vemt deMq ble~ll+
+S'l~>Hficity o[ ihe As+++eiati.n
The ]Iro+l~+clive sLiidleit have II++~lgtlrotl niolhllily d,la r<+l. ;i I:ul!r.
, m 3 '' ~, ~I+{!" l+p y )~" e ~Io4~ s o s evii]i,iH-+~l +,
t~ON F F NF F NF F NF F NF
~F3OK E A 1-10 IL--2O 21-30 31~0 411
H(;ill(b; 2l.--i|chltivc risk i)f deve]ol)lng larylix Clill(!Ct for
lll~lh:~i, by IItlll~l~t:r oie t:il~lll.l~|12~ snll~l(~.!ll [l~r
day ullll I~: ,~f filler (l") ~lll~l nonlilO}r (Nl"l
Lira iil(*lLalily I;IL]o~ of I~lrynl{(ud (?;illC4U" ilb COJll]Aitiit;OI) WiLh olLl~l
"l~,nU~rol Ilelati~msh~p t~f the Ass~eiatio~,
[9) Ih~lt u~ill~lillt:~[ the ¢~t~Lil'l'~lll:e ~lf l;Lryn[~a[ c~llct~J" i~l hli{i~lly
l~allhyH ~ f~ ]e~t~ I ~, I~. ~ I1~ t llll~olalte[~hl~n
~hiI, cd¸ lllt~ ~l~,s(.:~lli(~l~ ~ str~l~t~lhl~l~t!d hy ihthl from II~L nlollelll
ill~ IL(lll~EILoll~r~ (11, 5{~ I!)¢), ,!~2b/) A ~lU2clrllll~ I~t¸ [lll~tllLLlil~JLILIbL
~:ll;~ll~ i:i ~:~ll ill ~tryrl~!~l] [i~tl~ ~[" ~lno]~2r~; {llJ~ i~ i~oL I~lu~ld ill
? bCTOg9
III
35
B
112
,¢
NON F N# F fCF
SMOK Ei:l 1 ~r} 211
I~I(]U]~I~ 22.--Itehltive ri~k or itvvcl,,phll; I~u.yllx (:;lll(:¢!r fl~r
Irelnllles, i~y IIiLi~ibcr ¢11 ctil~ll+t Ilt:~ s~ll(llt¢~ll i]~,l,
(lily ~lllKn i1.~ ¢11' lille1- {].') llll(I Ill,ltlill/.I" {N[.')
I:i]~u'ell( s
(',dtcrl.m!e i}[ lhe Assucitlliol~
I)ose-I~esponse I~]elatioosllip
The I~lld~ng ill" iJ ltl'~(~ re~]loJl~e r~luLil~n~Jlil~ [}~lweeJi sllloJ~icq~ allq[
I~ltyllg~[I (:~ln{:~r incJd~llCt~ ~111¢i iiioltllli~y ill I'(~l¢l~;pt~(:{iV(: ~llld
of inhahltion~ Lhu liumber ol¸ y~Li~ ~inoked, ~lJ~l Ihe ~,~e at iaitJ~lil)Ji
12~;:~ 27ti), all or which supl~ort ~ dil~eL cau~nl rel~,tion~ilip,
71
'rAlll,l,] 21.--l.nrylsKc:ll ¢nncer 11] lel+iIl y rall+~s, l+y t,ili+>tviiL
8111111~i!iI
l',+l,l,IL,ti,n, i~+~,,+++l~#+i,,y ~1,~i"lily ~I~ i">p~,,,,,',~l~
IIS Vri~ i ,+if. N,~1~ib,& ~t I(II
.~11,,~# I ~J 52+4- i~l l~i I,~ 11,~,,i
3rb ~t 9~t ~i ~p,.n,rlr~
:I~I4"
(;orre(ation of Sex 10ilrerences in LarYn~lea Cancer W(Ih Different
S+nc)(cing ( lallils
],llryll~t!It( cilnct!l- i~ [+r~ttl~mln~lnLly i1 di~oase or iiili1~5, l](Lilotl<l~]l
the li~l~r i;l( J[~ [In]ling fenl~l [c+~ (lil~ (llr:r~sed ov#r tile tl+ISL 21J ~l!li rs. A
rll:ili~l~J [~nl+lle riiti~ ef 14.!):1 wns repmled in 1!)56 (312i. The s,~x
• ~ • . .
rl(I I~creis~d (~ 4>f~:Jly 197 . II ~tli el.re d s consisleill with
Iht! llll~l¸ ll~#+,lltJ+m of ci~alclte s]iloking by femtt]e~ 1271Jl [irlll
i~(issihl(! ill¢~l(![l~e [11 ~illtlle ilICll(iol ~'+lll~tlmptioll, ~iVell the s~rlcr~y
h(,L~v~:ll till! (wll ex lltiSlli+t~. Th~ ~t'e~l |(~r a]colit~l c(m~u m IJ[ioll tl In~lll~
inliles +Jill( lh~ s~rllng ~J~soci~ll.it~ll ll<.Lv*,~en i~lryil~t!lll cnnc~r lln<]
~lJctllllll c[inmlJllip[ion (sc~ (lelo,,~') life ~lm.~itlcr~d [o Coll~Fibilie I<) (lie
exc<~s~ (iF nl~Jlo (o fenlll(~ l£1 ryll~ea[ cllll~er mor|£L]iLy.
Corre(alion ol Larynge~J Cancer Merlalil¥ Amon~l PoGulatiQn~ With
Dif[evenl Tobacco Con~ulrlption
Ill sttillies of I~Jplllniions with low propoltil)ns of sinokcl's (e+g.,
~,,~l,~m,a al~(I ~eveilth Dily A~lveil(i~l+~), tile incldelice of I~tlyll~{~,l
~l~llc¢~r is 81ib~lilntittlly lower (~+3, 165. 16fL 211, 2~.)4), t;Ulll~lltin/~ '.lie
¢llU~a I i eJii[itJn~lli(i IJe[VCe~ll 51nollil~g ll¢ltl i~llyll~e~l CllliCt!l'+
Laryngeal Cancer Morla(ity and Cessa(ion ol Smoki~!)
A ~w sttld[t~ I~ve e~amined the icl~lLletmhlll [letwcen ~i~tl'etle
~,l]ll~kiilll ce~stition £~nd risk for laryligcill cuncer+ One reLro~l~t~clive
~ttl<ly ~und a mnrked re(luction in i.i~]c fo[[owln+~ c~s~itioll ~llnoil(+~
~txle~ e+tx~l ~ln~le~ (Vi~t~ 2,1 ~l~l 24~ ~l~ ~g~e~mL tll~L "10 t++ L 5
ye+ll~ Ill ces.~itiorl ~lre rerltJil'~l (N,filrt! (he IOll~-l~l'ln S]llOkel'~ i.i~k
~lppr<~:lches thnt+ of n llon~in++ker" (,+/27). In tile U+S. Vctcrnll~ +~,1~]
£&t'£TOG9
72
16 -
t9
1220
£A$~$
N
~RES~NT I ~ '4 6 7-10 11+ NOt~
SMOKER , ~ .~ ~ SMf}KEF4
FIGURE 23.--Ilelntlve rimlt <)f Ifevelt+l~i,lg larynx ,~att,',.,+ f+,r
mn]t+ (']c-Rnlll]iet.s~ hy yl..ll?'s olr !;lli(}[{ill(.r
of t]tt~ rlsk ef Cll r re~tlt 8mokP 1"$ f(~l" ]fl F.Vllg43iil PA~ It C/" r'~ IIO%VOV~I'* tlttTM 1
i'+([
was ~till rotlghly five time~ theft +ll'ilte IlOllSl]lOher If;.~. 2.~4) I|<.,-,~t,~
flIIL[I W~['~ IIoL [IF4q~pl~[~d I)y ti+e I+~)llll)er lYf y~zlrs +)li+ I:i[![II~ti('S. Ill(!
hig~er lel;~tive rie+k tx~ay he <lttc e+e I~igllet t~+rt:tt[~y r~tte~ oflrtt
~)])~(+rv~d in ['C]F]Tl~'r snlflkt!l~ {(~vl+rl ~Ol~t.LlZlt ~(] (ll CI~II~ hlllill[[ tqnll~({i,l~]
<lunlng L}+o itlil(~l yl!n n'++ of ~l~+t~l{~rs~ cess~llill~l.
SmokinEI r~f tl[~lologFc C(Int~t/cs in the Larynx
Tile reltltimlsl]ip (l['stn(ikin[I h:l(liL+l I[) llr~'l~lucel~t,m (I,si,>tl~ ,~f lh+~
wele n~)n sl+itlk~l's (/~?(J)+ Pr ccnrico r+,ta'+ ](,slims (l(y~l>hl~ill lirlrl {![Ii q'l[l(I
inn ill Aitt#) llii¢l ct~rcirlOlll,~ (ll.ctlrl(~t ]~ll:~t [IPtllit'll~ly IIIllllil~ n<lll-
smnhers (4.2 percent}. The rr[!+lt i~.tl<+y o4" these lesii~lts ilscl ,'+~ml!,l (~.<lt,I
I25 pPl~Oll[ ill tight SlTiOhl r~ (r~ 229 i)Ul.{~cn~ irl ¢ll(il)~ll][(~ ~li)l)((('l ~4
lind t+~ 47.2 I)c I'<.~ tit+ ill hertvy ~mtlkt, r+l. Similor fill Ill I I[l~ WI~ t I~ I~ln]l (e'<(
?:1
_-" ~ +
=~ l~+i---
+ ~ ~-1;~ ~ -~ ~ ~-~ ~I ~ ~¸ ~
~ ,~
~i+- ~ -~ ~ + ~--~ ~ ~ ~
I .............
II....7-
LL
tt,IJU~!~ J~ J,)llll IIU 041 ~[II Ihllll~&~lu tll p~ll~ilxa ila~ual~
• ~1 , I , ) "~alulS p~l!Up
".i,)~k~l&%lllJ '[~,),)Itpll! UO~III O^l]lJ ~JL)IILII'~ l~.][l~ "~JLi[IpOJ J~lJl~ If! ~/OLUII'I
~l,llllll)#l£1ll llil,~lJ aAl]lI ~lU~IIJ!J~III~ 111~,~4 IUJB~a,~ '~[)llJ~ .~jllll~.l!lJ~J
JiiJ ~;ljj;IJIl~J;) jlllll JOlID;)III j(~ u(l!~lJlllll~llO;)
iz ,J,l o
~v{ll)l.i
690134790
~ ;~ ~ ~ .~,: ,
,j&
!7
. .k..
-,7
'['he It('11111 I'll [es I)1 whi[~ IIIllll~ ~l!l II) !l,l y['llF~ oil II1~1~ IInI[ f~l thnsl' nl
]ell~l '15 y(,llrs I~hl were I~wer h~ 1977 Iluill in 19(~1 (Figulo 27J, I~lrL
rllil~ w~r~ ]li~]l~r lllnon{~ w]ti[~ llilll{!~ I)clw(.en }$5 lind 74 y(~lils ill
II1~', I1~ w(~il JiS ~lll(llll~ willie 1ellllll[.~ in tll4~ s~)nle Dgo ralll~c. In
('ollLlllsl.. llnlong illll~l" I}ilill w]iile llllll(~ i11 cv~ry [{}.y(~nr lll!c ~lOlilI
1rqlnl ~15 Ihrongli ~4. ns well lls nluong [eulal~ I~Lween ~15 ~n¢] (il,
nlc~l laliLy in tilese .ge groups wa~ I]I) ll~rceni {Figure 2~).
W}lcll lll~c+spocJ fJc i[(,IJ I h rill c~ I~r~ pl~lllc~l [ly CHIcnl]ll r year ~lnd lll~f~
{lei~ule~ :]9 ~nd 3{I}, II Ihree~]il~ti,ll~i,~ilal graph i~ produced, wlii[:h
czln ~u! i.:~ n~nin~ll |'~m 1~ }~ ~)77, t)r tr lull ~.lle r~el~e persl~eCl~+
~¢lll~llnl)u~ i:~ll cil n¢ol" iv the nlo~ common hi~t~l~ic~] Lyl)~ (ll" oral
C~ ccl'lllidcI ilrl~!~ ]J~ [~0I I~(~ to[ll~*~[um ~. ]he,~-yc r
Slll.Vivzil ~or c~llic(~r of lhe I]~r o1 [¸lie nlllll[ll, lonl~tle, Ol~d p}lil}yllX
rllngl!s ~ronl ~5 lo ~ ill!r¢cnt.
Nnnl~rlnl~ epidemi(llagic~l end exl~erJlnelll~l BLu(lie~ hnve e~tall-
lisilel] ~ c[l~e n~lcluLJl)n ImLiveell nrnlliling and ortll ¢~lncer. Al~h(ll
hlls llll incompleleiy undel~l~l hut inip~rlanl ~ynerglstic tale willl
I~ulisnl St~lllflcanc~ llf Ihe A~,lelnlh)n
More lllnll 25 reL~pectiv¢ sludles haw examined t.he relation-
~hJll Ii¢~[w~!(!!l slnokillg ~nll tile l]l!velopm~nt nf clllll!er of [ll~. Ol'tll
¢llviLy (2 f;!/, "~Tlil.
'l'hl~se sludies huve })een done in nulny ¢ounLries, in different
~reas, nll,I have invol'~d divers~ study Tnelhnds. AImo~L uni[arnl]y,
I ~y ~how lln n~flci~ll~Oll DeLw~n cigaretL~ ~nd ~Lhcr [~rlll~ of
f I c~o s .nit ncerofLlenalc~viynnlphary x. qie~N(~*~
sludy I~!.'!~) and the t|~wlliian ~iudy o[ Five [~lhnic G~Ulm (11,'1)
rl, l~Ol led sinlilar I]il,lings.
Si~ ill l]~ nlajl)r i~rl~l~eClive sLudies examined lile rel~Liollslllp
bcLwee sllvk~a dvra]ca cer ~lle~ I la prese ~linlalle24
S]low zl C]l)s~ ll~n(:illl i~11 Ii~lw(~n ~]nlo]cinl~ illltl oral ¢~n~r.
~l~:Jlglh of Ihe A~sc.~iati~m -
Tile relaLiw tl~$:s fo~ ~l caner ~111~ng ~m~ker~ ~ere ~l~L~al-
ly I~leilt(~r Comllzlrc~ W~l.h non~lnOk~l~ in the rcti'~]~clivo s~Ll~Jies,
~imihlriy, in the prospective sLudles, Lhe nlclrtalily rlltill~ for ctlneer
411" Ih~ or~i ciivJl.y ~lnfllll~ SinokcT9 i~lllll~(~([ fl~*lrl 1.22 ~rnolll~ Japl)ll~(~
females ~ ~ver 13 in Ihe U+S, ¥eleran~ ~n~ British |~hysi¢ian~
sLll~lies ('l'nl)]c 241.
A d~se rL~l~l~rlse ~ehliionship was noled ill muny of lhe reLr~pec-
live and I>l~isl,ecLive sLudies {'Fable 2.~) 164> 98, 120, 131, 27,~;). The
AlilerJcml (!;racer ~ocieLy 2fi~Sta~e Slildy (/'55) repol't~l a re[hil:Lhm
L
+ $-9- n_
%,
\
R~ Tt'5/ I Of~. OOf]
i
F~
,, r,
FllIUI|I~ 2?,--Age.sl)eclnc illllrlnlily rates for wlllie~ in Itll~
|Jni~ell S{l~ll.~t fl~r i!~tlt.l!r I)r the. I~lll-¢~lll ~!lll,~ly
llhis IJl'al llhnryllx
Itl
lid)
'""
tlJl iI
lul~ liJi~lil11~ in ~ ( ~L~o~i~ li~ ~lln~l~ or ~dl~kl~C~ O~ i~ILlrl¸ cil~Lr J,~ I L~
i
i
30
[9G5
1965
IrIGUII~E 30.--Age-speclfie mortnitty rates by f-year a~e
gronl)S for cancer i~f lhe bnt~cal cavlLy an{I
phnrynx for whl(e females, IJnitcd States,
195i1-1 $77
,~/iccilieitv ,¢ Ihe A~m~eiation
The prospective studi~3 htlve rcp(~elvd merLality daLa ~r a large
iluml~r ef diseases, Sis0cificil~, whirh is re]aLed Lo the nlt~gnit ul]c vf
Ihe n s.s~lr]~lLil~ n between sinohin/~' nnd orld emlcer, is evldellced by Lhe
di[Ivrencf~ in Lhc mortality rldh~ (.~lnnkcrs vel~us nensmol{ers) or
(inll ctme~r mid o~wr cAlulc~rs IAiiPel~lli~ Talal~'a A. tmt~ P,I These
TAIII,I,', 2l,--I~lorlldity rnli~)~ ft)r cancer oF tile o~al ~:nvily
Iir(milc(!{Ivt~ ~llillll,~ ..
Nur,,P~,r
CiO,n,.tl,,
SlnnJv
an.H,,.h,~a
3&IXH~ ,,,,I,~4
( ~p~Hlin~~ nn~ak,~ r,q qx~9 mal~
It ItKI t ~Z ~,,, dr. ,,ut~
t]i[~'+reIlre!l ilrl+ e'.,pll ~relll.er w~it.n elllllll+tris+lilm tll'e DI#II(, wilJl lh{+
ni[Ir LiiIiLy rll1~I)a ol" heavy ~nl~kers
Tentl*wol ltetnfitmsh~l~ o[ the As~'iutitm
Evidence for a'temimral ~ elatl~mhil~ of this n~s~clntitm i~ p~>vi, h.d
by Lhe lltesp(~Live altidies in which l)t)pulnlinil~ nf l]lllmt~.llf~y
(]iseasc-hee smokers and non,mill{eta were f~,lh;wt,d I/Vl!l" bl}l~ fill
oral canc'~r nlortt~lity. In addititm, lieu fin4ing {fl illenl~lliiTn:lnl {llal
Ill t]~{]~l i Ch~ lII{e$ in gt eat~r l~l (q ~;}t t ilm~ oI' Stltelcel s lluut lll)ll~lll{~I{ pf s
('oheretwe of the A~.~{~('i{ditm
Dose-Response Relalionship
'rile findinff nf II dosc-re~pm}m~ lelnliortldtip I.~tweeI+ ~ll)itld+l[~ Iiil{I
oral t {lllccr lllDl'{~lli{y in h{]i]i ielIo~poclivc n~id llel}~pl,q,fivc ~:hl{lie~
h'ntlfl ~:LI ppol'[ ~0 th(~ C;ItI~tt I II;ll lift! OII ]le ass{~{ ialion.
69013~95
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on~ +
i
uot~ill~UO~)
"l~" I ~,'1 IKql'lmiP OFfi 'oua.iq ttti m :1 ~l },llll-(l~ 'l~llO~,(llIllllIzooq II~!~
ii!.lllll!li3,i~J "b,IOISLUUl JO '~i!qqliJ 'J3!lU ill /~'l!AI/~l iliJ~l ~ill (I) p, qlddU
;l~l,lltl~l!+l [lllll .)llll II~ .)l~Oll~l'~l~ +llllliOJ U.I.~(1 '!OU ~U I ~.Skllll)~O{~13JIIJ
jl;i0 .jri ~lllil~ [lll(iOllll.l~li~:~o Clql JOj lallOui ll~uql/u [l~JOtill V
Ll ll~" I I ~ )11Jli¥~{)
t~il li il Ill I III i: I ..*
6901B479f
• .lilal~un ll! ~311/~u! s.iUl~n] o,'.~1 ~sal[I I[~lq~ .(q lll~!ui~ll~(li al(.l~
"(1~) ixua I1 ~cisla II~qT~:isoll u rlcllI ImlI ~u!]louls a IF~J I!~!.~ liuli I.ItlO~ln J++
()3oJJa o~.!ll~!ld!tlilm e) .lILioll J:~ 1~li!lS!p V "£1!ll J~id Go]~J i~:l!a jo ~;llti]
auo ul~l{l a~oul [mlloul~ £al(i l! O'b~ pue '/:op aall ~lllOJl?~!.) (1~ ol [(
pallotim &aql J! ~'~ 'Xl!Ull ~+a[ ~o 1[3ud II jli:ii-~uo tl.~ ~ioio~ Xoq I J! [ "C pI
11 ~!.l o~!l~[a.i n li~ll .{~p .illd llllltl31il Jo iI~OUl .io ~*~litiu} L ]~aUl ~l~;llo.l uq.~i
tllO+I as~l oll~l l~.[eUl ai!q~ ll! .io~nl~=. &l!~tl:* llllo .ll~j (7.U ~tt~l!.+l)
uo!~l~.la~u! ,e p.~lOU (6Z 1)~t+lll~ :ltta3~,l V '{IJll; 'Hll: 'I.'fl,], ~,;: '!/~.'l ~
+.~ t~) [olif).)[il Jo ill 0~1/ J.)!~l~oq U! ~l IlOillUlO.~ ~JOlil ~L~ R330 ~o3{i lt3 ill i0
a~,tte[) lll~O at>J ii~l)ti~ll~K) l>u~o liltlO~lV Jo ~lllll +l!)~i!.'iaau~.~
+ouoitl ~!illll{ J;llll!G tll !At u .'l~l~ olu 11101[~ J;Icltl ll:~ itl~tl Jo ~lliLI
~d!ll X^l~all '((ll~ '~L! "~1 "D'l:l) lt3111i~l Iil~° }o lu,~ilidlqll~,rql ;Iql pill!
~11 !~lOIIl~l J UII!:i JO od!ll lion [oqO:llll jo ~Oll ~,~il !ljluO.i ;Iql I liiOr~l ),lq till! In
'lall~ill ,~oJ 1LITiaUIiIIi!S ~'llli~!i~! ll~ I~ t~lilO ~ Ir.l~ )}S!J ~!tll +J;l~a.~lllI I
"JJllUe JO ©.'l~liqo] ~U!~*II,) JO ~]fl~l ~[IJl~lOJ pill/ ,311!111 I1! ql[lOlu
puo ~tln~ o~11 Ja s+,a~tJe~+ ,l~l] ti~!s as!l~lla~ ~a~ litl p,~ lu u I f;{j~, } Itt,Lll} I
p~¢ ~mll!l[!~% '.{aaJnN J~til+;) I,UO!~leN ll~!q.f, aql /IJ "osil IlllUU 1~1
JR/ }[N!J E;~;Ot ~ 0 Oil,l, "liOn'} SllISl103~lllqoILIOu OI ~NI I t!d LIIO~ S J;llll{!l) [IilO~
OlITIndj ~'~ UOII I I~ ~Ul~ lll,I 0 101 IlU}J U! ~1~1[~11 ! ploJ IIl(!J II IMIIII{I IIoll,} I
"lu~3~l g "(0I I,' 'l'{j~ '(~ljg 'pl:g Zllg 'gN[ N{~)l,l~ttua Ill~l llu~l ( ~lalia lltlll
NUiIl~ .3il~i lli)ON.~l~lq ~l[Iiq!l~. Illlll OlII U! l)~:lU(lO~ p.llOll~lO(I Jl) lllllIO.l~
• lliJ,Iq,I ~11111 ,~ t i
.i i ql~l i lUln*ld~,l !hl~l I~iiI ii,r .q ~iiIi~,~.
O~.l|.~dl~iLl(i jO ,~JI]lllillll~ V +~+l~ljlluiI~ O(l!lj
ill ~ .~t~l~, I I .~l~tl~'~ lllrill allj lll!lll~ ~)~l~ll.lOl~--'!t~ ;,l>lliV,I,
/yj~~ ~~ ~
~tj~ ~i~
r ~
m •
m~
. ~_~ ~ ~ w= ~ ~ ~ .m~- ~¸ ~ . ~ ~ ~ ~ = -- ~ ~
C~
d
RArEStt~,OUO
m
FIGURE 34~Agc-spce fic mort~li[y rates for whites in the
U~litvd Stales for cnl~ccr of the c~ophagus
'~ S6L.I:'P.TOG9 "!
RnT~S/IC~,0n0
--~ -311
IIIIIIIIIIIIIII
IJllllllttfilJ~
196S
.............. 90
g
IIIit1111111111111t1111111 011
7a -ATt : k,q ,,:-i- o
L975 Q 21jtl[i I~lj IJ0
iiIlilllllllllf IIIfllllffllilllllllllflll
I rr/f' +
I/lit
fl
I!)1!, I!tbb I lill fill ill *qJ
"Oll
g
fill
3fl
[}
I"llilllll'] ,1t --Agc.sI vl:irui niorliilily rille~ hy [I,y~ilr illft~
I~i'llllli~l iill" I:llllCiJl" li[ lilt t,~llllhllt~ll~ filr while
lilillc~, I]ililell Slalom, 19~11-1977
lliillll'F N,,it,,,,It'm~,,, I,, l,lUt~lfpft
II iu i~al ilnal ed I hllt ill l !18~t ill lJll! I IIIJl¢:<l .qlal I's Ui~rl! ~ill lie 14.{ifJO :
II(!w I!t I~i!>; iilill B,$11 I[) ill!ill ]1~ II I}lll [hill IIi~elise 4.~},
A illiiiiher ol clfilh!iiijol~ll~J/~lI islll] t'xta~i'Jlill!¢il;*l ~tlulil!s lil~ve
I!:ilahli:,ill:d fill li~RIcIillillll bl~iWt!~ll ~llllJllill]~ illNI leSophgl{clll I'illlCel,
t 6&l' 10f;D
IIIIIIIlllllll~
IIIIIII1~
,lfl6S
~lllllllllllll ~o
II1~
ii.Li~'.{7~,7-~:= i* I]" lJ II
l£lf~ l) 20 I,O SO
1¢1{III111{ 37,--Agc-spvciile Illilrhi[il¥ r;ites by 5-year nl~e
I~l-Otlll~ fill, ciiii{tl~l- of |[ll~ ¢!~ll]~il~ll~ilS |lit W[llil~
f~nl~llc~, Illliil~d .qlalcs, 19~0-1977
{~i~ll~all ~]gnificllnee ill the Ausociuli~m
~ltsislclll~. llf I]1¢ Assllrillli~ul
hl)~weell ~lllllk i lll~ Ilild t~l)lllllll~l:~il c[lill:e i (~1. ] {egll i>ll h!!:~i ill
lill!|lllll[
nlll~. I i.~l~ i.~li~lis WOl.e COllhJ~ll~lllly inl!rcli~et[> I)~llll Illllll the llll!jol"
lll'tl~llel!livl! ~tud[~ I'l'iiill~ ~'/] lll~l {]l:lilllli.qlraLl: eon~isle¢ll[y hi+
~l'l)ll~eil lillll[il]iLy i.~lti0~ I~)l. ill,lie ~,llillkl]i~ tls i~(lllllllll'l<ll wiih iltlll-
95
,l~uJ,~OJ 'aloul Jo sJ~a£ ~ aoJ ~lJ!~louJ~ ~lqll]llb aaIJV "salla~l~!~
11o ~ltra~ JO Jo(l[[In u a=[I ~q :t~[~/;I]1'1tJmu Ja~uua It~a~m[dosa JoJ 51)nt~
uctLI.puno~~ tft(ua|| LiLl~!~amV al(1 too.i] u~u0 ~ua~Jd ~ ~n~[~
jo i~m]w i~mjdl~sa J~ ~i~!~ a/j1 pl!q~auo lrmll~ ,~]uo pmI ~la~r~ul~
-~;~ 'snq,L 'Xla~!lm~dsa~ ~'~J i)uiJ 99( a~o;a ~o!lm~ ~u!puods~Jt,a
~ I I~,i t~t¢ Jt~t~lJ | '¢~, ¢~ ~tI~l ~Lc, ll(~tt~; ~¢a J~o~ o!~u4 ~!lu~lotlt ~t~. ~1¢I
ptn.~ Npnl~ stnualaA '~'/~ oq,L ~u! ~].ul~ ~u!)1!nb l]UU sn~itldO~a atjl
j~ .~,~a. uo .~tU s~!~ i)Ja~Ll~l pa'lO u ~a[pnl~ a^!laad~oJd atll jo Ill.la^ a~
I~,Rt~a~S Jo UO~eS~aD puv ~!ie~Jo~ ~a~UeD i~qcio~,3
"(9~g)
]~ttu ~Ju!)[Otll~ tl~)aN*]oq d!i]~tlo!|lll~J ~¢lJ~lsdJ-.~l~) Ee ~;! o
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d!qsuoll~'lOEI asuod~au-~soE]
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,+ ,,, ,~,e ik~t tl I
sll"r ,,. ~,hl
~,~!J)li~b *),'~!],Jq)d+;i)III---J).~bIIJ(lIN ](l~iOILlll /~iJ
~**;la:q,II~J ~i[l J~P .i,~.~i~iI.) +i~i ++~II,0 ,(l!lllll,qq-¸ 'II~ ~I'11!I/ I.
G90134S00
,'f,q~om9 troll ~u!lsa:l,'fils m'p [~!~°[°lS!ll oa. ola]lj 'tmjl!pim u1
'I~tLIDIll3Atl3 [~,~[Jil(JSt~ JO IJDUIdO[~AOP ~[]~ JOJ J18~.~o [(1J O.[OM ~=l.~O [ I1~
~+aJ].asuas!p +{{tu!1!u! Jo su+]tlupldod t(~ttt~ u! sa!pn1~ a^!1~o+l~oJd
ml~ ,~q pa~Joddns s] UO!lU!,~m~', S!t[1 Jo d!qsu¢~Dtt[~ ls~o:lm~,! oqJ,
"(11 pue V s~lq',l, XJlnladd V)s.[aou v~ i~'l ~la~ ,'f u[~m~s aOqlO
~o.1..= .~I [~om a I1 ~oa a aJllp ~ u~ ~lnm £, pamla +!^a sl a;~u.~
I.a~L~tldO~a puu ~u!~totus uaaca~aq uo!1~!:~o aql JO ,¢l~3!J!3ad,~
,.~!m!o.~V a,{~ J. ,q!;.Jt.~d.,¢
i;al~Ja~ uaaq os(~ smI so~i,*~u~!~ atqloo!u ix=~ a~ Jo,~+,I jo s~o~ic;t.s
~. '{gg al ]Ud~) Pal J1~u° uop ~=~&~ d[tIsuoHula~ ~¢~lio,lua~ as.p ~ 'graph
a^!l~adsoJd e~ItI aql Jo aimj n[ "P'9 Ol 8"I ulo,U p~hiu.i sa!pztl~
o^{1oadsoJcl ~i(1 re! so~lu,[ ~tlil/=mtl !sJ~lnU~s X~.,)tL ;hronitl I'[|
¢~1 ~'[ um~J paJ/u[u Sa]lmlS a^!loadsoal~ aql u[ so!lu= X1!ltqm~
"o!~"!a'ssV ;.11 Jo ~ll3uaal¢;
~W; ~x~l g~ z,q= ~ i~, ~,1w. mw.J!i~)
*lU..*lu~.) ~l~e~ m~v,ul~,N~N ~p o~ ~q~q,,,~,~,l
~1~
PI 1~9
I,I~,~LNI 1.3 4.6 /.IOII Ib161 r~)H.
F](IIIRI~ 3&--I|elatJvu z.jsk of m.lu uxs,zmk~r~ for cancer
,ff ilia C~ol)lmgu. by yuara .in¢. (]tli[li£z~
sm,ddng
(:olrchlli,~lm ol Sex Dilferences In Esoptlageat Cancel" Wilh Dilferent
!~m.ki+l!j I lahil~
i+]+~lllJll;igt:~i ~illl+~Ul. i~1 pr~t]li£11illLillLly +l di,~cilt+e uf llialub. +J~Jle ~t~x
Ilill~:n'i:lil:u:i lil~t~l'V4Jli for e~ollhill~t3al <!all(tier inol lliliLy aye CollglliLJllle
wilh Ih~ acx diil~leilces hi ~nlokiuig llliiluril~. A~ with oral aild
hilylnl~t:;ll i~;lllCt+i', U~)ll}izi~ui canlctJl¸ h~s ul~l lluuul zulaLed Lt]
t:), t:t~;+:/ivl: ilh:i+h ol +J£~ll~ll illilLioll, 'Phi++ 1il ll~,| lit) +~liil~id u i'£~ d li~
C~llll ¢ihtlL-
illlJ Iqi I]14J eK(!~+~ L'IILIO~ of m££l~ Lt) I~Lllitl+J 4~OlJlial+{~iJl ¢~llCt)r
IL.,i li, lily iscc hehJw).
Co/rulafion of Esollhaijeal Caocer Mollahly Among I~oi}ula)iol~s
WiIh I)i11(+~111 T0hacco CoN~tir~lplio[I
hi i.qll4iill.i<lll~ wil li Now proi.,<)r Iion~ (iI' ~ltl<lkt~rs (~.g>, M~ i'lil(lll8 lk i1~8
+~l:w~liIl+ I)iiy A~lvcilli+;t ~), thu illor|aliLy I llLes l~ tlin <!~l~ p h ~lb't)~ll <~illil +~l
TOS[' TOG9
r]'ABLE k~*,--Mortality ratios hit" ca*}cer of tilt. vsophtxgus in
cil~t~r Itlld pii}~ ~lll(Ikt:l'~--~ ~unllll~try o1"
i)z-lj~pective el)itleniioLolIical st~(lies
.'hl~Jk it+~ t~l*+
pl~ll {'~r Ihl~ '[~pl iiLi~.
(~ig,~,xqie
~tudy Sll~kcf Ol41y ,,.13+ t.,d cit~,,r
,,aly I*li~,~l
&l',~ 9 F~.ie .SI ULIy + I0~ ~lWi 3*J8 506
Jlriti~ll Phy#ician~ I ~ &~O 4
7tt 9~)
~.C~ ~++5 ~t L~t u ~iedy 14~1 397
nmd~ 3!w;'
U8 V~t~an~ I tt0 5¸321 I ~tl 4 <~
643
, I ~.1+.,¢. ,1~1,, t*[ or.L I..~,,~. alkd vm,i&~
Smoking and {-~isl(+logic Changes in Ihe Esophagus
I~xaminaLion n[ 12,598 hist~gogic sucLions of C~olgmgeal aU~Ol~Sy
liss.~ from 1,26£, men showed histolagic fintllr,gs which wt~l'e ~imilm"
te the td~normalities genurally accupted l~s belllg premaligrm.I in
resilir~tory t~act epithelium (16) OJlly '26 ilerc~llt el" th~ ~lidt:s horn
ctn£¢nt smoker~ exhiliited nu utyl)ical calls, cOral)arid with 935
II,I~L C~11l of ~ lid++.~ I-1"43111 tI(JHsInlJ k4215, 'lqht~ ~1 BldilL~ 4)~ (~l) i it!rl.t, ii ~ i)r
I~I(WI3
'l'li,~ esophagus is not (Ill'at (ly UXliO~ud to illhalu~l I,>J);Ic~'~+ ~ill(il~(!,
huL 'Loba(+{~o +~ll)oku ¢(Ml~[itllL'ilt~ (~t)tid&3n~g ill Ihll linl( oli~ Iil(:L)lhl'~klltt~
ill Lil~ iiil)llL[l iJ[l{~ I)hlll'~HK ~llltl ale ,~w~dlowed, tlm~ tt4)lllll(!lill~
e~Ol~i~a#'J~l calls Tile 4~{)Jlh~J~tl~J i~t~l) leCU~VtJ5 II)II['Ot3~ Clt+lll+~'l~ Jl¢ll)l
the It£1H~s hy the ciliary nluthu~i~m oz+ by ctmt~Jlh'g W[hil~h Jr; ~lJSt}
~w;illclwc(I. Vari~aLi(ms in Lieu it~halatioll (ll the SlllO]{e +ll tlilfcJ'ent[
to[)acco preJl JXLCt+~ Itl:Jy lzot. Zq~lJt e¢i~lh[y ~l~[ut' [ht~ th~gr't~l~ of t!Kpt~U] ~ O[
Lhu e~)p],+~KLIS +l'his Imsslbility is Sllgge!;l~'~] hy thC+ ]H'(I.'+JJc!t:livu ;trill
3"ULl(lSI)~cli~e t!llit[~'nli<J)+~[~it~ll ~ltlt~i~!~ which (h,ltl{ll&:flr~tle ~ill~il~ll'
I)ipc~, ~ItltL cigarettc~+ 'l'Jlese ¢l;fl;~ are llresc:l~tud Jzl ']'~iilc ~!l.
~<~Vel ill i.(~tri~SllOClive itlve:+Lig+dioti~ hilv~ I~ l~;I Illillt zl Lil(! a~lit~ii~ I ilin
lieLw~ull ~l]l~[~illl~ in VaI'iou~ ~lllll~ Ll[i(~ i.;~lit:t:r i}1 Ihu i!~(lllhlil~lis
('l'ah{e 30). Theme sLudius ~u+!~+.l Ih+fl Cil+t~r, Ifilm, am<{ cil~+uulltP
hil[ller [}ll~ll ittl ilOllSinoltel~ lill<l IliilL liLI [a Iliilcl/'ilc~s t:xi~ls I)¢Lxv/'~il
n [i~t<)li)l~il~ dlttlll~eS ill Ilia ISS.lill;Igus h~lve liu~!tl i ~ lah!ll Itl I~lll0k ill[{ ill'
cil~;In~lle~s litzll ~+tlter fl~lms <if Irnl~z('c'11 I/I;). ~verzzJ r+,LII~I~.t~(IVL~
=;ftzzJJt~:~ ~'nrzt~uc(t!d Irl th~ Itnit~l Hf+ztc~ Jmd etllez" COLITIJ.ri~s hjl,,,e
(!X~llllilteei JIB(! ~yixerlJi~lic l-r~l~ (]1" Irll~jzt,co I1~0 and ]l*,llvy ak'zlh(li
iltJltl~! ilinl ~ll~ r~it Of fliorla~Jty ~lqlnl ('allot of ~li~ esopila~ua, A[
I~'~1'~[ [~Ptlr °f [h~!Ht~ in%r~[i.~tl~iOIIS C4ttl]lliFI da~t ~)ll pipe and Cig~xr
sIli,bl[iel~ (,'~,'l, 172, 17,+1, *'/t)Tk ]1 IZl*l+e~n~ Ihot 61nnkJn~ jll ~lly I'oi-m ill
c~lmbi~l~lli<m with I~eavy IlrizlkJ~g re~ullx in e~l~cially hi~ll r/tLe~ oJ"
'J'AIII,I~ ;~(}.--l]eljzfive risk t~l' cnzli~(~r 4)1" lhe e~ol)he~tis I"()r
IllL!ll+ C()Ill])~IFJlII~ CI,l~llr, ]PIlll~, arl(I cigarette
~ml)]II~l+~ wJ[h iZOll:~nl~)kl~l,s+ A ~lll~i|li~ll*y ()l"
i~,,~ ,,,n~ ~,,~+ I,/iym, ~l ~m&i~K
• *p,,h,~ ,ml~ ~,,ly I~l ¢,ll.r ,~nl7 •
I~mla~b ............. 713 I ......... I~ 3~ .... r, i iii~
~ ~/
O ] CTOG9
,~yll4'l'~imli+' 114+I(+ <+I+ AlctlIl~ll Ir)l IC~)l)l.~+tt+aI l~++Zliii~(ll
l)t, lw(,t,iL lhe ll~t~ o[ tobacco ia IIllril)us f(>rnls+ alz-q+h+~I t'rln~Ir111111ielti'
t~ t] e cw C~l~ e of c~ ~ er +" tho e~(+l+]~ni~Iis (! I!~ l,'I~, 14,+I, ~! fl,
21,I, 21;.~t, 2!~, 307, 32,'~). Sonle hlvemli~nt~T~ rei~rt Lh[tt ~nhi1cc+~ i~ +u
mole ilnD~rlJln[ c+}rc~nr)~on tilall lIIcohoi, t)llt r+(ht~l.~ r~l~1~ tirol 11~I+
J'evetse i~ Lrize+ M~L oF the ~ttJ~Iie~ repnrL ~ ~yI1er~i~m with lht+
Cnlnhhle<] ~i~e nl" f~)})acco arz~l a]c~Jil+)I, ye~tl]|inF~ itl }lii~h~r rZllt..~ ~)f
crtTI,:~,r <~[ lh~ t'~ol+hn~u9 than wnt~]+l }~e oD~ervr~l I)y L]le n~k[~tinJi <Jr
llle l+%*vi~ e~tll(istlli!~l+ 'IIIil~ lll(.cI1nlii~tng b~+ +.~hich [he~. l.wl) ffii.l~l.Z+
in(t~l £i~I. are x+i~t kno~rn, ~It-<+hNI it~iiv [t~i. [z~ IZ ~ii]vPi1t ~ir earcitlt+l!i, llJc
h~'tll+~ca~I)otts itl the L+JI)llCC£9 ~rnr+kt~ or ITIIly nI[Pr in~rik~llz+rlt
ell *ymt~+ it~ Lhe m ucemmll ee]1~ nl'~ he e~plla~t1~ (,r~o+;}, 'I1~i~ h~+l'Ul h''sim
h~1~ l'~C~,iv(!(i SUl)~lort from exi'~,iil+l~11tzt~ o11s~rvatitlil~ (I~0), IL hIl~
llt!,~n niiLi!c],, hl)we vt+r, L}Inl ItlcilllOlism rally l>e ~ccom p~mii!tl by ++eV~l e
liIltl'j(~r~l+~li t]eficiencit!~, which itl~r) may lll+etli++llO<+e nn itltlivi,liJft] Ill
ccrlnin ~lisea~es (.~71)+
I~xperlzne+~tn] Studies
']'her~ is experimental evi+l,'t~ce that benz*~[nlpyre~ne ]~ al~le Io
pc~Ctl'~l~e th~ ce]l J~letllbr,~11~ O1" fiz~ emophel~Clll civil h~litltll, )~rl}~]uc
ink ]~npilloma+ and sqllflmOtl9 c~ll carcinr)ln~. ']']l(~e ~tllllip~ ilrlll
o(llces Itrc pre~enled irl the ]~rt, tll'+~,hin Rel)llrt ,~n tnecJ+[lai~llle~ Ill
eat cimll+eltesis.
I. (, gnrelte stool ~ s a n n i~r CnLise of+ ~Ol~lln~etlI cnl~4~er ill 11<!
United ,Statem. (3ignr ~ln(I I+ilne smokerm experiellce a risk of
('soi)~mlTenl cnncer F~llllir a r hi ~.~IIIL 1)~ cigarette emoher~
~. Tile risk nr esophageal cl~tlcor Jncl'e~s~5 with increllm(!ll mtlol[~
exlmsure, a~ measure+~ by the mumber ~1" ci,gnreLtes sm~ke~l
daily, und i~ diminlslled I)y discentinuil~g the hi,bit.
3, '['he use ~f alcohol in eoml~ini~lion with ~m~king n¢l~ ey nerffi~ll-
early LO ~really inc+en~e t]iPe risk for eS<lllha~ezll czattc~'r
In<~ t+llily+
Cancer of the Urinary Dle~fder
|n{~'olhl(,t i(nl
]t i~ estimnte~] LhrzL ill ]91t2 it1 Lhe Unil('~l ~lnLe~ Ihere will he
37,11)0 new eases ~n+l |(),60I) ileolh~ from ~mcer hi" the I)h~rkl~r (2).
The I~VI!T~II~r~ fltmulli ~TI¢i(I~IIC~ I"C11" maae~ is i~lmr~l, Ihre~b [im+,~ Iil11[
Ir~l •
10o
I
1
O~
I
RnI£S/100,~00
a:
~E
~2
FI~UI;ti~ 40.--Age-specific mortnlity rates for whites in (],e
UnJled State~ for cancer of the b~nddcr n11d
~Lher urlnnry g]onils
t'OSF~'TO(;9 ' "~ : = ' ' :'
IOI
d
.-~ ---: ..... ~. ~ _
~II[S~ I[Io ,ono
F[t~Lll{l] 4f,--Age-$peclfie nmrlnH|y rate~ for nollwliltea 1,1
/he IU.ILed ~t.les for cancer ~ff the hhidder
a~ad other tlrinnry [~]nnds
H~5
CD
~D
~ ¢ . ~
- ~
-N ~ -.
TABLE 3I.--Revlew of ]iterature on smoking and bIadder cancer reported since 1963--re~rospec~:ive
studies
A~ 19:2~T~ ~a~m ~¢ al IY41
334
l--~ I~%
:~t~
750 ~.L~¢ ~i~n~
I
'I'&IILE +J~--l]hllhl~r Cll~iCl~¢ la++~rlllliLy rt+lJ~--llrt~Ul~Iv++
Aa
w+,,,.J
Aq~
M+I,+ La~ 2ca
......... ',%
+++~i+++J + • ~r+++
&O~T069
+i.+, i~, ,4
-- m'm+++ -- k++'m~+
;Ifld III II~fll'l:livl, H~Ill lil,~ ( ~-1~ ;ItlIIVI? ~ HI I I'111~1 ht.ll~ lilt' I!11] I1! I
t,llCiI Ill LII(~
Correlation O| Sex 1Oif)erences In BlaiIf)er Cancer With Oif)ererf)
Smo~ing tlnbils
']'we inv(.slif~nlets (l~h'~ Ill.5). rolmtt]ng If) years =f)mrf.. follnd I~11
II:~'~¢R:i~IIfoll h(!lw(,elI 1~111e tr~lldS Jn mll(d(illl~ Ii~ltl(!rll~l iii1(~ I~h]dlJ~!l.
c[uH'gr lUl~ehllily =llnoll~T [)olh I]lll](~ NIt(I f(~llllll~S E~tf']l [OUl)[] =1ll
illCl'lfasilll~ li~,~ (li bl=ll~ilet callc(~r wit It il)cl.cllsirl~ 51ll[l~It~ eXlll)~;tll(=.
Correlntiopl of Rladder Cancer Amo=~f) Populalion$ Wilh Dillererd
Toha c*;o Corlslnnllliorp
(~ohl, rcnce el` the n~it~Lion i~ also illustruIcd hy Ihltn ~¢howil=~ ~
hlw r~l-Cv++r(,nc++ or this disguise in E;<ml~ with Snl~ll] iir<)l)orlion~ of
snlolcets 4~ K* l~l~rlnerim ~tl(I ~eventh J)ny A(IventisLm} (79. /+15. /(;f;.
21I. 2!It),
l]ladcfor C~tncer Morlalily and Cessnlion el Smoking
~;tlilll] (if ~lnllllir=~ i]ecrea.~e=~ t]l~ ri~ n| bl~ldl]er Cftl~c~r cllli~-
~1111l~11 [¢) |hilt ill" ~(~n|hlllinf~ ~mo~er~. A 51.Uq~ of n)N[e ~x=sllt~k~rs
(l~) f()l~ml :* risk I~f I~ Lima nne-hnll` tha~ of c~lntinuili~ ~n~okers l~
~.eal~ IiIh~r qllillill~ ~mokillg; *'~ sillo[;ir ff)]dinff w~s observed Jl| Lwo
~1¸ Lira =11~ljor l~l ~p~ct ive ~lud ie~ (GS..~ZI].
Ilhllhter C~tnc~r ~md Niin-Cil~arctte 'l'ob~cco ~se
'rw~l i)rosl~c(ive 8tudir~ h~ve no[e(I a relationship between pipe
~111~1 eil~=U¸ ~uml~iil~ nnd cune~r ~f |be hhulrler (~.~. 131~. It= tbe |hili~h
I~hy~i~'i=ll~s ~tmly. a nmtto[ity rl~lio of 1.5 w~s ol~served for lira
c¢lmhf)l(.d ~al4.~l)ry i)f i~ipe/ciK.qr ~nm]¢~r~. w]]er~]s ill Ihe [l~.
Vcll!~l=~ ~Li]dy. ~ i~l.~ti¢ln~hilI wlJs holed only for pi£e ~rrl~keT~
(ralil~ 1 .~1)1.
~yl~orl.~istic I~:ole of Olher Stthst~nces for [¢lndder Cnne~r
The I'~]uti~nsllip I~tween eil~Jrellc ~moking and occul,~ti~mul
~XltO~llre(~) is c~Jiiil~[e.~ nlld hzl~ not been cle.r~rly ~hlcid~](~.d. A
iiiiiiib~r of e~lr~ill~oDs ~ll~¢il~c f[)r t]l(~ huin~n rlhl]der have ]~t~l!ll
iqh~ntilfo~l (45). Some o.r thee eol~ll)Ol]llcls are fouled in ci.~lrell~
BII1D]II! ill very few C(]llCOl~r~d.iiin~ (~i~r~t~t~ ~l)taki~ pro~lo[1]y lJt.t~
• ~s ~11~ in~hq~elld~nt agent in th~ d~velollnlen~ of bladder cnn~'cr;
h4~weverb the=~ ]r~y ~lso be ~dd~tlve or ~ynm~isHc inlernction~
I ~'(.weci~ cig~ll~tte 81ziiikin~ ;1nil ~llb~( ~111c~$ ii~e]lt i]1 Lhe work I~r Ite~.
'l'ho~;e who work wiLh dy~ slul~, io[~her, leo|her, print, lmirll.
I~r~Jleu~l~. and o[h~r organic ¢lle~tlic~=ls are a~ higher risk for
bla¢]l~or cancer I.~tn workers no[ ~xl~l~cl.
1,
Coneh~hm
] • ( ~il[llr~!t(l! ~nlllkilt ! i~ Ii cl~lll i'i]~l~r y r=~cl~r in I h~" qh,vi~h q.ll(,llt
O[ ldnl]de~ czlr~l.i¸ hi I lu. I hlih!d ~L=tll,~. 'J'his If~hd i~r~hill i~ n~t
it~ ~lrlllll~ a~ Ifo~t n~ph~t for Ihl! Iis~l~l!i~llil~l] I~,lwi.l!=l ~lll~ll~irll~
i1~1ql ctllicel 5 ol¸ Iht. hllll~, ]Iii V*lX. I~rn] c~lvity, alibi (.~qd.ll~l~. 'lfo,
I~'llll r'l'~lnhihiihtry lil('l~lr" hv nil n,'~ln~ exchld~,~ the, i~l~ihill
t~ q~l`a ¢n u~l role for ~..dlin~ ill i~ulct,e~ ~d Ihi~ ~ift,
C~ncer el the Kidney
|nlr4,h=l~tllm
Ove~ the i..ri~l 1!)5() 1!)77. |be iq~e adju~ied mt. lMily r~=l~ lill-
k~]ll~!y c~ rl(:(.r i.l~ l`r f~l~l 2.2 I~ ~ Th~ Iiiinl]aP iiiii1~]1~!1¸ id dl.lll h~ ~foe
1it ¢!nrll!er ~f thl~ I~idncy ince(.a~l.d from ;[,(;.~;I tl~ 7dl~:~ II i~ i.~lil=l~]l~.~l
IImL in 1~8~ Lher~ will be IH,I(X) i~ew eflse~ nml H.;III(I d~.~dlm ~fo~. I.
k[dnf!y ~ln(I iiIhcr thin~ly Ir~=~'l ~lll]~rs ie] Lhl! lIililt~ll HI~]I~ folhvr
I hill1 Iir=l¢l~ler carleer) (2L
Th~ d~!;ith rate o| whit~ nmhm wa~ hi~her (h~n |hilt ;~1- Ihl. I~lllel¸
LI]J~'n e(Ihlr-~.~: ~lOlf)~ (I~i~lul! 45) While al~el~,liu~t!(l ~r(l:lfh In~l.~
[hrnll~hollL L]li~ pe~[o[], r~lte.~ aln¢~lll! ill her t hi1 =1 W]lf)~ Iit~l[~.~ at.I tl;l[]v
deel e~sed ~li~hlly nfl~r 1!11;7./'~ m~,l~ w hit ~ lem~lh.s, the ~l~e mliu~h.il
]'z]t~ illCl-(.ns~'d Ii~tw~c-ii If)~(I =111~1 If)~7, whl!n it ~l~ll~ilizf.~l Amcml~
¢1111o1' Ifoln while fon~nle~, who had Lhe 1owes| i~l~e i=llill~h.iI e~lh! q~[
~le~l|h l`lXJm Ihi~ disen~;e, mclllnlitv ~;~l~ l`~)m 1~2 Ii) I/I i~/~l¸ IIII1.11111~
TEl t]tl! while ii=q~lllutiiin. Ih~! ml~rltllily ~ rMh~ (1111111./1~1]~=11(.~
ir~:r~.~.d ~m 1.75 in 1 f)511 Io ~'24 ill 1977, relh.clinl; the rise irl Ih¢.
m~lh! ~ll!nth rIIl~ ~ld the lelativ~ slubit]ty or the f~l]mh! r=~l~. In |hi.
othur th~ln white ilolmhllilm~. Ihl! nlt~rtnlily ~ex rlllln w~q ~lit~hlly
fewer du ri~R Ibe ~H:y~a r i~el irl~l.
Whit~ males ~nd white ~lJ~les were n~ ~re~ller ~i~h from Ihi~
i]iFen:~e Ihall w£.r~ |[Hq¢ cllllnl(!11~lrl~, nf)fo~ll~h ~]~ while to ~l[ler-
I bel~-while di~erentlal nol rq~w~ll Ihroui~houL the ~tu~ly p~r i~l~l, lu MI
fotlr t'~fllr.~x f)rolJiis, dea(h r~tle~ ii~ov[.d I~l!n~r~]ly upward ill Ifo.
IlllTiilh~tion Iir!Lwc~n 45 nlltl ~4 yeor~ of n~e (l'~iKtll('~ 4(~ ~lllll ~'/!. In
1!)77. I~oth while mt~l o[hcr than whlh~ m~l~ I~(I hi~her ih.=d h rnh.~
from Ihi~ di~e~e Ihnlt did while ~nll f~t~l~r th~ln whilr, fom~f)~s hi Ihl.
[()-y(!llr¸ a[~ ~rol]ll [l~llt i *~ Ii~ .1~.
The ~t~e-~pec[~e iI~ii(h r;ll~.~ for calliper of Ih~ khfo~y ~]l¢~lv Iin
Illlwat~J |i-el~tl ir~ t[t~ o](]er i1~ ~roul]~, wilhoo[ ii sil~llJllclln[ inc.l~l!~.
in lh~ r~ll(.~ for (]~ yolrl~.~c.J, i~l! I~rolf)l$ when p]!)ll~.(] Iin ii Ihl~.~.
~liln e~ii~n~] grnph for the I~m i~l l.t)Sf~1977 (leil~l~r*.~ 4~ and 4!1)¸
There are fo~lr primal3' hi~l~fl~l~ieM types of kldn~'y cmu.~.r: fll
i~lln[ c[q] ellrcil~onlll. (~) rleIthlol/ltl~;tllnl~t ~W~hn~ [111111)1.), (~l~ ~lr(!~).
TI:I
~S~E
~ ~Z,~=*L ~
- . I~
=.
C~
C~
G~
nRIEe/l~.n0u
I!lIT [II f I llO ,000
FIGUIH~ 47.--Agc-spvclfic mortality tales for norlwhltes in
the Unilc, d States for cimcer of the kidney
0 t I 17 0G9
Ill;
II R II
- -- i ......
ilillllirtfllllt
illlllllllllll)/I~
1965
I !1(;5
,,
111111111111111
I qG!~
lJ1
1111111111111111111111111
2t~i Jlj 7 /s'I/~
I~1/') () ~'11 III) Ilfl
ilrlllllllllllllllllllllll
~Jkl J I~1i] I I I i r:ll i i i i i r iI ii r
FIGURE 4$.--Al~e*spcciflc illorl~lltiy rates lly 5-ycllr hi21'
grillIil~ rot Cllll(!er ol Ihe Jcidney lilt ~llill,
Inale~, Unlicll Slilles, 1950-1~77
till
17
l
~'fl
u
I~N
'111 !~
l,I
>>
,'IF ~<
inu, niifl (4) epithelil~] I.UillOrS uf the l~!illll pelvis ll,,il:ll ~'~,11
cllrcinolnll~ ~)rilpr~ ohollt !Ill llClc(!nt cl~ llidncy tllllllll~ llll~l
generally ~llT~ct indiviehla]~ ~flcr¸ flgc 41) (live rlq~e 55 hi IiIII ( I~7i. Thi~
Ltllnor il)ny h~ ~il~nt lintel I~lr llllvnncclJ *l'h~ nlcllilill ~lllvlvlll 1trill!
for Jliilllcy rnrlcer in the lid(ilL i~ llhlnlt ~.7 yellr~ Gir Ih~ ngl~l ~1~ I~
54 nt the tlme of divgnc~is [~nd I year ~r Ilillsc G5 ~r ~h~[~r 1197L
IT?
IIIIIlltllllllll/
tl
I !lb!,
L tits5
ill
?l]
I(J
0
;l(I
IiiIIIIIIIIIlllt rlllllllllllHIIllllllllf ;,il~
I!J /~J i}]h% '~
, li
I JllJ i I1(I I,II ill
I
I"IGIIIII'I I!l,--~l.l~u Slieei/fo mm'lalily I'lll~ I~y g.yl!lll, lll~l!
Ill'OIIJb~ fOIr (~IUlI:~I" (if Ihll kidlll!'*, fdlI, Whill!
I~:mnle~. lhitled NIides. IIIg(I-J!)77
~ll dill I: il41H.,ql I ~,II, i I. fdmil a i~l~P
I",lli~h~lniollpitieill .';hiilii!~ lulv~ i~Jhdlli~illetl nrl ll~}l:illliml l.!lwel~n
IHt~;LI I~1 le sliillh iBil~ lltid kilhl~y eiliBi;lll"
~llll!Jlll ~;ll[atlfit!ltnel~ Of Ihu ~.N~ol:iillioli
~'-m;~Mem'v, ,~t~.ligfll. i.id ,%~.i'i/iritl. ,~/" tile As,ir~l'i.ti~el
~il!x'lllll Ii~ltll!~pl:l:ilvl! MillJies IlZlV~ i!gillllirl(!ll II1.~ I'¢!ldlliOll~llill ,
I,~lwiu~n l;llillJ~inl~ llil*l hilhle~' ciiitilltJiiiil Iililn filiJU Ihe!le ~lll41iea ~*
,I
('l~iilile 34) ~lsow u llo..;ililtl! ll~.%iicinlion between tllillil~illl{ ilnit ki(Itiey
eilll('~r wil]l lel~llve li~k~ I';inl~hill fl(nn 1.(111 telovor fl, wilh ~lle I~hl~iy
~ll" n~211111 llelvi~ emicer rep(inlhil~ I] leiil~)hl risk for ]10~ivy eilJnleLLe
~nllllt(~rII. ()lher l~ll]llie~l llll~o rl!llrlrl~ll llii inc']'eiJ~inl.~ i-t!]llljve ri~ll lit
leilnl lltl~llOClll'Cillfinlll ilnll i!llncl:r Of {lll~ relllLI I~iv]~ irl cil~Ulel(e
~llil)llul~ {20, 21, 13fJ, 23t~1; llie incrense of lelnlivu iislt +if i'eilnl
Ilfiqlll*ll/CillOlll£1 IllllOlill 12il~illl!lLI3 I~lllilhel'a ....ll:l I'lillilil [fir lll}lh
iiiIiIif~i
lilld rl!iiliilr~ (770i. dli ~il~rlilh:nlit Illl~itivlJ li~O(!ilili(lll hoL'~.el~li I:ilf~i
I olin ~lnokinlf [ilid ri.nal 1211111!l~l. Wll~ llOtell ill Ill0 *1'i'1(~ ~liilly (J~!l!JJ
mad hi Ihe I h]wniiiin Sillily ill I"ive 141hnlc (I I'mips (H.Ti.
hi illO~t of tile lil'~llective ~hlilie~. ezln~er ill tile ]li,lni!y ll2i~l!l~ ill
hlnltlrtl ol'i~hig from tile I t~li;il ]lllll~ll*2h~lllll ll~l wl~]l let Ill Illllll)lZl hi
Ihe I'Olilll ll(dvi~ lilil] Ilrell!l. lu ~v~riiJ of tile iilllle lillnlili(~ilivl.
:~lihliO~i (Tlible~3.1). Illl iI~lit'hlliOli Wll~i I'liilllil Iit![lvelm I.ill;ll+{:Lll]
blllflkilll{ llll(I clillci.r lit Ihe liilhll!7. 'I'll/. lllmlnlily rllti~l~ lin all
Cil~lili'Ill~ tlnlol[el:~ vill'ied hlini 19ll Ifi ilhlli~:iL :1. C~llllinlell wilh
IlOll~lllltlier~. F'~ur ~f tile llliliilil!t'livo ~tlnille~ hurt. illlll!d li ill):;l~-
I't'~illllll~O l<ol~LiOll~llil) ll~ lllell~llliql Ily tim nillllhl:l' Ill t'il(illl~lll'~
~lllol( I~d llOl" liii~ $'l)r llilhley I~llllilll" {(~, I (J~, ~l, L~!Tfl) J)alil [i (iliA Ilit!~l~
~Llitlie~ tire ]ill]l!llli!(I in Tlllile ~h~ (ien~i'nli3t. hiJ;iv.7 i~lilOllel~ hilve
in(~l llllily rnlios il.~o Io till.el! Iilili.~i i~ri211ter Lhllll illllltqllollt~li~. Ill the
I I.~. Vel~21"ll II;~ ~Liitl)'. ] fol~'o t llllll ~ i i i'¥Zl~ ob~el veil 11 dei lille ill I{
iliiley
t'illlCl~l" niOlllillLy illllOnlf i~x.12il~iil t!l.le ~illiOlll!l~ wilh II IIIlillillill~ I'iil ill
ii~ |.~{ ] vel'~ll~ |.4 1 for i~Olltillll i Iiif i~iliilll el ~i "'l'lluv> I hi. ~1 i.l!lll. I h o(
I ]itJ
ii~ociflLioll of cil(llle[le ~;nilokillll ll:hlh~ll Io kilhiey I!llllr(!l Ii~k i~ li'~
nlll Iil i'll I folil thnL for I!lllll!l~l Ill I lie I)111t!r ~ill~ I li~cll~l~tl llllilvt%
(]lieinieiil I.leilivn 1 ~ ~illch ll~ Io~ill illlll I'ildlililllil. hrll Ilil fill.h, illn
iziinlt
I'ndiiilion. Ilent~lie ml!leelllillilili~m, il~i well ;l~ lllhil¢lll hlillikl~ foivl'
i.[icil I)t!l!ll BIl~t~12~tlltl li~ 19oh:niliill i'li+Jfol~iC foilllilVl ill Itli~ tliilt!ii~i~
(<'J]?Lil. ~t!Vel'lil sLIIdi~ ('~/. 7J22. I.'tl}. ~l.#) nllive lill(lWll llilii li ~llli!ilillll.t!
llli.~>/.llL ill I(llilil!l:o ~llllilH2. (lilni!ihyhlilrcl!illlllilll!. (2litl~t.vl llidlley
I IIIillll ~ in lidS.
"#l',limr#d Ilel(dioll~lllp
Till! lll{ISlieeti'#l) ~tililies i)i'llViilt~ !;illllUill. fol tin/. lellll.ll;ll I~!l~nlillli
i~hillolLll~lls~lll!hltilul.
(~lllll!ri'//rl.' (if file A~.iiu,ifllil~lt
I}(l~o-rleSpOllSO PlelationshiI)
~l'lLtt (le~e-rl!~ll(Inse i~!llnlilinl~hill nt)le(I in folnr ill¸ Ihe lU'(i~[~clive
zlLulfo..,i lelili~i ~LlllltorL I~i Lhl~ ~!~lhel~!nce d~l" LliiJ li:~iol:i;nLillli i~l~lwl~ll
~lnllll~ ~lll~ iill(I ellll(!er (If Ili(~ ili~ hl~3*"
TAI+I,I¢ +ll.--](id.t~y eltn,++p moth+liLy, rliliom told reli,~l-~i+
ri~l+m, proml+c,~live 111111 ~+l~l!/~t] re/ro+pe+li+~
~ludiPs
N,pmlm.r m+ ~r"f~r'hU< rM4+., ~,
~'llt+ll,ll HII, 81.Jr ~i~ ,1~.1.~ N+,~, 4'~r tlr
I3~,+l,~nr B
t.l~ 9 ~llipp
~'+Lly
Vr il.r,,pm
I~*llh,,,,i~
~h+l~h
I,r t~l.1 liW t+l,Mi,
I~? AK~ 65 "El
~.~GI ~1 I I~1 I 2.1
Cortelalion of Sex Differences in I(Idney Cancer Wilh Differenl
Sme~intr I labils
'l']~eP~ htls I~,en nt~ Jncreose ~11 Hie whi~e male to ¢e~mle raf~io of
112+ ~J,14,rr,p~
I+~p
~i~++,~ III ~,~i
efl~+~l+ lip lhe li~i,er itlitinl+iorl ef mlilolIil+l~ fly l~+lluih,++ ~i~ lwld(.nri.,i m<i
l'le+~rly by tll~" rP~en~ incret3~i!~ ill ~!l]ItlllJ Itil~i! ilt1~l fnr~l]i!i.;ll i!~llll t,i'
Difre~lit Tob~l~0o ~on~ompliorl
*I']le r~lll~i~e ri~+~ of k hlt]ey em1~i+r i~ r elhi~t'<f ~n p<llll11~t ~tm~ wlil+ l+
h~w plopm+tiot~ of ~mol~¢i~ (~L 16,5, ll~l~ 211, ~J. l~llho~il~h lhi~
reltllt~[ioll 18 not ~s ~l~II~ ~I~ lhl~ i)~l~+(.l.vt'~ Iol¸ Itllif~, l~llyr1~,
8mokir~l ~rv3 }ttsl~o~31~ Ch~t~s ~n tl~+ Kidney
No htJmnn mitope~y sf, tid]e~ hnve been ptil)l}sll+++] which exnmil~e
hi~olol~C (']lllll~t~ ~n the] k~[lllO~' IIn~Olll~ ~ll~Ok(,l~ COl]lll;ir't'd Ill
iioll~rllok~Pr~+
I73
ammmmm
-w4ug
~" ~,~ a~, ~;~ .... ~ ~-
Q~
q.
~J rJ
'a
FIGUII~ 51.--Age-specil)c mortality rates [or whites iJl thu
IJllihr(I S~aLes for cufJccr of ~h~ |)a]ll!reas
I,~1
~Z
rr
&
I1(I
I)
il) IlO
12()
ill)
, , , . .
I |(,l+lll fi.l.--AgC.~llV,jlflc m4ji.imilily ralw ]ly 5-yclu, al+(+
I~l'llllll~ ~(ll" ~illl<!++l" tl~ lilt: ll~lliCt+t+ilm I'dll+ whil~
lii~llcm, IJllilvll ~lllle~, I1154~-1~77
~itiJ+t i rd,++,~,J4",,+,, i,,~+i+,+l~ll++b
tlllllll)~ wIIhlllil mllllii~iCillll illCll+ii~l!!l ill thu I'ti|l!tl <)f lhu yflllill~i,i, lit{lJ
II I'illl li~+' il~ l:i i+~illil Y ~illll~l I!l IS whltll iiill! ~ll~il'i+' clciil h i'iil ~ liil
Willie
Iglih+~lilzd il~lliiill!t+ill'¢~ lllllll~(l(jllla lillc(!iilll~ ~+lil itll, l~apIi(J,'il~Lli.i<~
+rill iill~l fil)
' I l~ CI C II ii+ t~l~llCllilly Ilii<h!ll!clt~lJ IlntJl hilt iri i1~
< 4iill .~l~l Ihll! Ill llil ril!lillil~. Jil tlJ~i~ nll~i~ illld Ilil~ illlll~lll~cii iis ill ii
ill,l~ iiI"
IJliJ lllt+~>i~lll[lill ~llillllllll~ I~l~lll~l;l~i~ Illl~lll~ ICJilliV~ly /+lilly ill lill!
'~lll
........ I:+(I
IIIIIIIIIIIII II11~
I~J~J t IJ(J ~i iil~l 61[I 1 ~i'~' IIII II11 ~17']
I ,:(I
"r2Ijlllllllrllllllll\ IIII '~+
,lllllllllllll till I~
rlI !J 7'J I !lt+b llt+~++l,+ li
iII~ill I11) f+tl llll
'~11
I"I(ILIllI+ ,~,l,--Agc-~lleclfit: illiil'lillil~] Iriitt!s lly 5-ylflll" lilac
i~l'llllil~, fill' Cillll~t~l< ill" Lilt+ I~illll<l+ClIP+ l'<~l' %.+,lille
fclilllh~s, |Jnlh~<l ~tlllc~ 19~4i-1!~77
cllul ~ illP Ihi~ d J~l~l~l~, chill i'illt II illb~ l+l Ilil: lit Hli¸ ~l yi~ll I" ~lll viviii
i+illl! ill
2 II~r<~cllt I I!111 ~lld ii llltJ~iri ~,l~i ~iv~il Iiill~ illLvl+ i[i~igllo~i~ ill¸ ll~.'+ t hllri
(~ llillllth~ (~#l~rl> 'l'ht~ lilll~ii lllllilllllll Itiinl ill¸ li~lnl:ll:iiLic I:iLlll:l~l" i~J
iill(~ll(ICilll~ill()lilil+ |l£111Cl~Llli¢ I'llliCl~l i~ llil~l'O C~llllllitlll llllll)ll~ Ill(~ll
Ihliil ~llll(~lll~ wonll~ll itx Ihl! ~Jnill!ll ~l~zill~, I~lll. I}ll~ illilh! ill ll~llllllc
i.illJll hil~ ll,t~i~n llt~l.cil~illl~ ~ill!~llllly rl.lllll 1(~1 illllinl4 llll~ lil~ii(lll ~ll"
I!ll<) I!)1!) I(i 1¸2;I +~llilllllt~l in I~)l~<l (~7~1.
~CV(,tOI Vll~[l{!IrliOl(ig]<:H] ~GLu(li(,F] }iHVl, (,~;il)l]~]t(*ll Ufl ti~;q;~'iit[i41Jl
~tw~.'~ll ci[~;li'et~e Slli(,kill/~ tlnla IllitIcleliTie enllcep. ,
Cmlm~I ,~Ignifienn~e of the A~mlehdinn
~bnsi~lr,.T, ~'O¢,ngUt, arm SIJeri~e, ty of the A~.~neiation
#. fntxubt!v of ££,[ i (~ll{!t!Liv~ ~,~th [ie~ 4ttJ vt~ e:{tllff [ited tile r~'[lt~Olt~h [11
I~!twl~lt ~;n.l~ting JlmJ pmtcrentk" caJ,ccL I,t Ihe 'l']lirl~ l'~aliolilt[
L'.nee, S,IIvey 1299) .mi iJt Lira Ihlwlziiml Study Iff Pive ]~th.ic
Gtotlpa (113). Ihf.re wn~ l, ~iKuificnn¢. 0o~itiv~ relatlo.Bhil, Jletwoon
81ltoking tlnli F~a i1crt.~ t ~c cztnrer./~ltl t.zlr[ier reLl'os|~octlvo cllso con t i'ol
MIl[iy eft .ql cttxes of p/UlCl~l][i¢ cnncer (3/~0} found . do~e-rospol~e
reh~lion~hil~ with a relative risk of .~o for males ~mokinv: more than
Lwo packs of eigure~te~ per duy (l'~g.re 651. A recent report found a
imsidvo a~oei~tlo, fnr both malc~ nnd [t!t.loJe~ who [lat~ ever mnokcd
and cltllcer oF tim pnncren~ (r~Intiw ri~k .f J.4L but not for pilm m"
e/gi,r .smohe]s. 'l'l~'y nlso xe[rOl'~ed a ~i~dficauL de.se-r~poime le)n-
(in.shil~ flit I~!inolt~s. A ~imilnr but ~ot M~nifieant dose-respo.~e
reh,Lion~hip wa~ no~ed ~or mM~ (Iggl.
~everM of the Imge pre~l~etive inv~ti~atlona Imve r~l~rted
tool f/ilily ratitm ill Xll)llrox hllately 2.o for m/lekell~ tlS eOlnlmrm~ wi(]t
r o.~p~, me ~ehlLi+msh)p~ fr<ml fetlr or t I~e~m,[or pr(]sll~t[ve ~t u(liett are
[)X[:~q.'ll[l!ll ill '/'llbl~2 ~l'/. ~IllO](~I'S eon~lll)]}ng ml)l~ L}lon one I):lck of
cigl,'ctlu~ I~!r cloy had ItlOV~tilty r~,lios two to three tinws gl'e~ter
L)I~III [110~{! O[ ~r )rl~ll)~l(er~,
'1'))(,,-;e d:l)~t eOll~J~;tontly SIl[lflorl. nil li~l~i~L]orl I~tWe~,ll 2]lnOllillg
t~lld Dtulrl('alio zJtl]lCO~, ttlthl)Ug~l ~]1[! ~tren.~t}t o[ t~le ~x~o~illti011 i'~
le~ Illa~ tha~ nt~ed f~r smoking anJ Calicer o1[ the lung. I~lry,x. oral
'/'eml~el Ilehdionship ~]" the A.~sorlatlon
~Ulqmtt G~r the t~ml~rlfl r~laLionship of" lira a~oe;tiLion is
provid~J I~ file ilrt~pecLive studie~ LhaL observotl ~u~ects river
vllry[ng I)(7ril)([8 (if L[ine for th~ tiovl![(qplliC, llt of" puncre;l[ie cancel+.
~tll~l~)l't [or the tempornlity of Ihe a~,~oc[~tion is ndvalwed by a
h~v~oh)gica] ~tudy ~howing a greaLer I~quency of premallgllntlL
chnnge~ il~ pancreatic tlssuo ofsmok~t~ wilen eolnpnre<l with ti&~.e
t~[ noa~tn~er~ (1¢?~h zind by cohort analysi~ 8bowing eorrehlLiOtl
bl!l weetl Lren~ ill slno~iilg piit~rl~z¢ and I:~llle r ea I,ie Ctlnce¢ ii ulr[~ii[y
9T£ £T069
ii
i
CA~ES
, ...... .........
~MOKEO
HOOFCIGAR/TTESSMOKEDPER DAY
FIGUl|l~, 65,--llelnllve risk l)~" I!@nerenlic enm'er in mah.s,
l)y iltplober ill" e:ilfllr~!|tt,~l ~nli~ht!(l
Coherenre o( thF A~soeinfim*
Dose Rr~spor~e Iqolalionship
Tile cohel t'lt ce of the zl&~oc [tl I it,ll i~ t~tlppor ted b3, (lip tlo~,.i i.~ll(ql!~t!
r~,hll i(tllnhip nt)led nbove, nl 1o i~ i [[ ~ • ,~ irr ~ (!ll ~,v; lilting' II,~ll'd
~Dr SrlIok ~11 ~ II11¢1 ot [lel" Ci~ll~(!r S
CorreMtioo o[ Pancmatl~ C~ncer Among POl~Ulaliorl~ Wilh Diffetonl
Tobacco Consumplfon
'/'lie findiT~E oF a low inchl~nc~ of pmlereaLic ellrlcer it1 ~l,erinl
glX~L,p~ (e,g., Mormons mid FJ~venth Day Adventi~(~) with o mnr, II
proporlion oF smokers (79, la5, 16(;, 911, 2~4) is cml~int(mt wilh o
Cnu~nl i~lnLionship.
I [!?l
W
I
~T~TO~9
---
:2L----Ira
j~w~.~~ ~ ~ • • ~ ~:I
~, i
d~
= _-
~Z
']AlllJ'~;lfl,+~h~lllill:ll (!lllll!l!l, llll)l|ll[JJ}t pJtljll~--|ll'll~ilt,(!liVl!
~(lllii¢+s
~rF
¢~m,41r
~<hl,I y ~h,re ITidh~
IIi i~ll~lq~fld IY
Ilrl~xl 4~ rriq~
~L l~l ih~
Illah~ pllrJ 1'~4~m ti) I INI I ~1
TAIII,I': ;l+L--Slmtm+h t'n.eer murl.llly rlltiom by n.lml.t
hi imnh'llsl wiLh the abo':e i.vumtilmtlezts, the ]lmvz+ihm Btudy ~1"
I.'ive I']Llmic GrmJll~ I-niletl to show tl ~h+tlslicz+ily I+il~t]ilic~ir~l t~s~aci~t-
ti<m huLweeu m.~kitll~ lind ~t~mm+k cm~r ( I I,~). l l~m~I et itL I!HI
l.lmlh,ll ~lll illtltP/l~<,<l ipI;lli+,l, ri~l~ ~411 ~l~1111lltll ¢+;+rlt'4,1 /lllltlrlp[
mni+I<i.i+ h+ n mvh.+ <+l" +f~;+ l+nli<ml~ livilq; ill II.+ llil.~hi.ln m.l
I~i~+ll~i rlle#echlrPm <)l ,lal,lm; Iltlx~pvfr, Ihr+mp [i.<rirll~ w(.H, .<It
P~hllimlil++llly mJi~n]l]~tllll. I. +1 mimllnr mhl,+y +~f ,hffmi++,m, rivJ.l~ i.
~II~+~Xi~, (L~p+ +;XlXI(+ +mtllm~ (+12) fmllxli IX mh~Iktic:xIl~ mil~+xi(i<';mt
ill(!Itptl~IUll l'i~IC It+111+l]~ ]m~r,i ~l)<II(cp~ bul III)~ [I111<Illi+ ~i~lJ 'l'hr+
lll)~I, ll~ of ~I ~ll[lli(i('+In~ +Im~l+l'it+li4lll hl+~wl'Pll l:il~llH'lll+ ~l+h+Ii+l)l~ ll+l<l
~ll~ l'i(" t'll IIC(,I. Ii+l<~ Im+,n I elll)J +I'<l h~ t+tlll+l" iiiii llm¢+ l ?,1 f#. ,'~ l +~ )
'i'h4+ rt+Inli,lll~llip 1)elwt'I+rl ~?lltlllirl~ 111ltl ~l(lllfil<'il l!lllll'l'l X'~II';
il~' 1111 i(j~l XVIII ~ Irl(:l l!+l~(+ll i~ll. #+lllriIil+l ~ ;1~ r<mlrml l,d w+< h ll+~llSllll+Ii
++i ++,
/ht++<~ il)(+lP[ime~ W(,ll+ mlml] 'l'h+Pip I)[ [hP ll)tll' ilmj+,r In++:~pr'~ li44+
l~t lldJp~ llllf+(+l~ fl ('(ll1~i~[1'Itl <]++sp l<,~ii<)liP]p H,l++lillls~1]ip +i~ lll(++tfilllP+l
h~'
irle mili~h!,r of <!il~nl elli,~ m++(jl:+,+l l~+,r tln~+ l Imwvl,t, lh4, l+inl~lifl.h, ++r
lltld +I+ h+,r I'+l n+'<'l+ rail I+~ Irl++ihl<, ;+n~.
( ~l)llehl~l iIIII
cil~n rcl ti~ ~rllti~ inl~ nn<l ~Ir~lllllt:ll t!llli( ++r¸. +l'h+' li~!;+)ei:ll i,lr+ i~ ~.mll
ill t~rlil~;lli~lll ixil]i lh:il liidl,tl ~il- ~nlollili~ illul ~llll, +illi+.l.
+.'ii r I(~i,i ~. .
Cancer of lhe Ulerlne Cervix
~lt~ll[I)' q~rc]" ~+'~ffl) WOlll4/rl <]ietl nJ" etitil!l!r ill" Llll. tllr'ritto ('/+1%rl;~ ~ll
I -r J/;O. T]+Y 1!)77. L]le t(jflll nulllimr ~+]" iIt!lllll~ Ilfl~rihu h!ll I~1 /him ~ih+ hJl+l
ill~cro+lZ~ed Ix] ~,Jfi,~). rl'h(~ nl~lHliljlt~;Ipll i+niP Flip wllill! r(,in:ll<+~ i~ iiiily
IllmuL mlc.-thlrd that ii~+:r vl!t[ lile i'Ilces oflle+~r 1him while (:r .~:1 vmmtl~
!kl+;IH Itil.'u re t~9)
~md d+c~e+metl h~ 7!+!~ by ]!177. 'l'he ~]Ke mpecifle rid e P+)r while Icmnh.+
rh'<'rm~e+ml [rt)rll II).l~ h) 4.17. ,~er I.Im mnl+le l]nl+, pl!r+otl (Hgdle (71)
~+lllltlllrllt~ C~+ll Cihclltomll ip ~he. iiiJIjOr CpII |~/j~+. 'l'h<~ <~vt.t ull ~'~ y<'m'
~l]l'vivlil I'nll~l~ Irroln tt~ imli~eliL [(11- til<i<le w~l}~ h>t:+lll;+,<l ili~,un<!~ it>
,~l) lie~ont J'ill. Lhll~, wil h i t!t~ifllnll JllVOl~el~lt+nl, xlrlll #rl ~ lint ~:l'llt hll
th(l~ ",~i~]l (libel hilt. IiIehml~lm'!i (~).
hliYe +Jlll'l~ i]]141 I"fp4]uct~t COiluR+ wh+l ]illVC i+llrly or llttlll+llll, ilizll+
tr+!qltent]y (i4t). 2~;.I). It+ mhlilhm. ~t numlml of oLh(+r vnri,hl++~ Im~]e
ht'x'll elLtttliei{ tlm~ Iml~' I~l'l~!('L the licit f~r Cel'~km| timer't+ k~ehl~llll~
I:r7
~gBI
• ~-~'~.~..~ i :=
---~ i!
vL..,leal inF~climi~l eJt~llmci~ion :~llilllt~ nf cnn[nrl~ itlld eXOl~(,llOlh~
h(u nmlles (2f; I).
A liT~ih~d nnml.,r of shrlles Imw~ uttempled Io ide.llry n.
ll~ICillIillll llelwlen eil!llreli0 ~inl)hill~ llnd Cel'Vicld ciln~r. {)lle
Hhtdy 11921 Hq..led n rekdionMlill hvlween snlokiol~ ~hllu~ {never
stn.kl.d, eX-Slllillil~ls, illeSi,ll[ [~lllllkl!l.~) nFld ~lls[fielOllS or llN~i[ivn
I:elviv.l lylolu~y. Tliillml~ 2t;41 aIludllisle,oq a o .' q tm r, rP
It* ~I~4 I~.llth!s wil h ilhnormnl err vii!nl cylrllob~y ~inl relx~r U,d that the
lll'(eailli!n(!e el ~nlllkilH~ wil~ 7(l l~[!II'l!Id, ill IPII~{'$ wilh cnreinlmln i.
mhl lillii [~H pi, ii>eld in eoulrols l{}l)~< p<O.lIB) When nd]nsted for
lhh Ivi.l illlu!r vadnbh,s (iududinl{ >3 biIllm, fiiH. llri,l}noney [irhlr
hl zlge ~ll, lln~bnnd's ¢ireunlui~ion llnd prior lllll~liil~e ld~hily, and
mmihd i.stabilKy, amon~ othn~.~L he repolted . "l..derli.e"
~i~nilie~ml la, kdive ri~k ((lC)2<ll<(lll5 for cnrein m~n D~ Mlu, nod
lion ~i~rlilicallt ilillerencl,~ [or dy~llhlsin,/~ ell~e nonlrol sLuily aIllOli~
~Iflll Mosl('IIIS fltn] nnn-Mc~lem:~ in Yul:~dnvi~ [l~tllnJ lhlll, celvkal
i'llll~'Of lllItiI!lllN Wl~l'e InIiro likely to ~;mllli~ l~in] [o Bln0ke iiil211~ lhilll
Ime Irl(:k Ill'l" day; tile diiFl, l'l!lle~i Wele slo[istically ~[gniPiclmt
(p, I).[l]) nor Mo~leru~ {I40L B~tlJ~,,luently. three olher rl!Lro~i~!ctivl'
sl udi(!s in (~l,l nnnly (2(Jll, I~ngland (.'18, .705k und Czm~lda (2D';"} Inw,,
lePlulI~l Illilt ~lllOIIin~ was II ri~k l~Icll~r rnr corvicld ¢~ncer. q'he
l~u!:lish nhldV (I08} exalllin~l :I[ wnmen with dy~plaskl, cari:inonla
ill ~llil, lit ilIV~ISiVI~ l:llICillOlll~l+ Hod llIlelllpIl!d [0 COlIII'ol for kllOWll
li~ll li,cl.l~ KIIch il~t ll~e ~'1[ Nl'~l~ inll!lOlllll'Sl~ ~lld lltllil]lel of ~eXtllll
llnlhlelS tlf blltk wil'~ lllltJ ]lusb~nd. 'r]ley r~l~l'led no eITnct n[
hn~ballll'~ ~n.~killl~ habit on Lhe i>elnllve risk of cervical nlmm'lmdi-
I il,~i, bill. tl SI iiI i~liC.ll IJy Siffll j~leall I ~J~ ~,~ ri~k timong wives who wt!l e
(~llrll~ll[ ~nlnkt!l ~i (ILl{ 7.9), alld lin elewlted risk fir wom.n whu wei e
Ii. lll(!r nniolc(~i~ ([{]{ ~1.?) nvl, r Illut, for women non~ninkel'~ (ItR 1.0).
(o i, f>ol), kllwevl!r, Lilt! Cnnadinn ~Ludy repel'led ll~elldjtl~(~,d
l'l.lil(IVl l'l~k~ for ill @illl ilnd illVil~iY(! ~llllC~l[l [OF e[irlelll. ~lllnk~21~ [i[
:1 ~ alid 21), hilt no Inljnstnlent w~s Itlnde Ibr other known ri~k rnClolS
for lhe di~li~o. In Llm Third i~nLintml Cmlcer Stndy (2,99L WiIlintns
IIIIll Ih)l III hllv~ lel,orted ~ si~niJit'll]l[ positive IIS~l~i~[IOli belWeell
well li~ ll~lwl~on iI(lll~tnokinl~ [oI)al~'o Use (~llll If end eJlcwin g ~OIiIICC(I)
ev k Ill. The ~wedish (421 ntld the dnpnnese (119, 120) llrll~llm:[ivl!
~ludlos included (llll~ on smoking tllld cervical ¢llnCcr. Cig,rirni~e
~lll¢)lll'l~ hgd illcr~lls~ IllOt'l#llity rillin~, ~nd a d~e-re~l)Oll~l! rPJll-
tionship wlls ~nled ('l'alde 40k None of these studie~ eonLrn]led h~r
other known risk fnclor~.
Stellnlatl eL al. (2561 examined I.ke rceords o1" 332 patlenll~ with
eevvicul elmcer (shq~es nol. identified) wko were eontrol~ for nnother
8Ludy of mnl,kinff mid llealth oi. different Ii~spitnl~ in severzll cities
The coiltrols were ilolienl~ IiospillJlized for nonsnlokirlg-rehlt~d
Illl
,t
TAIII.I,: ,ltl.--Ct,lVical i.lilll.i,r illiillglily fill IIS i'~)I. Wi,llll,ll hy
t'llrrl,n| lllllnlll,r o[ ~ rl!ltl'~l ~inll)lll,d i~l,i, iIrty -
i 19
z,i 2,~
J7
i IMI
i iir,
:1 ~>11
17?
34~
:1 io
711~1
di~ll~ Illld nl/ll~eht~l For II1~¢% race, htllpilnl, lit1d hospihll 'ltllhlq
Isl~ml privn[e vet~llt$ wllrll I. ~leillt !l~tl(Imie .~1 ntll~t wzl~ (ll~l t~l ulillln I I~
the sul~c~L's e(Inentiotl 4tnd ilCCillnll.~t~n nnd hy Ili¢! liu~;hnturs
O¢~lIpiiion. ~l'heir llnllly~tli4 ~hrnved lit1 overllll illl~il~ve ~l~lilllh~n
hl'lwoen ejl~nr(!L[e BlllOllinff {lllql eetviclll cnnt.Pi.¸ Ih)wl,~f,i¸, lllh,i
authors did not lind II ~lntistlenlly ~ignil]eont n~,lciulill,i Thl,
lill{holll ltltl~gl~l. I.hn{ tim n~socinlJlln ll~lwei.tl liliOkilll~ niid 1,1,1 7h:iil
COllcer is Ilil~lily eonfollndod nild llo~ VOll~ill('lll. wiIh n /'ail~;i]
hylmlhelil, q'[ii~ ~{tldy rd~li, llilwover, fllih!ll I. ini!hldlTM dh~,cl
IlleaSll re~l nit r~l~nLial i~Oll lilu lldi nil viii iabk,s, ~iII1!11 IIH ~f!lllld 11(,I ivll V.
It uhmdd be hotel thnt ill lira ~weillsh f~J lind (Jerlllllll (7OI) ~1 uilio~,
diff~renc~.q in ~ltmltleconoiilln ~lnliJ~ dhI iio[ Idleet ceivieul I~lllll,f,l•
incidence.
q'he ~qoeinliolm d~rilled between ~ivleld Clltlrer iliaI ilnltly
other vnrlnblelt, in llliliiLillil l f) Ih~ vnrlntllln iu l/~llll.q lir ~ludh,s of
Ilie lit~slllle ~l~focill[itllI n/eil~lllt, ilt~ fmokilll~ nnd t'ervlelll Clllll,Ol, d~l
tlOl Iler nliL II eonehmiFirl on Ihe i-kill IlCII,F oF tili~ rekllion~hill iii Ihi~
Ihne.
Conchl~ttOll
1. There urn I~lill] k:ti ng remll[~ in studie~ pnlili~hrd tel Ihlll! ¢ln the
eli~l~llee of ll relli{ilmlhil~ hl!tw~ii ~iniokinl~ rind ePrvil,ill
~llllL~r[ furlker i~selltCli i~ iiPl~0t~l[ll-~ in llelili~ whl,lhol IllI
ll~slleilllion I'xifl~t lind, if so, whldhel" {kill ll~llCiliti#ln il ilill,ei
or itldirecL>
ltl
D~@FDTO89
FIGURE 62.--blortality ratios h+r all cancer sites for
~urrt~nt ~ln(I px.~;nlol(~r~ hy I~Ulnlper i)£
ei~ar{~tt~l~ mnokcd daily, U+S, Velerans Study
[{)111111 {leclil~[n~ cnncep moz'tuli~; rn[ic~' For I?x~mOkel~ by Lh{!
tlllt~+ller Ill y~t~l~ o][ ¢i[~urett(,8. For t}lo$~? ~0rmer lll]lOk~Tl$ who had
qlli~ lilt ~0 yt'~ra or mar~, lhe ov{!talJ c~lncer m~rtali~y rate was
n~lllrc*~Jln;~t~ly ~*~ i~rcclnt abiiv~ Lh<~ o~r Ii0n$1xto]~erm but StlIJ~t~ltl-
lially I~eh:w th~se ~)f continuing smokers (1.27 versus 2+12) (P+gurP
(Jl)+ ~]'ll~e irlve~Lj~toT~ a]s(~ n+fft+tl LImt Cl~nc~r m~rlllli~y [ll]loll~
rclr tuot" cigiir ~LL~ [~nlllk~l~ W~S c{lrr~l~l{etl to I}le nunl])~r of clg~lr~Lle~
sml~k(~d p~r d~y+ A clear gr[idic.n[ I)y the allloull~ ~tl}lllllccl is ~vJ~lCl)t
fclr eX.~llX~kel~; ~ts well ~ continuia~ ~;mokel~ ~c*r o,~er~ll callcer
mortnlily {l~'i.qure G2), Overall cnncer marLality rules for' former
~i~t~ i.~,tl ~ ~lnokel ~ wete 40 i)erct, n L gl I!~l[er L]I~II ~or tlollsiilllk~r$+
(~(mcZusion
I. UigareLte smokers have overall mortality rates substantially
gloater than £ho~e OF nansmokers, Overall cancer deuth nlles
{If HIItIC Stllokerg me tip[91-oxim[~Lc]y dou[j]e those of Imnanl{;h-
t!rs; overall cancer death rate~ of G, nmle sm(~ker~ are appn~xi
malely .+10 percent hlgiler {h4~rl Ilo~rll{)k(?l $~ HII(] nrP i[tCr4~;iS[ rl~.
2. Ovcrll]l cu Beer mortality rates Ii nllmg enlr ~]{ert; are d a~4~r{+ [ H IL~I
I~ la~gl~ur~d by L}lO ntlrli]~er (ir cigarettes $ll~oked per tiny,
Heavy mnokera (over one pack per day) have more than three
timca l, he overall cancer deaLh r~lte or nmmmokers+
3. Overall cancer dealh rates duwlirm with the number of years or["
cigarettes, al~pl~tlching the +[[~zllh rale of llOl)smoktrts will1
incre.sing duratinn or ees+ml i ..... t..¢~ I~ ~' 1~0 ~ ()
I,Ii
,I
Summary
I. (~igart.ll~t. mn~l(~nf! ist II~, in;ijol~r~aLl~e of h]nl~ t'~lrlq'~.l" in Ihe
( hilled .qlnlt~s.
2. l.utll! c:lnc~'r nmrlalily Jm!rt.a~t.~ '.vi[h hlt!l~;mi+ll! ~l+t!~:ll~<. rl[
~;itlllkt~ {,xll~t~;lltt~ (as mr.;l!~al+.d Ily 1]It! iiLHtllff.i i~r riI~ll~.l~.~
sTnl)]ted dn~ly. [lie dlltalion of ~mokinK. ~lttfl inhah:li~m i~al
¢~'lllS~t~d is ir~vl.i;';+.ly rehlh'd I<l~lge shirred (ll ~nalh~. ~ttl+.ll~.t s
who c~ll~llll~C {wa tll" illl~rl! i>;t~'l[~ +~r ~Jl~ll~!l~e~ 4hilly ]l~lve hll+t~
< ~lncor in<l:talily ];ire~ 15 Irl 2.5 [hnt.s ~t e;tter Ih~ln n+lll~tn+~k(.i r;
3 (~l~lr ar)d pipe :Sial<ill ~1~1,' ;it e ~t I.'.~ t!~lJ~ll [il+-llll ~ ¢i~t¸ Itl+ll~ rl~l~lL~q¸.
]hllv(.ver+ 1he inajnt Jly of¸ htnff canrf!r nlqJrl:llil~ in II.. Ih~ih.d
.ql a{t'~ i~ dtJ¢" (o cJgn rl't t e ~lU nil il~g.
4. t~'~"~:4~ iI i~ )11 o[ ~l~ll~l<it~ I i.<ltl~'~s ~llt' r~slt <it htlll.• C~tl~Cel+ i1+Ol I;llily
colnp~lrt.ll tq (hn~ ol {It+. c~n~lill~lir~ ~moller I"t++ltlt.r srnt+li~.r~
who Ii~vt. q~liL ]5 ~r tam+. ?(.ms hay{L hi.ill, r~llll+i!r ill~lll~llil~.
I~te~ o~lly sl~.'hIly ~ll~{~vl+ I h{~t+ I~." nml~mi~k t.t~ (all<ltll I~v~l I hm.'~
l~teaL(!r) The re~id~znl rlmlt rl['dev(+lopil+~ lutli{ c:mcl.r is dir~ of Iv
pr+)[lorlion~l Io overall li[c. lime ex[xl~;lxr~ h~ ei~n;eH+~ ~mrlhf.
5. Fillerud h;w{!r Inr cip~ll~.llp ~111¢~kpt.~ lucre a Ioxw.i¸ II1+11~ c~m{et
li~ll cmnpar~[I I.f~ nt~l+l~llerl~(], higher tar cil~l++fl+, sul<+kert~+
IIowt'vet~ I.ho risk Ftlr Ih+.s;o t~nloker~ i~ ~lill sull'J:btlli;llly
t'lt2V.tl [e¢] abovo Ih~ risk ol ii{m~llXOl{(~l ~.
I1. ~qince the e~lrly l[~0s, lunl~ i!~llcer ha~ I~ef.n Ih+~ h.+rdinl.r <+l+ll~.
(IF crtncer doath tlnlal)l~ i+l~ller; "i~l Llll! [Iitiled .qI:ll(+~+ At+l~Jnl~
fOltl~lle~, the h]ng c.~nc{~r ~hqslh tale is nc<elf.ral;tlg ~ll)ll will
lil<ely t~tlr[la~s lhnl. l+f I~r.:l~l cancer in (he ] !J,q{l~.
7. Thr: econt~nllc illll:+lcl ol lunl~ catlcl.r I[~ Ihe n~lfh~n i~ cml.~hhq¸.
able. It is esliutn~¢<l thai itl 1!175. lung cnnc~r cl~'sl $3 ~l hillh~u
ill Ir~ entnln~. $37!~5 nti~lhltt it~ t~lmll It.lln h~llilal ~:l~ts.
~TI<I $7~ millior~ in IJ]~y~icla n I~e~+
~q I+nt~l; cancer i'~ laity'ely a ptev(.ll~aI~le di~etl~e. It i~ t'~iht~lh.d
thai ~ pet~t~nt ~lf Itttl[~ cnr~l~r nlmlali[y cauhl h;tve ht.q.H
avoided if it~dividaal~ never I<l~h nit s+;.~kinl~ I"~]ltllr~ll;l<+r,,,
t~tll)~tal)llal re<hlcLiolls in lhl~ numlJer t+f (l(.llllls Ftt)rn hlnl~
tNltlcer Ctltlhl Ii,~ arllievl~+~ if tl m~jar 1~>r{iral ~[ Ih~. s;m+~llirq~
[l~}~tll;l[i{)tl (plll'(ictl ht r]y y +)lilt/2 I+cr~tlll~) COtlld I;.e i~t+t ~;t ;;lll{.~ I
tl~tf
~. (3iffaretl o ~nlok~nl~ i~ I h~ I+u~i~lr cause ol¸ Inrynge;;I (!~t ii[:l+r hi I h{~
Uni{e<l .e.lales. {~igar nts~l i>ipc• ~tlltJllt.i~ ex[ll.ri+!l+ce ii I~ll I~l
larynx!hi ctlllcor t~illl]hll to IhttL(ll nei~all~lll~mr++:~tq¸.
10The risk o~ devehlplnl~ I~tlyll/I+!+ll r'~rlcet¸ incrt~+lm.~ wilh it+
crorl~e~l ~pOstlr~ a~l iiiPa~;tlr.l.d Ily tll~ nllDll)~l¸ or Cil~Iltl.fl(~
t~lllo~ed daily i1~ wt~ll ar~ rdht.r +h~'~e rn(!a~tll~lnr.i)f~:. ~[t.avy
snlrdlets have latTnl~l'al <:npn~'r tntlri+l~i(y rislt~ 2{1 hi ~l{J Iilltr.~
~leH[¢.l" IhIiii t}Orl~lnlllc4.1~
Ll~
---
Pil~ ~i~ Lift II~lte('~ ~lu]be I~1 ol~ieltl~ nr i'q)~lllportd)ilily it; ibe pr~q~rlloLifHi
c~[¸ the ~hlli~,i('~d I111~[111~ ~lrowll rrq~l~l ~1 wl~iely of ~urc~.
Anolh~r I~]qIIIlt'UT] IP[ cl~nH)n~lllili~y in Iiior t~lli~y r111 e~ is irl( i~'~lnl~'l,iI
w~l(!l~ I!clell~l~lt i~1ti1~ ili.p nl;Lqi[! (ivt,r 1bile ~)r ~l)~cinc Cliu~c!~ (~!" ~](.:1(~1.
'lhi~ i~ il~'~lLl~e ~)1¸ Ihe IIrJll~l L~ Ill ]~c ri~)~llci~lly revi~e Lhe Inl~!i'nJiLil~n-
~li (~l~l~illcnIidln i)l¸ ])ise;tsc~ ~1(~1)) by wbi~b e~Ll~e~ I)f i[t!~ltFi ~ll~'
I,w,l~ 1IF y~;~r~ ~inc~' I!)(Xl h) kl!l,I) ~llli~,~l~t ~r I~l~d~c!al iIIIIIWleI]K~,
F'~IC h qh'~ rn ni~li I [!vi~i~)l~ h~n~ i~rl~ h]~:n~d ~i[~k~ in~ tile I~lnll)~e'a~l~[i I y I)f
¢ll~i~(!-~)lL~il'~l~]l ~l;iLi~ti~. J"~r nl~lny itl¸ lin~ co~l~ i)l" qi~l il iI~c~ i[~c(~
A ppe~lllix Tobies
9 UT069
---
(ll AIqI/f.IN.*I'.I~SEI.I~Oll I{~.h:ll**.*ri~l~tdl.hlrll..mryc~merlnchplr.ttdldf~.
(2) Ai~I}:III(:AN I'AN( Ell F~R!II~Ty I!~.'/!~ f~,~- ~t,.~ .~n~l .~,~,rm.~. Amerien.i
( ~,k,,,.r ~.i,+t ~ I.n... New York. I!1~1.al pl:
431 ANTIIf}NY, II M. TII(IMAS, (IM I~lrk~l,ler i.m...~l~ nl~.l ntb~:kiJ~l~, l.t. rr,.e.
ti,,mpl ,]..rtJ,,l~f~.~*r~gl: g~ ~72. M;m'h 15. I~O~I)
14} AN'III(gNy. II I~1, TflI)MAS. {; M Tu,,wu~ of Ihe tltiw:ry 1,ladder Air
iit,~.ly~J~ ,,[ I~le ~,ll.nllrm~ of Ill:J~l i,~LLit.ltlS in I ~e~s. EIq~lr~.hl. */IJI~W.ll rlf
(~1 AIII?III~I{, V~, WA(;()NI~R..IK, I.ITNDIN. ~E. dr UrmdtJm mini.l! nn,I
'gill 21 I. Malch 11~7:1
I&~l AIIM~TZ R()/.Z(I. B. I;AItR()II. A, I)~)tJ.. IL A retrtml~tive nt~dy r~f rrnal
/I; t fish */r~tlr~t,d,q~{~l*l~er3;l: I ~7-1:Ri. 19711
4!~}..J~,ly 1'2[;!1.
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PART
IlL MECHANISMS OF
CARCINOGENESIS
MI','/I'IIODOLOGY OF EXI>EltlMENTAL
CIIEMICAL CAItCINOGENESIS
Experimental Assessment of Carclnogealclty
]n o~dcr to determine the pc~sible carchloi~enicity of tobacco
~;Bl()l!e COlI~LiLU(!II(~;, £hc S~llle Ilfdlc*~dtll'CS ~hlltihl hc elllldlbyl!d ;~s llr~
u~cd for olher ~ul~tartc['s. Vzt¢[inm crile=ia ltild iguidclincs liar
4~;tlcinlll~t!flicity h.~t~ have beta .dvoeul(,d hy sevelal ~ovl!t'lllllt'll~Jll
mR] illt~llIMiOlllll ztg{!nvi{!~; ~ttld By v~ciou~ ~l{ivi~fll'y ~I(}UJ)~ I~()F
ex;mqfle, the World lleMtll OJlfiutizulion {WlIOI t29k the ]nL~rnil-
LJumd Agency [or Resczuch on t'uJmcr IIA]{C) fS}, the I~J=VilOl~menta[
Protection AgeJicy {3), the Food and Drug AdJiihli~lraLi(m 44L tl~
National Cancer IrIsL~LuLe - NaLioaal 'l'oxio~logy l>togJ;ml (22h
IlcalLh and Welfare or Canuda (2L and the lic;dlh ('OmltLil ol the
Nclherlallds (13), as well tls tithers, have i~ued I~nid~'lil.'~ lie thu
~I~S(ilII[ of colllpoLInds fog dJIl(:Jt!ll[ [iS[Ilt:~R of IWUlt~ ~llld C[IHHlii:
to.iciLy.
Chelnicals
As a filet stop in tile testilld of any nluhniid for i>o.~ihle
C;zlcino.qcnieiLy, the lesear(:h~tr ~hlllll¢~ Ii~J{~il) LI t!(2lll])~t~ ~lllysit;(~-
chemical chax'dcteri;qltioll Of th'-" III;ttel']~[I I~xlltliilz~H[¢~l~S by SllCh
lecltJtiqtlr:; lls thin [zlyer, g;m liquid, +ll" higln iIt~il~lznlu+tcc: liqtlid
chlI)lllIItt)gliqdly ~]lotJld affi)ltl =;tUlle i~t!;~ ot whctlml lira Ili;lltZti;d [~
ide~llilicatim~ *)1" the individual txmq~on ,.hi n'~md delel iniualioa ol th~
vidi,liiy mid ~igniliu=mce of t Im i t~B~(~; ~l~;ly I)(: qtlt~ll il;ll~.ll
Ill ;UllnilLi!:Ll~flilJn and {he Ih)g~: mid It('I~llt~llt~y ol uIhililli.',llalion.
I'd;it tlll~ I~d;di=q~ ~ Lhe lil~itn;d il=t~ the &.l*¢:~.l[.~. :diaiil..~t~x. u/~t., dicl.
~l=l~lllitl~*'t)kL~ tlllllOI i%ll ~d~*llCl!. i~ll~l illllllUlloltl~it';tl ~lilltl~
Ihmlc ~1 AdmitziMr¢llirm
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{'I)tlIIIIHIII([~ {ll~l~ II~ty b~ inll~ih:d its dtl~;l~, dl!;H(~(i ~1¢=111 (h~ ~tilW;4y:q
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173
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ill t' I~lt~[lll s or COil c(!l'n. Vohdi]e clllllllou ads 5ts)u[d [ll)[ I)¢2 give~L in t he
dlul. I'ul Ihe H!sultald h}~s will lead lib inacculncie$ ill dose I!wek If
JIiW'll ill Ihc dlinllirql wnlel, ~otsbilily and stahiIHy nlu~t be
('O J iNidl! I (~d
'J'Jle dclmnl roul~ ~]illH]lttf-e-q ~:po~llr~ el" ti)(~ 5kill ta~ it ocotm in
OC('U [)~ltillll~tl ~iLu~II~OliS or iT] the u~o Of cugr netiL.'~], tsnd ~IN~ I~0ell ii~ed
i1~ xt ,~lllndl]ldlz~d ctlrelxlogenici[y i1~.~ily. Ai)]dleotitln o[ I1 gollJ(ioll or
the I~,~t i]lnterlnl IJy nlelllls of.'~ pil)~t sllo~zhl I)~ i1111(le in illl ~ i e,'l tlltlt
emmet be H!ached by lira nnimnl. (}1 herwise, the t~nima] will lick the
trl!lllt!d nr(!~l SO that Ol~'d i[igl~lilm occurs. ']'o z~void Lilt~ ailinl~ds'
liehiug each oLher, single cI~ging is deslrnble. In this type oF lest.
IIdl:(!* ][IIIIIS~P[~ r~lhl)i~, find ~[aeth~e~ ral~ are used, Per ~l[[[Ifltff[[IS
apldiCi~thm, mice oF the BAI,FI/~., C:lil[', or DBA strains or tim noll-
ild~r(~d ~wi~.'~ ~tlain me in.st rl!~l~l~ilSiV~. SENCAll mice have been
eslll!ehllly Illed fi)l" sensitivity in iuittsti(m-plnmtdil~n o~snys The
ghln ~]tould be clipped Ilefore algol[cation of the to~L c~ml;~tlnd, Dill,
+ltll'~;itHI Or IlIPehlllllC[ll ifljllry or the skin Bhollld be avoided.
rml)lanlalioll: Sub~utsr~ou~ and II~I~HILISC~I~[
Although mJhvull~lleOus injection or polycyc[[c aronlntic Ilydlocllr
111~1~ ill ilti~e ilzls proved to I)~ qllile rt!]ittb]e [18 ~1 [e$1~ [;ystem, the IIS~
el tlli~ le~t in olher species ha~ led to controversial results, The
iruhu:llon +~F tumors at tile inlplnrltatlon site, C~l~cialiy in rats, hy
il~¢l't I.idelials (if tile prOliPr size, Ily saliue SohliiOu~ or }ly oi]y
solveul.~ i~v~ indicated tim limi~ttsn ol lids lest,
Irljection: Inlral)eritoneal and Intravenous
Irltr~ljl~llttJHeld ~ln(I i~tro~ollou~ injeetlon~ ~ll~y I~ qls~d tO lest
(lltlgB, but rot vllrioug re~ons ale not suilab]e fi~r repeah,d (h~qillg.
'l'lley ate u~ehll f()r ndministeHu/z u sh]gre (lose or a Few doses of
l~)Lenl CHFclIIo~clI~ for illudE2l exrlel'illlellt~, With IJ1is It~hnitlue,
~X [~SU re or per~l}n)le[ to cu rcino[~cli~ i~ illirlizllts[,d,
Inhalaliol~
Inhalation is the major route by which pernons are exl)~ed ~0
cigo I'ette snlnile. For hlbnrntory sl,udy, complex instnllatil.ls, such tm
~.~ Pumlm or nlelering devices, r~re noc~led to allow uniform delivery uf
tile test ln~ltertsi to the e~:perlmenlnl allinl~[~. Serubber~ nnd t)lller
devices arc I~quired to prevent extmsure of any l~l~oI~ll o] working ill
the area, A test by tim inludation route usually costs nmcll 111010
Lhm~ .tudies ttslng oLher routes of adlltinlstruLion.
,i
TIt lie" e[ rising faille ildlld:llJllll eh~llldlers I11 w~dt'h n111U1[ll~ lit('
I,xl.~scd, il ir pi>ssible to use i:i1:llllb~!1~ into which (Ira hvml ~.id i~.~o
el imlividual nnimld~ lue lilh,d. The h,M mah, Hid is Hum fl.c~.d tsh~
lhe c]l[uld~i,r, lesUllhqz ill Iln tshnhdlon eXllOS~lI{, llplnliw,l'/ li,w
nr~in)ill~ c~nl b( tt'e~icd wilh 11 l~tscn clmlnl}~,r by lids nlelts,l,
hll~/evc r.
]"a{ hlt~ lh~It !~huuhl he con~id~it,d ill cv;dLmlin~ I h[' I(,rrlllr of flu'
Ill,hi Ill{• I!lll*els (~n ~l,('[elillll el n111¢(Jil~I zlllellllion i)[ I)lillllll?llll~
VI'lll ihlIilm. ~lll(l pus~i1111' I oxi(!il} Io lhe cilia in flu' ~ vspleah~ '¢ II~.l
The ddelilnln i~ lhal in l'olh!nl~ I hi! lln:tl only told phyrlohqp~ ill I h~!
• esphld ut y ltzmL alld the bioellellli~l ry a[ lhc hlnIT dilh,l Iruln Lllill i~[
hnln~lrls alld Ilia[ aUilltnl~ nn*lh~lrlil'n]ly le~clnhlillg Ihe Inuntui nH~
t:ll)s(!l~ UIO tOO c~pellsive nlld IILIVO li[oSlmlm fan long tl) Ill'r nlil Illell
tlSC ill rulllille I (!sl~l.
, l,'or inhMMi~.l IPrl,r o[ th~ em~'in~guni~:ity .[ hlh:wc, sm.ke .u~l
"¢m ious fIii('i(on[~ o[ tobilcell [~ll]ol~e, i),'Imsleis HI~' l}l°fernbIR i~ lili24
lind n]iee ts!clltl~e [hey lcsponrl wilh n Ili~l]t'i" incid~,m!(! ~>I llirw~ly
t11111or~ ({~).
Higher dose level~, ~l'etllt~r flelllle~cy lit lltlnlini~llnlhlll, lilitl
Ioliger pel'tsds or (ll$~,r val toll all? I I,qll il (,ll rtlr weil~ ('11 i"rilldlt~(,ll ~ ~ lil111
lii (! fat, eded rl)r ilOlOlLt onl)~+ For o~11mplc, T)lll(!fll ~llf,4,iglol~i,li~ ~llPh fl~
'7,12dimclbylben~lnlanthrneene ~Ir Ilitrl)sinuI!lhyhtlen i!~irl iluhlii,
cnncers in eerlain [inilanls ~tllel" Ii ~il!gle dos~ ()rl the other hllIld, a
single or very low dose or eOIUlII~IIIUlR SUC]I Ji~; N~ lhmII~ItyhH [,l:Ul~
ide, s:lftole, and diuxnrle rrlay uel h,ad In hrulor~ w}lhiu Ihe lili'sp:m
of the nnimld
Animal Factors
~ln:r ies
The clleit:~! or specie~ re~l~ lul r~evcrnl rnelmg, hlchldinl~ li[e~Txul,
size. ~ens]livJty [o ~ ~peci[ie eln~ ill" c~mlp(innd. ~nd awdhddli~y.
Enrly ~t11(lil!~ ou .qhln pnltllhlg qd¸ hl~l/~l[nlpy~ei~e ~h~lwed llult inico
and r lll)l~il.~ wero resl,ln~ive, while Ihe low oLher ~lleq!ic~ t~.sl(,ll werl.
le~.,~ l~!Sl~llsive. (]uillen pil~ life rs~)[ suitp~)~e fnr t(!!;lillg ~lil~11i:Llic
~nlidus and ~lminl!~ or th(dr Ilrecur~or~, They eillu!r Ilu'h Ihl! ('n~l'nlr'
~.yst('lll tll~lt getiYalcs nl~lrll~tlic Illnill(~ r~r degllule I[le n('livltf~'d
i~etzllll~lile so rnpidly Lh~Jt Lhel- i~ nn 0f~(!t Over4111. tl~il'e ure ihe
I~II)~L ilserLd iinil~lds ~or ~!<in ii:dlllts[: IliO~l~auys; i'ltL~ Illl! U~('ltli li)l
test ionf er tsl I hnl might Im fed, e~llectslly wil h nilzllsll cerul~i~u u~l~ ~ll¸
ill.onl~ltie all~ine~; 0nd Ii[Irll~tr!T~ s(!(!in I~t!tll!r ~uilt.d I~)r ildull:l~inll
sl ildies on Illhl)z~o SlllOk~ or il~; r[llrl[iOrl~,111 ,L
I.nrger¸ species includhlg Ihe I~dddl. the. nnd I~rilu~le ll.quirc ~
h~l~l!cr time (l~ nhfnill r~.~ill~: Ihey nt~ eXl~en~ive hi IlllI~l~:~!~l', i~
lu~dtllaln. ~111(] Io LesL; ntul Ih~y ~Zl~! It,L id~ly~ i'(.n(lily Iiv~li~ll~l(,
17%
Wilhilx a givca ~l~.t:jes. Ihel.~ lll.o liku]y Io I~u ~iz~dile ~h.ilin
VLLIiHIiIIdlS ill l£~pIlIlSO [a J111y ~lJ121?i~Jc Ulll l'il1Oi~ll, ill |hu ILI(JIU lluul
Ill ~h iliIj~ <i[' l£1t~ llul[ have ht.~ll le~l.+d wi(]I N 2 l] fill l.,Jlly lfi(,elilllliilu,
th~ i u~+lJi~li~e ill iJ ~iV~ll tllrl~ut or,l~illl Vill b+d fl.am zi, l.0 to u]itlo~l J()0
l)el'¢~:lil, d+'lwa+ling on tile bti~il] ~hlliILlrly, l+thitmili~ CiltlS(:S liv~!t-
[llliJiJl ~ ill ~ol)a3 ~[i llill~ ol ruts b[l(. lltlt ill sJt i l['l'S; I[ ~i llgl~ Ill+~] dc~ uf
7, 12 dimelhylb~i*daJi*ntJlia~oile h:aLl~ to u higJi incidence +if mailx-
ltlal y tllllllll~ ill ~lli'agl~+Jb~wlL.y-d~l ivl#d viI'~il] fl~laLil~ i'a~s ~Jld ~OII~
ill b(lllle ~lihel" ~tl't~ill~. mllUst~ ~ll'ilillg al~o I~jlibi[ clalsidl.rahle
{2KI
Tilt] gIIUIIIIIIII~(IIL~ incblellce O/" tllnlol'~ of pal'tlcuht¢ organtl vul-b2zl
wilh [ha ~h :tin ~il'mdmal ased flit the It,lL. '|'hi~ I'~c t cq" will d~lot hI|lie
Ilia nmnb~r of ~ninlul~ s c~luirud far a mPanillgfld a~xy, ~t j'aill~ with
II hik[li ~l~)lll~lll~tlll~ ill¢id~llc~ flj tlilllllls Illay b/2 I~l'ti~Ul£11+ly ~ll~i-
liv~ IO I~Xt)I)SIII'I# tO t~t COlllpOUl)d~, II I~iil~l'll~t~l'isti+3 Ill;it will also
~l|~ct I Lie IIII Ili~ll!l~ el" aninmls ne~,<lud l~r the assay, ~l~ci~+ vilriatiu tl
ill ~lItilllIll~Oll~ [[l[llor iI~¢id~ra]~ <l(Iu~ aot, howeVUl+i p~edict ~mlsitivi+
ly It] Zl ~ p~'rilie age/it.
llul~ltc initiutinl~ any bh)aasay, lhorollgh ~tady of the litul'ttture ig
lli~udt:d (a ,~ult, ct the ilr/)l~l+ ~ll+~tiil of ~nil]lal l~ll" tim typt~s ill
U41111iJtjllllds andt~l I~bl,.
.~+i+ l
'l'hl:lt: lift+ iq)l+reclahh~ dil'ri+fell('o~i ill Lh~ I+U+I)IIII~C ill nililo iJlld
l~:iii~ll~ u llialals Io ~lllllt~ klalwll (:ilt i:ilu ~t~ as> l~>:illlililos Ul~ th~ higlii!l"
Jtit:idt:Nta: i+l" +l, bl lllillm's ill llliiIL: tnice pllI~I" l)zdntbi~ wilh 7+ 12
dJlill:lhyJbt:JlZlii]~Illlbl'ilCUlll~ Ztllll I lie Gl~'all~l+ llllalber ill live/' IIIIIIDIS
ill llilih~ tills ilJl~l It!I+dislg 2 dlblcd~i ~ blill J i llJll tlal eli., With o-a llliliilll za
l~ihl~!IIl~, llt~Wt]vi:J'i ll~IIiiIlt~ llib:4] wl~Jl~ illi~:~;It~d Ili(lj'l! Ibilit alale~, 'l'lle
,lifl~t¢ Ill'~:s tll~W I+zsidu ill Ilia I'l+lu ~+ex h<H lilill]l~ llbly ill Ib~tel lilillblt~
t Jiu lcvtri~ i~h:t!z lit hl ilI:livilti/),~ l~llZyliars.
~l;lJ(! ilib~, <li ]ililll~ ~h'aills Ill:lit II£1lliliJ~ Lhl~lliSIJJvl!~i, CLllZ~iill~ ~il~bl
wUlllldZl illld dl~ii~ll~ The llal]~ l)l ~lluh ~Lraili~ ~hl}idd llO~ b(~ a~l,d Jill.
Ib~l III;11 il~al~'s Illilt:~ Ihl~y tli'U indivhhlally hlill~:d o1" ile/Ibn~iltnl Io
i~ill II tllllUl I'¢~14]II yllill)l~
Aria
lli liallini! It~sls, allililui~ Little iilU il l~!w w4~l~l~' li41~l wt~Iillillg iil.o
lle t~b~i i i.l :~i~ I hal llii:y tlllly li~ (~ x li~:~t!d hl I Ii~ Ii!~l n~unl liar life liuljtlt'
iJ~lll i+l lhi~ lil~ ~liiUl, If llle illlilll;il~ ~ui~ l(itl lild which llla I t.a1,~ bi,~i n,
lli~b, lilliy tJii: ~il" lILh~i, (!Ziil~ hi~b>i(~ llillllil~d hliv~ lima h~ dt!vi~Jiill,
Ni~llii~ilili Zlllilliiil~ ill~ lilta~ ~ii~i!iilibit! Io 1111111y c~il~illili~t!liD th;lll
~ui~ ylnliil~ ~id u It:, A ~ h'ih iiil~ e~iiliililt: i:~ llie illduclbul <ll¸ IiVUL" hlniin ~
T I/UTOG9
I ,'G
in llllCl~ trea ud on day 1-7 of life hy ilflatllxln RdAl"llll; much larger
thmt:s of Al"l|, adinlnisLered to w¢ilnlings or yountI ilthtll mice did not
induce liver tmnor~ (25). Siinilar r'---~tl]~ weit~ llolud with vinyl
chloride (121 llowever, the dillic ulth~s in using neonallil animals are
mieh that thia meth¢d is hardly used flit routiae testing of cmll-
[il)ll lidS,
Dial
Both the total calories available frmn the dial and Ihe type of dlut.
influence Lh~ oatcon~o of clu'ciilllgeilicity ~Ludi~. I~e~ttictbln in
cLtlorie~ may d~t~r~ll~ liar o1115' the |tic|tRent.he t)~ ~ll~JlLllllealL~ tUlll<lr~
ira £1nimals but tllsn the l~lltln~u LO ~ curcillOgOll (21~ 241. I)it:l.~
ll~lq~lell~ itl protoill, ¥1t ~lltliii~, Ill" tlL~lt~ i- ~nl.iLil I~iU[lll~ inily ~11 htllit ~
the action of certain earcinog~xl~ (lll. Oti L]IO olllm" h~lid, Iligb lavul~
.. of ~<~lll~ vitamins i~]er~a~u the activity of det~×ifying ullzymus, Illu~
dullres~ing ~r inhibiting a eurcinol~enic ~l]k~cL. Ilil~h h:vcl:; id¸ lill~
ullh~mee the acLiot~ of ceRtain t:iircin<lgen~ (1.1, 191; in<licallali~ ill~
tll~t high tiLL levels lead to pr~ducLion t+l bile acid~ {17~, which may
have a ca~u'cinogenic effect+
Adventitlaa~ dielary factt~ LhaL nmy al~ci e~lrclnog~nusis ~l~s~ay~
includ~ tr~lcu~ ~1¸ liitio~cmiixles, iny~lJitlxiil~, ~itid lle~ticidu~, Mziny
ilitl'll~tlllill~ £tlld ~OliIO Illyci)to:<ul~ i11"~ ilighly al~liv~ e~il~iilol~t'rls
+l+rae~tt of p~sLicida~ mtly illlt~l~'eu~ynll!~; that a~Liv;ll~ <~l¸ tl~!hlxil~
care|hegel]S, Simil~lrly, vt~geL~lblt! lllzli~tial, u~u;llly ;i I:tlhlll~liUllt Id"
tile lll'a~.u:~ed i'od~llL diet~ ~llbl ill i/~rl[~t I~ll ill, allli iizil ill× hbllll~ ~lrl ;1~
Uilzynl~ illlhlt3~l'~ llll(i lll~ly Illl~u~JlC~ Ih~ lalh:oliiU ~ll ~ ~llciilt~l;eab itv
,~l~rJHllllJt~rJll~ Tlllaor I//i,~/cll(,iy
~hict~ tllimy /,Xll/q'illil!ill~ will I:xit!tlil tlver Itlost ill Illu lilt!~;ll:lii IJl
tliu (~llerilliental iiflilllill~, h is Iltri:c:i~Llly Ill klllIW WhlIL !ilillllttllll IIIIH
I tlllltll ~ lliighl b~ e~ll01:ted, The Illally Iilurlllure rl! fi!rolirl!$ (ill tllllllil'S
hi V:ll'iall~i i>lit fir ii]allS{! ~tl,llili$ ~]tllllbl IJl~ iSlJliSillit.d l~l> 7, l~ 71, 7[l.
'l']iu~t- lillllJsll backgrotilld illllll'illali(lll till ~plllllillil'i)llS liillalr Ilit'i
dl,lli:O Ihnt ;llbiw~i till! i,(!sUlilClitrl Iii ilv(liil ii ~llibil willl o Vlrl'y liil~h
llllllOf im idcliel~ tllilL lllliy ('lilllllliclill~ Lilt, blll~l'lllLIiilillli ;Inll t!vlilli-
ill i~ul I)l bio~is~,ily ilaiaL 1 liiwevur, I IIIliOi incidence ill llli iilbl i:d :Sll'iiili
IIIily shirt iIvI2r li ll(:rbid of yeal~ l,+ulthellllOlt!, ,nllOt:ilic bibillilliny
cilildiliollS stich as Ibed, %Villl!l', Iillhlinlf. Illlll~illll, illlil lililullJlilf
llllicl~dlll4!~ Illliy llll~t:l+ the "~lll)£1talll!llll~'~ hlllll)l inl:bl(!ll(:i' l%+deqilillt!
naliilllq'~ +if ilnlrt~alt!ll 1~411itJ[li iiiiillOll~ nill~l, be+ ilil,itllb!d ill llllr
I '¢7
ll~tllJ41111, ~1¢111i~
'l'he inllllqtlll! ~IIILIIS of" ~tllilllIl~ Inllllt!ll(~$ [llelr rI,~IMIIIS~ hi Jll~
C~llI:inolg'llic Jieli<m (it vir11~(.++ rlr Itll i~ivhlh!t rtlt]i~llii~rl (/. /0, 1+/~, ~.'I)
*1'~1(2 ~,d H ill! IllllV ll(! 1.1 (1~ Jill" C}ICI~iCIII C~I PCilIO/~[*II~. /~ ILholllIh
illltllllllfl
~tllPl}[~'~:~IIlll ilI(!l(~l~I.~ Illo likelihrmd of Lumor iI0~hlllln~.,ll~ gH
I!llll'inOJ!(,IjiCi~y HLlld~(.~ lilly(! heel1 IhlllP OI1 ill)lil[llIO/$~lliiHf.R$~(~d IIHi-
l~hmt~inl~
zltil~ll ~[ll)tlltl II~ givon Lo (le]ille:tiilq~ le~+pollgib]e Pl~I~oHrl(.l ~ltlql Ij)(!il
~N'l~i~C d ul iPP+, Db[lljllin~ illlll ~llmlyV jlIEI [h~ te$1, ~ulmtlln c'e. seloc tinl~
IIl~ llllh]llll ~;IH't~iOR nrld ~rllhl. /~111] th,chlillg oil dose, roll[o or"
JllIltlltli~It4lthHl, J~!llI~h Of ~X[~)SIIre, Ilnillllll grollp 81z0. llll1(101HiZIl-
li.tl, wh~ll ~,lr~efvttti~m~ .rhntrlrl be ilmIle, nnimt+] htt~l]zmtlt~'. (Inl~a
il~q[lliSj(ioll, I)lO~q'L~ill~. ~((lr~l~(<* ~Tl[] I'CU~V:j]. IIIl[/I ~lnN]yqiB Or
~ltm lily I:ofll I ol mensm es [fl. Ih. gq;).
(~llll/ttll of Iq~7~'ri~lctlts
~lmnld be c<~ii~i(l~.,re(l: Iiil~lrtml.il)e [)f rl[!wly Cece Jv~d u rlilIlll Is; Siii veil.
hm~'e I~r¸ dim~:+s~,: proper ca~in~. I~en~,l'~l evtviromt~enL, lil!hLhl[~,
h~ml,!r~*~tlre, v+~lnli]~]Li+lll, .and hnnrlliIIl~; hellll.h mnllif, orln/~ or tt,~
+*rliln~d~ ~:lini(!M ex~iminu(ion; biocln+~lllic~ll slud[es of bh)oiI, uriell,,
~lrld I~,ct,p+; illl~l>t.¢ ilecrlyl~sy i~r'oce+llll~!~; hi~[op~ll.hol~oic~l [echlliqtl('~,
dl;lCmosi~, I~r~d sl~Lislical +umlysls; ~nd ~ elmr'~ I)relmratior, (,'/.8}¸
~m:h ~ltten~ioJI Lo devil, althot*gh cosLly, i~ ncces~ory to ~void
di:~+rt!l)tllll~h~ IhliL Ilmy co[llr)l'Olni~e or illv[~]idllt~, (he resll[(~ Dr ~he
study.
2'l'gF TOg9
r/ll
, +,
lleh, rellce~
le,,dr,~Jttlir#V I)ep~H I~wnl t,f I I, ~lllh rlml WI IrisH..,~ I ~:mm]:h H)7:1
#()lINT I.:1~ I~,1 19!~0
(I) I'()<)11 Ar~ll IiIItll~ AIIMINI?~IIIA'rldiN, Al)Vl~-~;Ity ('TIMMrI+II:I: ill4
I'IIOT(X~)I.~ foil /~,1'1:1'5' I:VAI,IIA'IIIIN p.ml .. ~l*~.i?.,p!,p..~N
1971
(5~ (;()(~llMAN, IkG. WAIID. ,I I~l, S(tl t lIT I+',, It ^. I!llII, I(C. I,INIIAll r. M ?~
~l,ol)lOsli<: nlld nnll.POl,l~l~lle h~L(,n+, ill lll~ilnl~ l+31f t~l~ 7i+~I+,,I.~?~ ,l.d
N~rrJm~.hd ?t~o+.rlle~(+t~h 16 Ifi~ 17fi I?JT~
(~ I IUM I~l I Jl( ;I,:1], F. III/~,ql' [I.:1 II, A II.. Wl~lgflq II/(]I,:pL ,I I]. fill, q, I'llh
I(
hl~lit~lt~ ,g~lll !17 ,IG, ,l~ly I!1 Ill
(~I INT~.:II~/AI+r(INAI, ~(]ICNI?y ]~lll III,~EAII¢ II qIN /'ANI!I:II h,+u~ h.nm
Ill} I,OP+~I~AIII)I, II, ~IIIHOZIII(A, II l,:pflm+~(~+m<,+fl of '~m+,l~qpllhq~,lhl~nln,.P
lJv(.r Ctlrchtov~,r+<,s~s i~ e+nr,+ [4~I +~ ChtlliOt~ +le~itl diel l~d,/1,++1<4,.,:I ,z,~o
,4rl
1131 'IItI:NICr/II,;III,ANDS Ile:dlh(',..wflofll,~Nr~hpOm.I~ yh*.vi,lhl,rtlm*o[
~11~ I'III~JI.',AN, J D, I'E(!KIIAM, Jl!, (?A~I'~Y, AI,~. It11151WII1,IL lip, WI:I~I
1973
It~q+l+ll~ 32:~!~7 'ITS, 19HII
I~ 1975
r-*i
r~H) Ill~ ATrZ, J~JlA~, (~ 'l*LJnlJ,r inqhlmlL~ EJu(l~rn~, i~rlLj alU[rilicHI hi Ih~ raL
,/out~,d~*/~,r/itllt~j~ ZJ~j~ ~1~) ~l~)~ Nc~W.lld~er J~l(;5.
gY ~c~.l AI~ll~d l't~,~h~v ~41. F)~2 ~Z~L~ Atlgn~t 197~
I~) ~IlNIAI;* J M. I'~llE* N I'. ~AI'I"J{)'IT[. II ~luid¢~hL~.~ ~r ¢lLrcilmgen
bioa~.~ ilJ z,~li~l[ rOC~lir u { ~ ~1~, ~1~,~ N~lli~nul {~l;l~C~l I~i~lltllle 'J'~ hni.
tul Krj~JJI ~'tic~ ;: l, N{!J (~(~ 'IR 1. Natit~ual Ca.~ur hk~li~utu, b'¢lmi~ry
{:~) ~J'I;'I'hIAN, O hurnutb01~it~ol ~,ulvei~m.¢. hi: Illutt, H II, Wal~,m. ,ID.,
Wh~tu~l. JA (I,~lito~k (ht~,*.s ~ll.~l~n I~1.¢~ Bd~k A. Voiltiuc 4, (~Ad
~prnJg Ih**l~l, New York, t~ld ~l*rh~g il~iL~lr I~lJo u~o y, 1977. pl~ 7~9-
1211 'l'lll!J{l¢ll' MJ. Tl~e ,~ff~..c t ~f I~u,g I~r~l~ fu~ r~lricLion oi~ tutn(~ l~k i~lent~
I:~ ",;I.~ELINOVI~II, N i)., ~,IIliAJIIIV[CII, N., WI)~&N, G N, [X)MBhR~,
I.N, I(AI), I{ '~ N. Al~ut(~xin B*, u h~lutt~urcir.)~,:t~ in th~ itl~ll~L ~ll~>lJ~u
(~f.~w*¸/h~¢u~h 3~ I I ); 22~ 2~9 I. Novcnd~r 1972.
I~;I WAI{I} dM, {~()OIIMAN, I)G, (llll~l~kl~l{, I~A~ ll/~ll[~l~'l'y, J~,
l*~llh.h,~l'u~d ?~h~.~): 371 37t~, Niiwlnt~r I~,,~n~bcr 197~.
I~,~ WARD. ,I M, G(IODM AN. DG., ~ll~lll L~ II.A., CIIH, K(~, [,iNIIA lt'l~ M~
IBli{~Jl"d iul~. ~urnul o[ Iha N~rltunul {it~.er I~lsrit~le fi3:849 *~51.
(J~l Wl!l~l; LIKII I!1{. J I I, W[~ISII {J R f~ ERiE [{. l~ta fi~r ch,~llii~M ca ~ino~:mt~. hi:
~t~kr ~1 I~*~itl~r) ~l~l~r~ ~u I~r~J ~l~u~,h l. N~w ~urk, A~dulnic
~1, J,IIIL I )ll!l~nizi~li~)~l, 1~7 I. 21 I~1,
L.,
EXPERIMENTAL CARCINOGENESIS W[TI1
TOI|ACCO SMOKE
[nlr t~ductlon
'Pobacco carcinogenesis CXelnl)lil~.~ a m~llllingful l*n(l succc,~ful
interne{ion between epidenliok)gy and laboratory sLudies, q'he Jmpe-
{tt~ fay Lh~ d*~v~[ot~zt~t~t of ex p~ in',~uta[ to[~acco ct~re(~o~ep.~ig cat~
from targe-seale epitlemio[ogic sh:dJe~ between 1950 oral 19tgl} {2, ,16,
Ill, 1'20, "201) that indlcat~d u cans;l[ assoclati~n }letween cigarcHc
sumkirli~ and cancer (sue tile Part in tiffs l{epmt on biomedical
evidence).
The Physlcochemlcal Nature of Tobacco Smoke
Dur big Lhe I~st three decadt~s, major I)rog,~ tlas h~en z~ctlieved in
our k no'h'led~ aL~nt t~bace~) snmk~, i~ tbrnl~ti(m, its physic~rchemi*
cul nature, and it~ compi~iLiml, rt'bi~ new k nowledl,'e tla~ c~m~ributcd
~ignificautly to biotogi~t$ in thulr study of the i)harmaco[ogy,
toxicity, and carcblogeJl[ciLy of h)baccn ~nluko
The conlpc~uiti~n of tohacco smoko is a funct ion ~ff the physical and
cbemical proparLie~ of ~.he leaf ~r ~t" (be tx~haceo hleud, ~.he wrapper,
and Lho filter, as w~ll as the way the tobacco is I~lll-r~l A variety i,l'
i:lp2utit~t*[ ~ntf [~lLy$ic~l t)lt)c~:;!;~:~, occur in [he I)xygI~ndu~icit~rl[,
hyltrl)/Jl:/1-rieh (!ltvironmoat o('Jll~ l)tlrnJl~g cl)nt~ {if Ih~ cij~'iLrerle 111
lenq~eratures up to 950~(!. 'i'lle.i]til~;'ity of Ihe i~l~ru than :~,t~{~f;
stnt}lle cun]|l{)ll~n~ ~u.,3 f(lliil¢:~[ iu i~ j)~lo[ys[~ diM i[J;l[i~;ll ziJll~ jll!d
bchind r}le tu!a{-genel'.ati~lg cclnibu~tilln znlL~ ((;. Ill). q'lm sllllJJlt~ [~
c;tJ[t!d mainsl.r~aut slLl{)ke if it i~ g~l/~l~tll!~l ih~rilt~ a {~lll~¸ ~ud t~xilu
IJ~)tn tJtt~ buLL end alld i~ czJlled :;id~t;clun bLin~kl! if i~ ILriS~LS IJl~tinlV
flOlll LII~3 l)~iv~ btu rtlng tll Ih~ Ioi)B~:co pll~lJlu:L ;~nll i~, i i~l~;~l:~l iah~
t h~ ellvil'oilnmiiL
Smoking (hntditions
'lLht! i:Oltlpl)~i LiOn O[¸ Lb~ lulli[lsl r~am ~llt{I sill¢~L r(~llil i ~,llll~lt t~ dl!lll!lltl~
[~r'l!ld]y t]n [tit! slll~billg colllJilio~l~ ~tnll l~i~ tnt:lhods lff l ol~(;c~iOll llllll
~ll;llysi:, This b~J~; Ioag beeil i~lbzed; illor~ ~li~bll ~() y~;tl~ ~tgl),
stmldnJdizl!ll s;noking COll~lilillil~ Iv~!rl! i.:~r;llJlislle(I fi)l¸ ina~:hm~
I~il~q~retlt~ ~lllOkill~ {.t), 1~): i)llu ~ecollll iJtlll i~L!r¸ iBirllli~! wilh IL
wlhnu~ of :15 nil at~tl u hul.~ le;ll~l h oi' 2;) mtu. I~l¸ [i11,~;' i:ij~m el tcs, Ihe
bull Icnglh t~ giwrl hy tl~t~ h~nl:i b t~i' the filler tip j)lt~s ~verwrap r~hJs
~ inlll. },'~}r. t[t~ ~tll~l ly~i~ ol¸ ~iII~M i u~J~l ~nlllkt~, gt ~i~:~l ~1 [~! is i iI~b~'~l ill
1;
water.coated gla~s w:~sel wilh a I~'~ immr voluum al 250 ud The
i:ij~arette is ~ilnok,ad IInllur Ili~ SI:Lli{I~LI'II ¢~JJltlbil)ns al)l]lied I~r' till!
• ~ilJPsI I t~11111 SIIII)JI(,, II11 III1" IIIIw O[ J5 Ji[cI ~I per in JIHI[(~ j9 ~IC tit. (11
rOtll.r Jl
Lira gliL~s w!~el { 2,~}>
The ~llliidalll eJRiIfel[e ~lJnokJnt; c.nllillon~ rellel:l, ibe nvei'lll~e
~lilllllill~ lllll~Jl~ id ii nl4ile ~lnell~i ill ii.urlller dlgllrefLeR n.~ [Ieh,r-
ml u~,~l ]~ yl!a~t4 ~l~ll (;1~1. 'l't~tllty, Imvgev(,r, I'~ w e.r I.htt 11 [(I lie rl:e vii O[ LtJI
{I,~ ~lllllkois Illllmlll" Ill I'ldh~w Ibis ilnlt~ln (I,'70J. The overage
~lnlillilll~ illilllllll,ll!l~ I~(!111]~4 lecllldi,d [7*r liRer ¢igaieLl~ ~nlllllel~
wele mie llulf ill I !11 to l.llil stx'onlls dilllli.]f)ll~ repealed every 71k!l l.
:Ill II ~eetnids, wilb n pull voluille or;15,9 to 47.8 nil (75L ~e ver tbeles~,
J,'l'l!~lan~blrd ei~aleile ~nlohin~ eondiliml~ continue io be u~ed Ibi
I~Lilll[lilli~llll~ Ill Illr lind niUl)~ille ~zJe[ll~ ill ILJlI~ lilllOl((! elr lli+elellL
Ciglll~iles lllllJ [f~r I~lllll[llll'iSllll~l IleiWOell jll+l!senl CJ~liroi.l.f~fl Illld lJlo~l!
JllllodUl:lion wl!re llll#.illned Iiil~lOl, Ihe ~tllllldl]rd $111okJng C(llllii[iOll~,
/3xel!p[ whlJl/, uI hel wi~e IIu{tJll.
I"or eiglu ~ni~llllnl~, tile fullowili~ eondiLhlils Imvo been widely u~ed:
Imit~lh ill ;13 mm II0#). 'lPb~ ¢~lndiGm~ u~ed f~r ~id~sl~e~lu em~ke
I~lilllJlhHl~ f~lr llilm ~lllmllinR hn~e IlOl been sllmd~lllizell, liiLIIOllgb
~flllliilillll~i lli" II ] ~el'lllld I~lJ[[ evel'] IR ~ie(,~llldl lilltl ii t~lll[ i()]ullle I)f
~ll lul huve been r f,l~ulllelll~ ll~ed (l,'l,ll,
Tenilll!rlitu re I ~rofil~
Tile II'llllll~lillllrp Ilrofile~ of I,]lP lllll ilJlll~ ('i~ll[~'lIo ol~o IlJ~el[~i~d Jl~#
llle It!lll~lb illliJ eJl.l~tlrilrel.eil~e (tl- lile ci~lJiel[e, Lhe n/lt, lllQ O[ I.be
h,hlicl:n [ypl., I~r }llenll, the mnount 111141 II[lJiJ~ Of Llle l)l~e~ed
tt>llli~ctl '+~h!m~>" tha wlllth af the I~ll~lt:(,tl ~llrla ~l~, the packing dm,~il2~
nild I lie llllli~l iIi i! emil roll of Lhe Loba¢c., Ihe prJlo~iL~ nrl(I JngrellimiL~
~1 Ihe i:ilfnl'elle llapl!r, lind tim design nf IIle filter (inehlding Llie
[illffl illlll{.I,flll iii1(1 plllKiJCil~l'~ IIt~lll~ I.eRI~LliIICe, CIJIII~[[II('I]OlI~ IIilfl
jleril)l>~lLillll). Ihlr il]~ tilll~kill~, LIl0 Jerllili!rllJ.llro o[ ihe blll'llill~ (Tfllll~
ll~u:lll~ Up Io !)50r'C; hot SllOlS on tim I,(,rit~hery of the burninff ~me
uuly rml[41 TI)~O~C (148, 207). In i~ elgar~lLe wilh Imlie~ of medium
pllrll~ii~, lbe tel.lmlnLllre fnJle from IIIJll~ to 4ll°(~ over ~lle aO nun of
Ib~ L~lmee~ ~mlulm~ ratj~eel~L t~ ~.1~ I<~l nh~g ct~n(~ ~185). Th~ higbesl,
lelnpl~lillures Of elgiir~ rim# I'eaeb ~liRhtly ~l~ve ~(I()°C ~nd Limbo oF
pilm~ iluif go ~ligllily libove I]Oll'{~; [mwever. the lemlierlatul'e
eilfnlell(% iwinlarily Ileeim~ of tim I~l'gel dlamcter of ihe burlllnf>'
CIIllI~ Ilntl Ille vl'ry IIIW Ilorimlty of ~lle ('il,~ll f W I'll I)~ l+ IlIITJ o[ ~Ill~ pipe
bowl (202i.
Ou tll~ b~is ~f 01~ Lemlmr0Lure llroli h~ I lil'(~ ~one~ nl~ dellned in
Iml niilg ~igni+etl e iI01hlg im[I] ng: Ihe bil!b lenilmraiuie ~ane {9111)-
t;(]4 I"CJ, wl]idl i~ very low i~ I'~ee o×ygell mul can lilins up In 8 vohime
I;'P. 1:01 t
Ill'l'l'L~ll[ Ill" hydlI~l~e;I and I.~ volalnle IN!;cl.nl ill" ('ltllmll me..xid.; Ill~'
rlxylff.il-lh,ltlcled llyr(llvsis iti~lithlllon z,lnr ((;llfl II~l<'(~); nnd IIIf. I,Jw
+l']l~. ll¢,lugll ~!oliPl~illoll ill iliillll~lll,~lnl ~niiih(~ ill i:lll,~ ~ll llit.!:l, thll,[~
z,~ll(~ hy hylh'ill~l,nrllloli, pyll,ly~i~, llx J~lllllllli, fll.ca i h~l~yl;llilln, ~h.hy
ih'lillon, iI,~li~lil~ Imlwl.l,ll f~t,shly l[l~lleialed ehmilir'al nlU'<'ir~,
dlsLi[lnLJon, ~illfl sllblimalhln. 'lhe i.xi[ II'nqll'rlltuil' elf Ih~' lli~lin
~l~e~tll ~llml~e rlml~+.~ (It~lll '25" lu ~11~(!, delmlldilll~ ~ul (he hull
hml~lh. The llrev[fllls]y rlh'll h.ull,Oiallno lulllih.~ i[,i llol tll~l,I~ h~
i:if~nlellos wJlh lint F~rlllf.ll fi]tei~ In Oils ¢~isl!, Ihl. s~ii~lll~, is dlhih d
I~ nlr d~lwn Ihlolll[h llle []lh.r wllllllll~r. Tbi~ ]lp~vl!ls Ilu, w,h~,,ily Ill
lil~ air (Irnwrl IhJmll~h Ilip hlllrillll! ~'olle. Th[, ii,~ull Js Ii ltilblf,
e¢llnll[l~r o i~l}lillluBI i~lil ll~" I HiP (i~ll:llr('l)
.~lnllbe A mlly'~e~
AbouL ~lf~ pl!ll?l!nt i,f" LII(, Inlnl well(hi ill Ibl' nmil~h~'nut snmkl'
ill'il~ ~ ii ~l~ ~.~ [i Olll t]l~ ~ohn¢'cIl~ ~ Ill! I I! II iliJ li[ll'i" i:llrlle~ I¥11111 [ h~.
Illl¸ ill ilWll
efffil(mL ~1i11 n nl)n[iller cil~all.lfl! i~ illllde lill iJ[ i~l,llsl llalli~,llb~ll•
rn~lller; iillollL 5~ Io I;5 peireni :ire nilrol~en, ~ 1~, Jl ll~ll:~lll Jill,
oxyl~Oll+ nllll Ih~ relludnl[l!l¸ c~ln~isl~ of ill]let i!i1~ illiil!;t, C~mllleli~ nl,~
f~en~Lod dllllnR snmkiilg (107J, [bldiluled eil~nietll, miu~llt., ~l~ il
[~'I1"¢ ~'~ (b~ I~o~LIip~e~. C~l~l~lill~ "~L~I I ~ .% "/. ll~~ I~l~t~vl~i.ii~ p:~l I ~.1~.~
per iill. willl rnlJlll[ and ~l,helh~ [e,l~ll~ llUih, iil~ in diniul.ll, r h~.lw(,~,il
O.g ~rl~l I.I) iI nnd n mediriu Imi licb~ ~i~e ~ff nb~uli. 04 it I,~ 107) h~ i hi,
erlse o[ [illpr e[garetLe~, the lii~,~linn [iz~lliel~ ~izl. +11¸ lh[, !~m~lhL. is
~(nnewbrlL mlln[le r (between (}¸;15 04 iO. ]"~lr ~ilfol~,ltl~.~ llilh Ilt'llTHnl
e<l filler L~II~., LII~. mule[mr id'llEu¸([cl(,~ ~euelilLed ~s ~il~llili('~llt [y I~wl, I
Iluul liar un filL~red ¢il~.rel le~ f31;),
'l'hn ~nl~,T~e parLi¢ll!~ thilt llll, iil]lnled zJil! ~lil~]llly ~:lmil~l.d wilh
ll]llluL I{)I: ('leelron~ per glnin i,I snullll~ {equlwlleilt [~l Llvql Ill Ihil,~'
ciglil~l[o~) ~ill~o Ihe mn~llle i~ pallhll[y I~eueillh.d ill Ille ~lxvl~ru
~h!iid~llL zlln~. |he li~ro~l h!uvll~R Lh(' nl, ullhlllf'e(' has ii.l]~l~.iIIl~
tleLJvily [hal i~cl~llsl!~ wi~h [lie litlnlb0r ill llld[,¢ ~[i';iwn ~lnd l[i;ll
di~nllllt.lll~ c.olnpl~l~ly only lll[?llll~ il~er 81nlli~l~ l~l,ll(.laliOli I/f;l~)
'l'hu~ Iresllly gellelnled ll~l:i(:,,, snl~pk~ n~ in~ulh>fl unly ~ll[t,(I Ibl.
refiltx Imbmee ~[ re~l)Jr~lioi~' Lllul lissue'l.
'rh,~ p[] (~f I~lb,aceo ~r il(~lt (~ i~ o1" llil~ll- ~il~ni~callCO ~ i ll('~. IL illl ]ll(.lll i,~
its illh:~hlhiliLy hy Lbe snioker liliql Ihe llv~lill~l~iliiy ot' UnlUld.nni,,d
n[eo[hl~' (..~). Figule I dl~ilie#s Lhe j#eleeil|lli~e id¸ ilillll~lEnial(,d,
v;~lioli~ pll FOr a blended U .~ rlRai'eLte, Lhe iiii .[ Ih~ nmhl~ti,,am
~lnoko vnljes b~tween .~.~ nnd ~ '~; ciluirel[es nl~ll]~ exl:bl~JW![y ll~nl
I~llr]~.~ ~r Ill~ek |ol
II 12
It
b~
G~J
a~
I@
(~ ..... gL ~l]iJ(;Ky
a 9 1o II 12 14 2o
2~ ~ ~ 41~
I"llilllll!~ ~,--pll ~)I indivhlll[il pJdl'~ id" I~da] lilahltill-~m
~lllllllO Ill' ,Jlifi()ll~ loJ)ill~,1 llr~lllu(:Ib.
~)~lJl~ E ill ~J'LIII'III, ~ll.lll,~lJIlh,llHl~J
IIIilill:~l I ~liJ 1 ~lll(}ke~ L)f ~0111~ It )~IH "l:O IlL Ildiic~l~ (~1).
Bioki:~;ays
hihiil;il h~,l ~I uIlic~
hh:.Ily, z~ ~ ll~l~.chld l ill {:ill~}~i~l i ~li¢*ljld l,e li~i,:¢I il ~{ili~ l Ii,! l.Oll i (i of
f; t'[2TO 9
hesu.I will, major diffle,lllit~s be,cause o~ t+)xiclty il~ti.~tluced Ily I~igh
¢~Li']l{~i~ Illll~io:~id~ conco,iLl~liollt, ~[~t~lll!l'~lliy 2.5 to .~ vohlirll~ ]}~lc~nt,),
I~t~(l hitch I~vel~ of ni¢~tino. I"ui'L her more, I~boralory anlnl~ds ar~ lloL
~vil]i.g Io hlh:~lo ael o~o1~ vcl'y deeply ILn~l ure e~p~chdly rehlclanL to
inhale tobacco Binok~. ]~ha}atio,~ ~hldie~ imve bce:l exp]or~d by
trail]il~l~ I~lLesu~ monl~eys an~ baboons to sm,lke CilpJretl~s, Th[~
~l],pro~l~]i doe~ iioL ]ll'od~lc~ l~lilt~lo~ ~L,O]II~]~II~S Ii~ltl~ oJ~ ill~:tll]i.
~e~oly I~ i~f r~th~v t~a~ tl~ i~l~al ~ (I0~, 1591.
~llv~lt~v/2 lllld no[iiJIv~siv~ lll-i)llcho~]v~l~w tllnlol-~ d¢!v~2]lll~d ]11
s~vellll of 78 riots that were trebled to ~lnok~ through n IJ'ache~slo-
,,~a and Ihal smoked cig~r~ll~ ,hilly for about 2L/. ye~J'~ hi a i:l'O.l~
of ~4 do~s that smokecl I~oJflilier c~ga]~Lte~, 2 animal~ d~veloped
eLII Jy iY~Vt~S~V~ ~quanloll~ ~:eJ[ C~il"¢illoiiiJ ]Ji []1~ l,lolwlii (4) ~ Iiiw~V~l',
i his obser v~llo,~ has not beeJi i'L!l~Le~l ~ flit ( I37"1
A Jmmb~r ~f irlll~]atiorz studie~ have l,~en c~,~luctcd wiLh ral~
Ih~cel~t]~ ~t[ley have yi~]ded tulllors of the rc~plrato~' ll'~lct (,l~ 137)¸
[1~ ~9~, i~.i~a~.~ ~t ~l~ Oak ~{id~ [ga~.ilma~ I~l~)r~to~y
~ licclt~d~d ill obl~il lln~ LLII nor.~ l~f the ,~ p~ 1.11 |o1~' (.r~lcL Of i~ LI *~ i~i,,l~ 11
highly devclol,~d ~i~olle illl[al~LIi~l~ (h~vice (4.7, I21;l. {hi 5 d~ly~ ~1~1~
we~k c~v~r ~h~il" e2rl~Jl~ lil~llllll~ ~(} i"~Ll~ wl!lo ~11o~¢~11 hi ~iii" dihllt~c[
~in~]l~ I~O pcrco~lL) ill sl~veJl ciK~J~Lte~ {llnl! I~il~nrell~ i)(:l' hol~J'k Af
L]IL! t~lld o~ th~ Cx[~o¢i,ll~nL, ~l iaH4~ LiLiinb~r ill i.ill~; }11]~1 ih:vcl~ll)eI[
Ilyl~i'phl~i~ or ille~.~ plasl~l Jii tlq: ¢~lJiLIlullu nl iif I}l~! n~l~l] ~y~l l~ill, Ih¢!
l~ryux, or tile ll'tL~:heu ~cven OI¸ lla~ ~i~hty snlul/l~ I:~l~l~'~l I~ll~ h;l~l
t ~i~il.~llllry I¢"act tLiliiOl'~ wl:l~ ~l~i~ll ill ([~ I,lili~lie~d cl~ll~ i"l~ I"i~1~ {.l~l.
lillu ~llldi~:~ ~l~ll~ l~ IO Jl~ Ih~! ~yJ inn Kohl~:ll hain~i~J¸. 'l'~li~ ~llli~l~:~l i~
llll~] ~ r~MatiL h, re~l~iJ ahlry [Jl(~'~tillll~ tha¢l ~ll e J~lic~! mid J ~1~ Jlllll i:~
o1~t llloltz [ol~r~l~. ol¸ Cil!~ll¢~llt~ ~,llol{~! I,~i.~). J)onl011,,vi~l I~L ll~.
I!Y Jbl ~llt~ chlnn h! ux p,l~[ll [~ I~l¸ hlll,l~Lel's II~ cil.q~r~t I l! .~nloiie (S/~. l,'m¸ 5
'l~Ly~ I~!1" week ~L~llJ I~r LIl~ ~ll~l~lli~lll ol¸ Ihelr lil~iillll!, Ihc ilaln~lcl~
diluted cigm'eLle smollc (l:l~l. In ihl~ iI ~l~,[~l~ ~1¸ II~l ham~t~L~, 11,3,
~ll}, mid ~1~ {i [~J'CClIL o[" t]l~ ~lliilL~ls dev~hllll~d I~Jl~ hlv:~ivt! c~ll~:i[ll~
hill, ilnll (I.~, 10.~, iL~d 6.9 ill~]~:unL hml h~wl~,w! i::Lrl!ilLInll~ ill¸ Ih¢
,~lOllj111o1" ill IIL~ allillull~ ~:q)o~c~l Oll!y Io |11~ ~l~ [~hll!;~ ¢~l {:il~li~l~
~L~lk~ 'l'r~tl!l~e~ ~lld I~l'~[li ~1( ~dl ~LL~[I~I~, Wt~t! (l~l~ Ill¸ t~eo~da~tiC
I~,~wlIL. 'l'unllliS Ihat II~v~hlp~'d ill ~lhl!,¸ IIJ~a~L~, Ill ihe I!Xl,~l~l!d
LIII
4)A!IiI~J[ ~l~ ~I41!)[IILLllAO LI! [njdla~I u,~,~[I s~zlI ,(uuNI] u!l[~ O~;Iil}lll JLLL
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XII ~lo{HiiI I~ZUIJ~!I~!ul IlUtl II~!LI,]II JO UD!IJIIIItl! ~[I J~J jll!ttl.~/ol[
J~ III~ID~,~]I ,l~*ll)lllf~ld 30trill) II t(l!t,~ ~lllk)l&l)lI~ I)al!lodoI /~] pa^~llOJ
~! I~o!llzJ!idljlt ~/1! IIk)l~Z.~ SrlO(Ulll lu~Ti~jI 1OU ~OJ) IItLl~ ~tlO~ll ~ill ~! ~O~l]!]!ll! .lOlil[1] II
(~tl AO ;Ij~ lID 1 IOX') ~l/ll111~1! /[~1 t/~(>ll !311z~Ip30{{J', "I)~'IOt~;!U!UII)t]O'~ OJtt
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• mimul t~I ,to!ill,]!Ill,hI Jtla!l)o} n0o(I slitI ~o11~]] [}~!(dll)!.l.j it! ~J{I~UliI JO
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p, ,li~L i ~IA ! I~,lIlil~l,~ ,]l~i Ii! I~'l!l ~{l~fJ Jo lihi litUl 14 ! I~'~ ,lll~ tl! ~l:i
II,].IIN {r~ ~
II1~%~ ll,),)IipH! II~iI4i dAi/II ~.lOilllll till~lI~J!ilillf liUll II~l!li~l "W~]qd
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illmI JiiJ ld.LIx.] "G;I~ "IE) ~lmliluli ~.J°ll:.l(llnl~[ u! I:ll~lI ~'JoiuJ!ii~,iJ
?, lil~lil ,15 Jl~ b ,.i. a .... (,
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J~d uoD!s~bp a^Dola,~ mll 'I!/gl ~'pn~s JaIHo mll Ul "r~in[ aIll u!
om(IJnr J,l(I *~Uill pall~ln~lll~ "1~ Ia ploJ~lJalI '({½)0'1) ~lunll pul~ Ilil: Ol
• Iql il! p~|!~OdaI) alI oI lloallll ~li~la~ Jirt ~ll BI~ llUli s~fiinlI ~ln[I II:li~,l./ Ol
ptlillg axam 4~ lid I~ 'aa!~aP uo!llrlt:ilU! a~l~lius 3unJ~!/J!P ~ IIl!'~ ~plli~
u JO ,~JliG~d~o LJ~lld J~liJl/ XllAlltJ Olll li! llol!~oH,l[I iil,l~ .11!| ;Ill ~JI
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(I 1 } "1111') I)laJuJ~(I "~mligl all!ill,!1 llld ,l~trling olll ,l(I ~.lir I llrrM,ll.! nI: ~!
.rclll.lli~ ~lllI "~lrtlil ml~ Oql ii! [)UUlOJ /llu %~ll~Fllml I '~} IHII~ '~l! Bill~'~ Fin
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SOllalU3!a oI liaplm ~ua~ ,]lk)(I '~'l)lll~ auo u] '(9~'11) (dll;)(ll I'~llmld
-!llOJOIi~31~a,3~ Ill!#,~. ~ol[lll~ J~[iilJI ~tl!~E I~o!l~,lllll ~!lll I),lll]lUl!X;} ,l#~l:lI
~tlll!1@~!'i~OAU! 0~,[, "pa~llll!,~ltlJ ,I,( II/ ~ll!l!tlla.I ~liinI Olll JrJ Itlillili!~l,li:~
@ll(l!ll~A JO O~luls IlO~un 'll!ll~l JO lU]]lio~Ixl ~!ia;i~iiU!.~.llt~ aA!lllltl
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I~,~ ILl ~tiO I~ ~ltIO '[oSoJo~ ~)l~lll~ ltIO~LO~l I [ Ll~ I]~!#,'. ~,+l'~:ll III ";hlilI
,~l('i Jo ~lOlll fl'l Dttl[ ouotl ! Uol{,I II.II Ot[I Jo IrulOl[!dihl I)ildOl,~Aop ~itlLt !tll!
aiD JO oa.Ul,I, (lUa~ml Lp~:) )lS!l ~u ~.lalSlLlUql L9 Jo 1no L~ Ll! xu~.InI
t i [lll~ '0:,31!111)) J)~Jil~-~li[J U I(I.II ~1~ I!~tlO 0 lla~ I~l ~,ll~,~lll~!~l II I!M
SnlllIJ!lU
~{ ,IqlJ ~l!llp ~,]!h~'; I~OJ;~U ,llllllll~ ~ill,lllr~!~l iu,']:~J,~il i>~ II (II ~$1~1,1,~$
(Ill fl~+ (~q Jo~ a.m~lllxa JllJ (;,+Ull:l ~tllllolla~t lhl!~lOlllW .nl,}, IS'llli!llt[lu#
3!IIOM{)U!:XJI!,) oI 01{1!1(].1~11~ ~! lltll'~ U!llll~ J.II~llll]ti ll,)Jl{u! llli ~ll!!:ll
3o lll!lui~imi ,~!ua~llu!311!~ rli~/ Io ull!litll{ll~;I ~l~[i li) llC.ll~lUi t¢!qI
ll, l!llhhl ,glllj~a;~lls O~,ULI Illllll~ i~liI llllll II[mli~lllil'(I Oll'lll:~ ll.)ml~lol
~vll tl ~l~lndlLrdi~d lliulh(id~ Oil lllt~ ~iilllU utl'(litl of ill Jc0 hliv~ Jlldit~il~d
ti I~l'ildllid de~'lili~ of tll~ C~Jl.~intiJ~nic: lu)[~jllliJjI 0f lllu ~llltdl~
p+uticulatem -I a lemling U S. cigut'eltc l+iantl durii+g tlJe la+t '~0
ye+£1~, Tid~ lUI]L,C/~ [~1~ uhLLI}~1~ ill lho IIl~ik~ull 0r COlllti+elci~lI
ci~til c tie+ { I~,~).
I(~r.clii)naltoll I~xlmrlmunt~
A~ae++iucnt+ have lieett made for Iho material+ derived primarily
li(llll Iw<) ll++~j(ir ~el)lll'utiuil ischernls+ employed for th+ JtJeilLirJ+titioll
(+I £1itluirig~tiic iil~unlEi" 4[)110 $~+ttml I)l~gill~ with ft'li+tiolltltJtln 01' Ihe
~liltllit~ li+ll Li<~tll+ t I U+ in[o lleUt rgJ, acidic, ha+lie, kind ill+ohl [~+ ]iijl.l.ionm,
li+iliiwud I)y i~ohlllln Chl,i}lll~ltO~l.llllili~ ~tlljfllil~tlolllllion l~ill~llil~~ [~jr
/ullhul dulilieniitiii of tunmrigenic conmiitalent+ (17. +d(J), Tim miler
~+lelll [(Jll~i~l+ Of ~he pllltJtionJng tip th~ Imiticul~l+s with +olvent
+y+lciii~+ IJlul (+f ilaJ milbSetlUellt ehrtiillall~ffrllldlie U/.lmrltlJoll+ {,~91.
Boil+ In~tho(l+ h/ire eleiirly ~+ialih+lied Ilia+ the tar subh'aetioil~.
~+]dt~h c°rltaJli the hulk iif l~dyntlcluav l~ionlutlc h!+,droeal b+n+ {l)+~ ll~.
ill~ Ih~ fild~ iiorgioll~ that elicit ~ll-~illOlna Ol1 ill(ill~l~ ~kilI wjI~n
lllipiild io high CollCl~l~trll~ioil~> 'l'hc~m snld'rtict+i~l+~ haibor the
llinjoriiy id" the tumor inJLitlt~lrl+, ltitr~itriicheul in~tilhlLion in ri+t+
ill+it led t/i ctircinonill~ only with tlio~e +uhfruetion~ that were lllghly
cl.i~:l,ud ia PAll. llewcv+r, the PAil sut)h-actim+s u]+<) ColltaJn
lltllli'id Coi'Zllt:Jn[l~!~tli~. T}l~+e +lie lltili.Cilrc~ng~en~c []AlL wlii~li
lieveillni+Jt+m+ I)+)letiliat+ lhu ncliviiy of curc/nogeaic PAll, The
i:ht:niJ~iit id~nililit:alJon lif ~till +thcl ttliltllr~[llO~Cll~ ilI these ii(+U~l'al
:'liLh ii(:l i°¢l+ II~dl il~ I tl litlliv+dlltilu h~t,+ne~ ~llld ~id Itit~tI tel litme+ ( i(jS)>
'l'hc xvi:illlly ill.jdj~ i)+llti<)lI ol ~ili+~l~tj ll+llliUilJill~i £illil its ~nl)h';ic-
li[lli~ hill+t! ;ll~4ii llt:~il ~lliilvn ll) (:°nlaJil Lliilltil ]~l'llln(iL{~l'~ ii~ well a~
JIIIIIIIILilII ttilCill'i:iliillJt+llm, inchldJliif lihi+tiolic i:llllllitllllitl~j itlnl £.iilt+
I:llill~ ( IH, 671
Tri£ I i~il lilt I!l: iII ill ( ',li let+ill 41 lie i io:Ji~i
lit Ilii! I~V/9 l/,jt<ll~ .~nni~>ill~r Illid ll/llil#fTi /I #~it]lti#,£ +Ji'lhe ,~'lilT~eill1
f~l+lli'/ll#, +t:vlPi';d illiU+li+lll~; wl~lt2 tid+otl ill iu+[ll~cL iii h,illl~ldill:tll[ill
i+ll~Pcl +; ill" t,illiil t!l it: +iillllliillf ( }~lJI, Al;livill illil ill i: i i ~y liil~i
[hill, ilUlllrl~
llil~iilhtliil: ill:liviLIiltil I)[> lienzlilnlliyIOlil! tlhll~ in lhu I~ti++l+Jn ill
hillliiill IlIJWlliililB lit +liiolllllg IllillhiH+ hii+ hi:oil illh!rlll+nlt+d lie o11(!
Iiidil=ili(lll o[" liter+ lille I I'll i i+ ltl +1 t!l~li 1 iII iiiilll-illloti ill tlilitllle
I!flli+;I il inPlil +
I II, 1'2,1i.
~t'Vt'l'+il i'l~lll!l[llll!lilid +fildle+ +lllil~i++l IhaL liiliil/tO ~lllflkt! hil~;
hlititilllll(X!lilill I:iiicinol~elil+ eli{J+l+, hllilijlt!l>l[tiiil~id inil:l+iliill+ ol
lllllllll'tl Illl ill llliv+ "il Ihllint~ Iht+ II)lll Ill l,llli dli~, <)1" goMiiLhill ~+1'
'tlJiJnii ~lil<lt+li Ililiil+l+r+ Jail Ill lliilaJi+ ill ~ ill" Pill (~lll~llt~+ [ilill it~
I+t+ilil~li iillil lillllitlililliL hllllill+ ill I'/ fil ~il Ilall+ d;lt!oliiii]l+ t)xll+ +t i
lil]] lti hill il'ilhill I<ri Ill ~,l liUiiil h+ <ll'ldl~+t!i v+llluli" ,t,ho hlllilll+l in Ilil~
I ;
L ..
ol'l~lii'illg were prinlflrily Iomited in the adrenal glands, pancreas,
female sex organtt, alid ]iwr. Untrented cllntr(d aniinals, lit Ihose
whose molh~r~ w~re itijectcd with olive oil alone, did not d~velop any
(unioYs during tile course of tld~ OXL)etirne~lt,
Thls experinlelit ~hould bu I'el)eUted, hi order I0 e~lahlish the
rcprc~lucibility of the tninSl)l+lcenlal elfects. Its lesull~ llre in line
with gerlIWdl oll~121"vll{iOll~i ~l' l~ll~l)laicl~lliiiI cilrcinogl!tit~is. 'l'he~
i~clude i)ronounced pi~naltil susceptibility, expies~ed in a f.lr higher
lil~tilne tumor yield in the ul/~pring, as compared with their moLh+:.
(156}
In timt dlrect actlng alky]£1Ling ng~nl~ tire generally the nm~L
cfl~:ctlve tran~l)laeentnl ctircinol;cns, the high tumor hlcitlence in lhe
olfsl)rJng of llam~Lela tr~atml with I.obacctl lllr is renlarkuld~,
Conlpound~ requiring liietabulic ticiivaLion lu ultinmle liclive I~)rtlls
ol¸ Clll-CillOgellic 81)t~cil~i) huw~v~r, lll.l~ Lll~o tr~lll~ldi~+./,nlttI Clil-~inli-
gent) tl!ough of a lesser i)olt~ncy thall dir(~ct nlllylaling (:iircintil~li~,
]~lil:ylil~'3 lluc~ltl.y ~lr iil;tivllti(m lily3 klloWll lo i:l~isL ill |h~! I~lll~
only at low levels, if at alL, llnlil just prior to birth ( ! 10). A nun,I)t~r of
|(il)ilcco ~lnoktz collsli£~lelll~, whi~'h lll2e(I llll!tldl(d~c ~lt:liv~ll~lnl ill
hi.dial• i.0 lict[uii'e caJ'cinol~t:lli~ i)lOlJt~l [i~, lllX: kllOWn Ll'iltl~t)l~l~unlld
citrCilltll.~ll~;. AnlOllg thl~o iile volllLill~ N-nil io~lllliill~:~, ILll)) o-L(dtii
dille, ethyl carlJ+lnlat~, a~l(l viliyl chlot id~ 1157)¸
The ride of nicotine in re~!ard to IX)~ildu tlall~l)lacenlal elr~el~ (~f
tn}l[le('o ~nlOko Ld~ci 1~2(lllil~ 41111h~f ~lu<:itl~ltil]n, ~incl~ il~ tr;nl~jii~l-
cenltil nlil:ltititin into thl~ +ulillllil fetu~ ~ias l(itil~' lic,~n knt)wn (/,~;:)1 A
i~tllok(!r ol¸ 2(I cil~lr~lte~ tli~Jly J~ eXl)ll:;(~d to 21) (<) 311 iiil~ i)i llit:lltint!,
[lild in ti pregii;inl, w<llll~lil il i~ lti I)(~ t~×l)l~l:t((I Ihlll ~f)ln(~ i>l Ilii~
nlclilin~ rt~a+:he~ Lh~ i~Ln.~ I']nzylmlii(: tlxi<inll~l, I~) (t)lirlili~) in Ih~
I~lll~ i~ vt!l~/ ~h)w, ~)~cl£11~ tJi¸ low (!nzyliln llc:livilit,:~ rl'lni.i' tiltl>O:;~£-
lllint2 li)l'lil~l[iOll I~olll Ihu tllllln~l~ll)(lli~ui] liil:o(iilt! nlliv nt~ill ~tl(:h
('<llt~itlertitit)ll~ suffge~t ttaz liul:d ful lullh~r (~l)t~)iln~lllld ~ltldi~ ul¸
ila~ l I lln~ld~iccil t~d ~li~!cl~ nf I<)l);icl:o IJl'<)(ltl¢ I~.
,l~yll¢~ill'~ilil)~l~lliJt~i~: ()tDt2111111~il)ll~] (~£11,1!ill(ll~ell~i linll ~lll(d(illl~
Ill Lht~ I]llil(~ll .Igltilos, cii!;liell~ ~ul(]l~itll~. i~ l~enl!)~dly llnlil~ prt:vll-
h:nL tltiltinlf llhie-(xllltlJ+ w<)ll~l~l~ lhall llnl()lll~ Ihl~ wlliil~ cl)llnr work
t~liViltlllnH2ri~ wilh ch(:Jllit:ill~, du~t.N) illltl fllnle~i Ih;llt ~lll~ Ilit+ii¸
ll(lll~lin)kitil~ ~oilritel.p~trt~ {~l;l. 'l'~ij~; illdit:ah~:; th4~ nl!(~(I (41 t~xtill~illt:
lh(! i~llt~ tll¸ ~in(iking lt~ it iXllll~lulldinl~ v~iri~dllu h) <)~Cttl)~lliull~ll
(~:~ll4)t;nlv2 lllld rllibc~ [hl~ qilo~iion whl:Lhl2r ll)hlll:4t) ~ill+lkl2 till~
~yil~lgi~ti(:illly with oLh(!r I~u:llll~ ill i.t~llillll (ll+y t r~l~l ('iu'l~iinll;~ti(,~J~.
In ]!1~9, Illlnnliond i:t ~il+ (1~) uwdual~d lht~ ~nl(liliilh' hJ~lory
Tho (:illclllLil(!d llll)rtilliLy i;lli(,!i ~lhl! i;llii) ill¸ (letiili rlilo.~ ill ~inl(ll~el'~
l:~)lllll;ll~'ll wilh d~ath lllll!~ iii llOln;lll(d;illl~ i]leil nr 11 ~[itid~ll+ ilgl!
),.,i
dit~?lil~tl(lilill iqll illlll~ q:~lllll,l' Wl,ll! ~ti~ll~ Jill¸ w~)l'kl,I~ wh(I ~llllll~r,l~
[h~lll ~(I ¢i~illl'~tC:~ I~l!l lilly, ~nd ~,~f~( ~'II1" II~ll(.~l(JS wllr]{ol'B who h:td
nl]vl.r ~]lilqll(/.I] rt.l[llIJIrl~. ']~1~ lllllhol~ nlF.II rl, pol ~el| f.h~l~ 4~XIIlI~LIF(~ Ill
IIsb~(ll~ (lIllE iR [11~ ~IIK;(!iI('~ or rlll(lllillt~ r))ll~ ]1IIV~ IILIIo or n~
ill~Ill(!lICo [J)l doll~h /'ILl&~ fTOIII ~l]ll('['r ll~" Lhe ~ollhl}~U~I i~II'~IIX.
~l)lllllilll,l] elli,uln ill [o])zI(;~'l) ~nlol(~ and (ill! various type~ (ll" n~be~lil~
[ I il('] I(!~l Ill" ] I~l~]l~l l!l~. I)riof Ill t'x I)Osll rl' [0 diluLed CivIl I'/.~ (~ ~111(lll
I', I{]
[illl~B 5V(!r !ll ]~ I]V~ r" n 0{~l iOI] O1" ~ IIIDilI h~ ~jn~ al@ jl]or4~ []l~l~l ~dlOLIt. j
I~uch o~ ~1!ri111t~1 ~$, ~h~ ~lllfph [! ~Xpo~ul I] Ilhlll~ did not I>ll)duc(' [ l)li)ol ~
in Ib~ lower ri, sl~rnt ory irilc~ nor dill i~ I~t)~nLill~ ~ I.he subt hx eshlJl~l
d~ of" tl., c~llcirl(,f~eni¢ ~sllu~Los (51). hi cl,JlLr~st, sy~ei~i~ii~ u e'tiol]
OF [OIjHC/'II SITIOk~ Illllj II~be$1/~J w(.ro jlllllell(ed w}loll ~Isl)es~)~ I'jb~l~
~l"~ fh~l incid~>~cl xviLh ~{llar~Lle tl~u .~nd Lllen adde~l ~o lltlnlnn
lynlllhl~!~le culhlr¢'~. 'rhis le~ulled (11 nil~rlill~lnll~/ inclx.~d hldue-
ii,n (,F llryl )lydll~l:lirbl~il llySr~xyhl~(~ tAIIII~ c~,inll~lr~d with Ih~
(171] Tlih; IilldlJItf mul~l~sLr Lhnt a suif)me kind cheli]iolll) illler~clion
rolmiflio, oF ~ lug.hIlL hiivhl~ j]il]h~r ~lr~ino~illc ~cliviLy Ihnll in
iilh(.ll:nl hi ~ilhl>r a~enl Ixlone. ~n ehli:ill~llion or #-he In~hLIIli~111~
illwdvi.iI ill ~(%('[l[IUilill~qlli~ ~1"('('~(_~ Ol (~lllllcx'o ~li%ok~ lll~ll [~llL~bo~
Jibul~i i ¢.q tllrl!~ f~lri h¢!r ~x ilOl'itl~l!n tiil ~Litlik.~.
lll~llliiiZil iniliel~ wili) ~lllok~ ¢ll~aJl:tl(.n (lfl'J~. ~rchor eL ill. {~j
('~lll:Ll~lll(HI (lllll Ihl, ILill~ I:iln~'(~r £~1i~ jill' I.~.~. Urgn]Unl l[lilj@l$ ~'~llo
IIIHI IIlill(!l'~ ~hl~ ~;lllllll@d [.~.o ol- ITII)I I] pltCkSi Ill" Cirri11 ~l I ~114 llLl~. Th~l~
l~l~>l~O) in pr~seriL in iobn¢~ Illld ~iglil'l'Lt.~ smoke ll)>O~i tel ).0
I)£!i/~>il~al~:lh:); howe.vet, il J~ IllllJk¢!ly Ill~l Ilie~e Lrlicos ll~llr~.z~ll/il
Inlijllr I'i!tll fbr the ~lxlok~.r.
(l!l'r)irp I) or tll till! s~une ilrllnium llr~ du~4t, kll[cllt~l with ~Jffllr~'lle
I~li)okl~ (~llilll~ 2)+ Al~r inor~ ~hlin zJ0 iIlllil(.h~, llll dolls showed ilff'its
or ei,ilhulial ~]l~llll~e~. iildu(lilll~ lurtl~ i~rl~ oF '.x~ennlllriosi~. tulel
AIL~F r11()1~(! I~ILli) [;~j IIIIHII II~j O~ eX ]:~}~111/... IU/I~ I"1 Oil1 ~)() POI ~1!11~ O~" }.~
I(~
((ll~ ill ~lOlipB ] Illld ~ colibxined I~rl~e ¢zlvilier wlihln 4]1~ (ltirOll-
cliyllill ~llr'lolliilll!(I by baltds of Ilypei'pl~lsLic ndellOllUltOOS i!pilllvlilil
snil~ikl. I ] 7ill).
l.itlle Iin,I hill I~rOull I/2.t) I~.~h.fl"ilm h'/lir,ihl'~i~ Ihnl :'i'~llll el
riidililioFi ll~'l~t l'411l!ll~i!iff(!lill~4 i'¢ilh i~rll).tilic:h.lll lilliln:lli~ h'~dlrliiu
I)nli'~ tI'A I I) ill I!~i~ll{ ill ~illill I'( I I! t~llllllll' ~lill~l 14llllll'll
IIlllll'll~'l!1%~1"1 I'
l~ivl:n iliir~illilrll(~lll inF:lilllllillll~t flf hi~v ll'vl'll Ill iildll !i'ilii) nllll Ihil'
silnllllillll~ltl~l.7 Ill" in S~llllf'llll! IJllllll flililtli[;illl'illl~ illllltllill>lil'ill
ill~lillclll~lll tl[ i,.Ikl llllll Illi[I llli I]u'tlr I~l~h'. Ihl' inlilirllrili ril
lil'llphl'liil Illlll( llllil(llf '/#ll~t liiilljllv llll~lillvl" ~elllll!liliiil lil~lllh Itlliln
ill il ~ill~lo ihml! I J[ 7iri] ~ll (I) I]4 Ill ~iJ llnil i i.lll!IZli~l 11 (Iglll(l' I1[ )l:i(' II
I.'.1 iiil~
7 w(~I!iI~), liowevel. Ilrildllpl'd l~ilr~lilt'irlol(('llll? t.fli'l'ts Aillllllff I;l!l
linilnnlg Ill ri~k in [ile I.~l'OlilI Ir~'l'ivlill~ n filll~ll! doll' Ill :ll'llo. ~lilll' I
nnilalni Ill 7 lie re~iil) hli~l I1 lnlll~ I~llllili' '('h~ ~lll~'llli~ll l~l~pii¢:ll i~lll III
li<'[lll z~ilil f]lll~ tO 13~ linhllnll4 iillhll:l!(I lilill~ IIIIlilll~i in 7:1 "1 liilqlt 117
llt>lCl!lil.), lllill Ilrll~ illflliO 1~;17(! Itllll(lll4 ill h.~s thllll .I Ill!ill'Ill id illi.
llllll~l I'1 ¢> ( ~ ~71.
AIIhllul(h otJl/~l'~l{.~'llll~llilllllil ~ilvllllnln~.~iil.~ liliiy i,livido ndllillrlll
Iii i~llle~l!l" ii~k rilC(lll~ (ill" 1"71111(L'l~ WIlD ~illiOll(!. I'lli+llllllrllrll~i(:ll llltlt
~ lll'r i in/.it(iil ~t tldll.~ (llil ~" lilll d+lr~ll nil'n h'll ~lll'll rl~'cl I1 II'111 I'll ill
ll:ll l!
li hll~i 11%'t:11 sul~ffr~slell I.ilil I ~ylilU I~i~11¢ I lirl'hlllllPlli(' I'lil~l'l ~' IIIIly
til'l ill
hi ~illill'l!lt(! ~lill~l(Ol~ wllll ~+.llll~ hi [lll:l~llli~ llll)l(nrilll( ill Ililll~lllll)~
i:hlol(llnelh)'l elhor (5!1), vlll vl ~lllllllflc. (g41. lilt k~.l 1471. ol 2 rl~lllli
lliyllmlliie (./SD).
Ah!ll(illl llllll ~[~(Ibill!Cll llrlil(llC(~i
~lllrll!nliollll~i¢ill fl~lltl lllllt> ilirtil'lll~'ll lhliI, Ilin ~lllnhJnilllllll lip
i]]irlllile% [ilellh~ll Zlll¢l Iol)iil'f.o (sllnSlllll]lllllll i~ll.llllv illf'll.llh(.~. Ilii.
li~lt
ror ~'~lll(~of ii]" Lh[- OFIll ~llTily. i'~irlllh~illtlS, nnll lilt yll:L, llll[ iii)1 I1[ Ih(.
lUlll~ I I~7. /'~!J) iclevl!l.lll lllls:~illll! liiechliiiifni~ hllVl! bt.l.Ii lllllllO~ii.d ill
ii.l~lll(I Ill S~iiI.F~i~i~ L'ifi'~'t~ ill lllb:l¢C~ ~lll~k(' llllll illl'(lll~ll I~.(¢~d~d
21t!lvi.~ ii~ I1 ~111.4(.11~ frlr Illl#llf:l!li t'~ll~illlJ~/.ll~. I)1 il ilill~l~ lift. Iiv,.i
inl!lnbll]i~Inl I][ .(obilcr(i i.Illl!imll~l.ii~l nnll. Ihli~i. lln~l Jill iliflill.rl
illlltlt.lt¢l, iiii Ili(illl~('o (.til~.iltllTl.lll.fti~ I1~ Ilbl[lllil flll!llli~. (!lli~lii~
iil~lllil~1 ~On~llltiplirlli ~oln~liillr.~ I(.iill~l Io ll#!lilg~>n~ie~ in (.~!~l'illi~il
inic.l'Oll lit rionlz4, nlllllin/~ iltl~ I nil.g.L ~ll~ Ilil]l O ~ll~(:l'llllllli' ill IIII I illll
i~t.ll~ ~l~lF~¢~ lllcoli(ll illdll/'l'~ I!h~illl~l~l ill llit~lilbllli~TM Ili" Iil1' llib~lf('ll
lolVOli~~ Jncl(.il~e~ Ihe ~tll£111rlTr+lli~ t~frl.(!l, af PATI, whi<'h lilt? Iho
~rHl~llllllll(ioFi~ lllnl)iil~ ol.hl~r ~111.~1~. enhnncnt llie ihlll( llll'[llhflli'~iil
e~lllibilll k'~ ~F Ilwr lili~rll~nllil!~ in both lilOil I~nll fllliitllll~ I #.Tf;I 'l'(l('
tll~(IIll~[i~i~ it. Lhe tiveu #if Ilif! [/llll]C('o I'lli'eJllfll~(!ll N i~Jhll~¢qIVil(lli
dhle (bllWl{). [~l+ i.~:nlllllle~ iI/lip~ oilhiini'~.ll ill i.ih~llil)lc~liislJinilll~
I!JI
li;lltl~IPl~ { f~]7) I~:ICU~JVC ilb~obol l'llll~lllllll[iDI] i~ ill~O kllowll lo b~ilil
Ill rill hJn~; other i:ell u Lt 1¸ irljll i ii:~ tlli~[ ililt Ll~ll¢~2 clll clllogelbi:~is {]21;).
Vit;,~i~ ~\ d~fiui~ncy. ~hhb ficqnmltly urmlnq~m/b,s Mcuh~d
ahu~u, irhcl~a~os ~iu~CClltibilily La caJ~inogcns of tbe PAll type bl
l.dJ¢IL,hny anbtmla {f7,5). VilmniJl ]Iz del]ciuney has been ~hown trl
imluilli;du rllt.cI~ of caicb;ogt!in::i iI~ mlm~o ~kin {37). Rats aln a zinc
duJbielLt dieL ~le i11oI~ t~tl~c~)|ib~i] to t~it~ e~l[flulgeld C~l'CblIII!ell, N.
tliho~obultzybLi~Ibyhilllill~ (.5.~i}. Tb~a cuu~hulgunicity nf NI~'I'I~ in
~y l'ill [1 gl~Id~ll b~llllSI~ I'~ iS ellhanced wliun tile azli~l~£dS aru oJl il high
~dc~hon diut. yet lbill ~n]lan~cemel~L bas not b~n abserved fi)r the
I~d~acc~p,,¢ifi¢ N*-~dtrosm~ornicotillu till), [,'urLber ~Ludiea of bb~
~bulilie~d cblltlLle~i al~d bioasutlys with ~oadxnblbltraLiol~ o[" ~Icobol
~lm~diHg ~ff tim ino~a~ed cancer ri~k of consnm~]~ who use both
Tumori~Jel~lC Agerlts lit Tobacco Products
Vl~llor ['lll/~u (',l)uuuilIIlll!tll:~
'i'lm dcfiudtionl of thu Val~r pha~ COml~nente i~ llJ biLra/'y and dc,e~
nlul L.~lll'e~:l~t Lbe tru(~ phy~icochemical clli/diLi0tl~ pl~vailing ill
I~llillct) ~liltdl~ h~ c[Ireirlegun~i~, Lit(] tobacco cbt:nlisL'~ dofillitioll
ha~ hitch widely uccept~d For th~ purp~ea ~f tbi~ discu~iull tho
h:llil "WlllOl¸ [~ll~ls~ eollll)Ollcn~~ blcbld~ ~al[ ~lllOlle CDrl~tilUeltt~ uf
whi~'h l~i~Lt~ Iban *~(] pelCenL i)~*s~ ltll'~Jiigtl a (~lltIJnidl~ gla~ lib~r
lillur ( ~dluc4i~ll; ~ml)Jl~ ~t~m a ubq~[e cig~reLt~ on a filter i~d ylchia
/~=il Jy ~:lJrodncible dula M~ Ihan ~JI) pcrccnL ol¸ Lhe tohd wei~;ht of
Iti;IJIt:;I/~lllh ~lllt)[t~ i~ Illilde IJi~ (~l Villllll¸ I)llLl~ ~onll:~llellt~, of which
,bt,~id~: ~md I:anl~bnl ultlmoxid~ uilak~ up t.~ to Et) ilei'CClZt by weigbL of
Ibt: Iohnl I~l~]l~t~Jnl~ id" l~i~L cigltlctLc~, iiJlle~a Lbc cigal~LIo filler Lip
, Pi~l~t;ti~L~ ~ll*J~l~cli~:~l i~cr[i~rulinlis thaL t ~duicu this ilerct:niugc,
iliJty cold lil~lll~ I(~ it~.lJil.~Liily c~llt!illol~t~lie~i~ bucilll~ of il~ blhibil-
i~ll~ t~lt~t I ~;11 t h~ nl iic tl:. cle~ f~lll~C int~cbillli~t ~1 i)I" tbo I'l~[lil~dOJ y [i-~lc~
(101 h~ ihllJ~;I illlll~>i|lltlt tt),~iC clti~:l, blJw~v~r. [ie~ ill its; hll~lh!Jl on
tbu t iit:tnhtlluy ~ysh!l*l bccilll~t~ iL ~:t)liti~iJIt~ wiib bl!tnol~btbill iff tb~
I.l~t~.l ii~ Ib= in= c~tn b~lny het~Ll~g h~l~bL
~,, 'l'be pl4in} cil~;Ll't:lltJ and lbe ctll~VUlltil~Jt/ll filler ei~[ill'ell~ clltllllill '~
~,~ h~ 7 wdulnt~ i~rct:liL ~)f carlmn ~nt)l~o;~ide II~ Imlt¸, with Ibc
~POri~ihlrldi.il bhcrcn~irll~ wilb Ihe liii~r Ihllfls. q'lae tllilil c~llblm
~k ntlt~nh~i,le bl ibe ~Jrulli~ cd" IIn~e cJg;~icltc~ bl th~ (JJliiud ~halt!n ill
~.~ l!)ll(I [!)Ill ;Li~l~lltli~ IIJ ~l ttJ ~ vlJliJll]c per.ceilt i:l¸ ];~ lib E(~
~ ikiFl/tit;itnt~14U. JIowev~n'. llh" dilnJlilnt ~f Ill~ t,l~lok¢: Instill cit~;lrl~lh!~;
wilJl ii i~t~i~i)l'atl:d ~ith:r tip lulhJcl~:; l:ilnbttnL lillJiltl×ide itl I) fi Ict I:1
ml~/~ill;LH'ile {2Z/!t/I, It i~ t~liilL;Lll~l IluuL nnllrt~ Lll~lli 5{I ib~l'~:lnl ijI¸
,t
tile cigal'eltes currently sold m~ thll US. murket bave Ilcrforatcd
filter tips. The smoke of ¢igms m~d litLl~ ci.g=~rs c~nlabLs carboxt
mm~oxb|e ~Mu~s up t~ 11 vohtme );ercc~t f2~.
In tbo 1979 report ~ma~ing .rot l/call/l: .4 HLTmrt n[ thc RIoTlt'Otl
(huler.I, carl~n dloxido, nJltog~n oxide, ammmfia, Ilydrogen eya-
ufide, azld vo]ati]e ~;uffur compounds an~d nih'ib*s have been discussed
in addition to carbon maxla~id~ { IR!)). -qillco IhaL tinl~ no 51glliJ=lcallt
new infm'mation has been publisbed ixt respect Io the cmdrihuthm of
these vapor pbasa compouteuls t¢~ the ow'ra[I toxicity and carcinng~-
=licity of t(]bacco smoke. IL shmzhl be rtoled tbat tile gradual
reduction of~r and nicotine was accoxnlpa nied by ~ gradutd decrease
of most vapor phase eomllOnL'z~l~ in tbo smtllle of the sale~-weighh~d
averago IllS. eigarett~ (8~J). ']'Ilia rvduetion dries not apply to the level
of liitre4~l~ oxbl~s (blCl~). of wh(e[t ~l~Or'~ tb~ttx (15 perc'elx~, art~ rdtric
"oxide INo). The NO. cant~xzt of the smoka of Lb~ ~du~ wcighhd
average IJ.S. eigureLte has leuzalned at a level of 270 to ~8() itg pcl'
~:igareLtc fB~}. One reasoll for tbi~ ~ll)llems to be tile nso of bwreasinlt|
])elci~lltilI~t'S or Blll'~y (obil~'o ~lllt] Of **~lll~t' ill Lbe i~il~ll(!lle blel~/l.
ItuHcy tobacco and "sh,ms" are richer tb;ul [h'ighL t~l>aPt:O ill
t]iLr~te, II mllilx precursor for Nt). itl the smoke, A mafllr z'~dazc/iOll ill
mnnlce Nt), can be achieved I)y high smoke dilution (14[;I. As
{~b;cits~ed bertwe~ I ]tese ~llSel'Vit I io~zs d[ll~ly tO tile SiIi(#kt~ gl!/i el'il I od by
Ih=t[ ill,lily snto[{~l ~ of low till" CJbq~ i {:Lh~ ~lllt)ke unol ¢' Jld t~ll~tdy.
IL lla~ t,eetx deutattstratcd (ll~tt ~t high pet~ uut;£q,,c ~=1 I bu ¢ilitthJxie
~lt!enls, w}lieb in]lillit the ItDlt; ch :hril]lce, ~lrl' I)l¢'~;t'ltl ill tile x'~II),=x'
phi~so flO,.l.l). These arc chitflly hyd~/;uni CY=llliijl~ (211(l I~1 !>Sq) li~/ciI~),
acn'~di~h~ (lO to l.ll) lq~Icig), atntuumill (IU 1o 150 llJ[/cilfl, lliiz{Ig~'n
dioxitie II) It~ 30 Itg/cig~. mid ii~¢m:lhlcbyd,~ ~1~ t,, !HI IH~/('ig),
~tltUtlll4>ll~ ceti ClilCill¢llllil~ tl/¢H L~ illtilll't!li ill I hi! II;t~;tJ ¢~;lVilit'H #if
I'it[~
~xp{~(d ill cllanlbeJ'S foi :ID bl~uz~, il w~Pk Irl IC~ plltn ol IoH.zahb:hyde
filr li~ ltltlllLh~ (1~) Thfl nll!~'hlilli!;lll Ill' its ~lclJl>ll i~ unk.own;
inel;d~oJJcaily, it is ; apidly ~idizcd lultbtw to Iormic acid,
'I'll u Vitl)~lz" I)basl!, i o. Ibilt ~;OlliOlt of Lhe ~lllok¢! p¢~SSilq{ I hzlmllb II
gill,s fi)li:r I]nll, r. (laPs n{~[ by itsell iuduce tumm~ in hd~t/lidory
(tt~itl%it[5, CKCE~II, ill ¢?el'ti&in 5{l'itJll~ iit' Illice t~//!~l. The cialcb]~li.'enzi~
*~[tt'~:l~ OI I{}w iPvq~]~ DI" vl)llltib~ .~mnllP cnll~tiltlt~ll[l~ inH~ CII[IL![5{~'~
~cnpe d~lcction by nleims el bi*>a~ays because el tim h~w dt~l~ ust:d
and Ibe low sPnsitivity t)l" I~lod ~l~ ilvailabl~ ill pn U~et]t (I()¢)). 'l'abh! I
ti~l~ the IIlajor COlllpllliellt S Ot I be vlll~)f I Jbl]~ illht~ %vbL't II~l' lht" llt~l! I~ t
J~ l'el)Ol'led l(l iltl toxic ill" ttnm.ni~:entic 'l'Jle vl)liliib N rliI,l'l=:;~nllllllI~
m'~ I;ln'l!Cly i'elahled by the sJitollu II;~ilicuhdl:~ ill Ihe 141a:~s lihi~t'
JiJl~l';q ~lll(~ will bl~ discussed ill t1%~! ~t:t!thin tin OI'~HII ~lll~cil'iC CilI'C~iII{I"
~ll~. Ill ~(DII(]I'~I], I)111" [llllh!l'~il;lllllilll~ Of [)L~ IIII*C]HJl)iSlIIS (1~ C;ll(?illtk-
J~'llur;b. by o[ bel volltti le ~llir)]l P t?lll il ] It HlttlltN it~ Z;i:;III t~.
N ii,,~:, ~, ,,, ,*i,, ~.l 1¸ • 6~ p1~ :lr~) j,~
N Jl r,,i,~,~ ~m~ (~ (~ ~ . I~ q,K I ~' in~
M I~l~ll~(~til~ ~ n tm~f~, rn~d ion or hy~ru~h~[! i u) ~ome ~ll Jltlnls yields Ii~'l~[
~1(i ~li~beelyl ~l~rlw~iv('~. u~J~ilo~l~h runJnlm~[~ i~ formed ~n d~g~ (.1~/~.
il:lve in.~Jl rL!pou'~ed {12.~1. ]ni~ [e~ ot~ it~ uneL:~boli~ Lr~n~foa'm~lLi~m
'['~(! t.~/ht~hl.ol]]~ J~J.~d) ~il~.ltl~ ~y~J~ill I'clt'nl~ .[I [i.-~[ogl~n~J~t ~l)O~-
~le f~*~l~ vi~yL ~:hl~¢i~e (8. ~05t. Ill tL~rn. L~d~ ~x~d~. ~luy yield
]~iJ~tj~/n;d ~J IL JlJl!~lyr J~ o~" i~J~olll)J~ I Jl r(nl.~h re~lrr~ngf!lelert~. ~(Itil [~luy
IJ~ the silli~ll i~m wiiil Lhe nucleic nci~l ~ldducl~ of in u~l. ~ler ~lCLivnle~
;!~ll~!inli~en ic in ~er rnelli.~[e~, Lhe ~pox 14[o rronl vlrtyl chll)ri(]~ ~LFlyJc!n-
~lll.~ ~>r n~t~ts ~lcro~ file N I lind Nk6 ~1" ii~lenosin¢ or Ihe N ~l Jin~i N-4
u[ ~yLhlir~e, [~rmlnlg t~ew rh~g~ in I~nn~e pnrLic~ilar I~1~ (~1) *l'lle
pre~ence i~f ~he~e u~ldiLion~l sLrln~L~]n~.~ wollld prol~b]y it~terf~r~ h~
the I~orln~i I~lse p~irielg IleL'~a~en i~d~losiile-~r~midlrle ~l~tJ gLi~lr~e.
~in~-cyLkliu~.
~lz'~]nl]:l~ is not ~ po[~n~ ¢~l~in(~ll~ iel I~t't~l~ o1" ~]c)s~ ~X~l~f. ill
~ll~l]~lL~l mice. ArLhough iL is nl~bLi)~lized fo N-hy~hoxyl]reLh~t~e.
~h~rh ~yln~ L3'~slt~ ~ ! 441. ~ll~r~ ~Li~l r~m~n~ ~ r~vs~i~n w~eL~le~
unlef h~m~' ~)n" N-J~y[Irox ~'l~r~Litatl~ is the ;Jcl~v~ nmLerhll I I,?,~ I.
0!)1
.*
'l'lttlna)r JpiiJi;ilou'~4
ehit~l ~[ ffl~ ~'fiL~'t~; qp[ I~;q. kl~b~.ll (~p~!ial~i~[~.llq i~ll.~t~( J.~ltl~, .~/liPe!
rlil~ liq~ii:]rirll~ ~J~lfJic~] ill ;i i~llltal~r~l, oH¸ ]ra~li~t~h~li~.~ ~l~.r~ ~;Jiown Ih~il
f.nll~(.'~l!fth. I~1~¸ fr~lcfillnldi~lrl ~llt[~h.'~ il~ a~ tllnru]~en~ (1[ (f~ llll~T
~l~.il~l [~nT)~p~l(I, ie'~ Jlll~l' ~]ll~lvln th~lL li~l! ~lmlor ~rl~li:n~llt~ ii~'~ich~ ipl
Ihl~s~! ill~lcir:nl ~uhJri~ctii)ln~. il~ wlni~h IJn(! (lllfytntcre~lu (nlr,iuntil!
(lllIIfn i~lil~tll~u~ nL fhl' Illl~ rew,l~; [~puml JJl tlll~;t~:~ inll¸ fl ~ lill..Pv
IIilnlJr hlilinll,:~ li~Lt in~y yl!( II1' ~dl(~nlli~i(!l] FJy ~ft!t~lJl~ C ~ll~iJ~ln ~ (iI !
~T~ nnllly~ IIF2i Arl o1" IPI~'!~. I'Afi fnlnor irlllhlto0:~ nr(. [l~tnln~'lJ
tt,('l.ttl i)JJ~i~lvll(iiit~ ~hl}w['~, ~llllpr ~irlp~]~., Jh~ll ~llt;Irg~¸ iilil~:ih~t~ :~1(.
nl~.o I'clulll] ~inllml~ ~]iJll.lhyl;~l~.ti or ii~Jyml![hyfldeqJ Lhrl!l. t hlp~ ~r~)
tll(d ie hydt'l~.l~t Jl[lIl~ i~1 which the Irl~ lu~Jt~lt~ f~l' ~Jy e ~1~ bl~l ilil~'~dt i.tild
e~nlnt~le i~ ~.~ i~iJu(!l~nylphen~lnl)~¢l.ll~' ~.'7~ '1')levi. re!l) yl~all.~l I~lrl.~,
e~IL]Cll fli~Jtc-t' cq~n~'eTl~t~tir~]l~ (F1~1.~. fl~ cOrl~[~l)rlt~tll~ p~l~f~plr J>t'~l[
'l'nbb~ ~ li~l~ Llm~ri~iLi~L([tl~ L~.II" ~e~d ~;.l-nl~el~. i~l~.l~t~li~.~l ~L~
toilz)v]~L~ ~r )lolls.
e ~ ¢~. ~'1 e I~'t b t~• ~l~ i~' ~ ( I~ ty~!'~Llc ~ I h%.~h~<~l~¸
Lhf! p~L ~ .l~nu~ ~) Irl ~brh![. I~n~~ i~ ini!Lnl~l)~'~.ll ~y r11(.~11~ e~¸ ~)11.
rl]i×(.cl Iqm¢[~l~l~ oxi~;J~ ~y.~l.em i~ Ihl! [~..']~. 4..%.. 7.t~. Jnpl~] ~9.1r)
eprlx~r[l~, of whh!l~ orlJy Lhr 41~ I~l)OXitJe i~ ~i:nl~il. [~l~oLIgJ~ Ii~ ill.intuit
i~ ) ~ irlll alllJ ~l ~ Io ~)c~. Jtt (lit! (.liver ]nlek~.tt~. rJ'll[- vl~e.i LI~ ~ ii~i~'~
~il i~. conv~rl(.[J to [~ht~r)oJ~. wllJl.Jl it1 [Lttll iiilly ill! ~'l)pliltp~tll~.l~
glAIC'U i 19~1 ]l r~ or ~t ~i rid (!:4.
rllhe i~l~l'tl~l[~ nl~ly itl~ll J)~ i>x h[i~'('d ~o rl~irtl~t~ee~ ~uch ii~ ~ }n(. I 6-. ~l.(~ ,
I ~ 2 ~ ~ue~i red fl¸1 ~ '." ~' ~i /~lel ~:i '~ en~ ~l
l [cllvevet ~ :[~ ~dd~Lin~ullJ af!(~v~dilm s~l.p ~.~ l i.qllh ~i. i~!~ ~l~' Iletl hr't¸
1~9~iIJJIfi~l~l i~r¸ IJio iI~Fnyl~t()lJilll~. Jll!~ll tl~t'di ~ ~ h~' il ~' tni~;e~J f~plll'fiflri
'I~AJI[.I'. ~.--'IIIIIIIIFP-jl)I|i~LIj3~ ~I~ulli~ ill thu I)aulicul:llu l)h,~u
llf lllli~l~l!<) ~illl(IkuI
I'....I...u~ J *..ILll.I. i~ t ~JLt...~t .L"I1~ #~ig
IhllllAaDi.~Jtrlu ~ I I . It)
z~J
• It, k.,, v * .....~;~... ~+.+.1# ~ ,,',u~ ,kl~ ~...~.~'. ~ .+ ...+. I,,l+,,~.~ m+ ~, ~l~m.
tll~k'J4;~lll;
......
+P. u.....I I..I...Hp.....l+~*..~ J.+. ~.+..
I:.~jl(Ixi~h: ilHI~ li~l>llll {1 lll)lll!ill'~ to I~1] Ille LICLiV~ illl4]l'lll~di~d.o, cill+ill~le
ui II!ill:liltl~ wilh llll[:ll!il: ill:ills. Ilf'll[I]ill~. *lll(l oLhel" C~]jLIOLII+ cOIINliLII
t:lil~ IN lhu ,luch:ic ii,:id ilthitlel~, (he II) [~osiLiIJll or[he diDJ up(ixi<le
wrl lisil.ud Ill thL~ lllDilill gl'~lllll ill I)le ~ IIO.~ilioll Ill ~LI~LllII~]iDt!.
~llll~l+qll;h ~.l)iil*: I~'lll:lil~ll willl Lllu Ph(l~llhnlu~ Iff the flNA ll;tt:lllll+l,~
illt;t J Ill I III llld
v~ll it)~l'. ¢!llzylllilliC ll[ill I+illlillillllll[llil);Isb[l~s have ~('11 devi~cd Ill
lllt~it~;ure the h~vel of ~llzJ Jlld~ IINA ;tll,lll(:L lit jlil>logic£d IIIlllel'i;ll~
(~L'l) AIth#illgh tile ~ICILIDI bi(Ihl[[i~t~d Irllllbelllll'ilce~ Ic:~llllillg fl'lHII IhO
Illll~lINA ;Iddtlul il~ive lllli b(~ll uxllclly dellnelllud, Lllule lill~
il¢:id dliriiill i+q iliclllive [)l U['I!~I~I~S.
Nil llllllit!s I)11 lJlO 411~l:}llilliNIll lif i:lll'CillOl~l~nt!Si!i hy IIit!lllhl>lil:
[,i.dlicls I>l ll~Jlycyl:lie helelol:ylJil:~ lucre Dtll~ll i~qloilc~l (Ill Iho
jlll!lliibc (hill liluy lllzly Iiu ii~ti~ilil]d IJllUlll~h ~l silliilill" lllcL~hlillibtll il~i
Jlltl ll~>ll'cyt:Jil: ~iIOllulli~ hydillc~lllluiu~, ~;lillll! Ill I~l(! diJlylhlldilll~ of'
ll,:llTl~lJ ~llld Ic[;u.i idilli~ il[ivl! ill~l:ll ~ylillic~ized as iiiIidt~l l:<illlllOllllds
{ II;11 'l'hl! i,l:~ilJl! IIICtll]lllli¢! h ilil~llll liilllillll ill N-llxide~ ~lilllllll il[~l
I ........... i,i,,,:,l T~I'~IOg.O
~'U i liU~' lll'O Ill<) |(D r~l
'J'Jio Wdler extrzie[ Of lll'Ocell~t!d liih~il~l~o lind thl! Jllll'tlclll~lt~ inallor
ing liiOli~l~ ~kin wilh 1~5 lltI of I]MBA, ]look lirlll t~olilillOl,lilOl,~ II<O}
I~lt illd t. h ill, lhe lu nlor-llromothlg uctivliy of tt )b~lcl~l)(!x t.l'~it ~l ~i i'l'l ili i
i't~
lliu CDIIC U F('l~ll p1"o~OIICO Ill LW8 li,ql'llls> DFiO of JLIr~l! ll]pi~uJllr x~ ei~lll
II.M). hls01uhle ill or~iln ic uul Vl.lll ~, alld llle oth*!l" o1" t~lliDll ililll(!l'lll~ll"
weight (Sl%ll, soluble iJi orl~llhr ~(i]TI31iL~ They ~11t[I0~ iluiL ih~ .N/kl
iilfcilt I'otlJd be ni(:oUi,,. (TfJl, Jklck illid [Jlliu~ioll (75) fr~l( lililliil/,d lhl!
[u)i'li(In wiLh lhe Dlv| llg~llt, by dillly~i~. A siibfl>li¢(iOll with
pie~Ulnlllivo iil~lleclllar welghi, gl'ualur lhlili l~l,(il)() i~×liibil/,d Illn
hitilie~l i'OlllamilltJl~g ~etivlLy %Vlll~n levied lll~llil I" with ili(!olitll:> I1
lll)llt~iil l~ likely [}lliL Iho LM frllctioli with Lho h ighl:~L ilclivil,7 clln~isi:~
of Iobacco leaf [)iglll~liL~ (1.1)
(}el'f~lin ~onlllound~ ii/~l~d or Sillf~le(I Ii~i ~tl~l(oF Clili£111l lll[t!lll~ I)l+
poslicille~ were. acllw 0~ [lllllill, jll'tlillllll21,st on i11ol1~o ~l~ill wht~ll
Ll!~totl ill elinCelltrlation~ b~twuuli O~i alid I () ]u, rl*~lil. ('/.lillill I~llly
~cill eStel'S liitd, fatty ulctlltol~ lilOllO~Jtl llS ilk!liClillUe~ll ~ht:iu{cal~
wl~l'o ilion I tl lliol" prolliothig ~l~lll~. ill 1~olll't!n 1.1"ii1 ilill~ iiI" ~l ill i 0l:111 tll
IJl'/~ltl~r. AIilllllg Llio ,ctive Itllllill" Ill'Olnllh~18 WOl{~ it I).3 llui,131!llL
~oltltion Of dodecyldlnlt~thyltlilliJi~, ~ll~glJ~ll~{I I1~4 ii ~lll~](Iq" i,,l'l)wth
ii/llillitl~l'; 'i"~en '?.(I l~l~ltl 'l'~l~il 171, tl<~il il~ ~til[ilil;llltv>; I llt'rl'elli i/f
lho hi~eeLicidl~t I)I)D ilfid DI)'I'; llllll ~1 iltq'l'12111, iliJ;~llll'l:N iJl I{llly zilid
'rll~ very ~nl~ill i'u~idual illlllllllll~b~ el lllc'~l~ lil(l'il~lllllllill i:ht:lliil:ill~l
fOIllltl hi I llll~iCC fl I Illltl~lJ iL U ulili*:l ~' ltluL llil!y IIiO Ill i'lllll;l!l { i ll!l
lilt I hi Iht!
hi Ill(ll'-pl'LIIIIIl~i li~ IICI iTily Ol loll III li ( ~, 11 il!l Ill ?;11
The Iollil ~llllil(13 ~(llill~ll~ilh:~, Ill lil{illl'l(~3~, ~:il;[li:i, ilild llillO~i iii'l ~1~i
IIIIlil)v lll'l}lllOll21+b q']ll# ill:live< iifflrlil:i llliJ lillllid iliiiilliJil~ ill Ilia:
w/'~ll{ly iiGi(lil: I~)l'li£111 ilnll ill *'[ Illiili IIl:llll'id ~llllllilllillll~, {ll'llilill
I)ll ly lit'ida, c~p/,ci;illy oluil~ ili:iil~ illlll ilh~lilll~ hllvl~ bt'l,ii i<h!llliliud ILZ~
w/,ill~17 il~illiq IIliDiil" lilfJlilOli, l'$ 'l~llliillr IllOllllll[~lN ill Ihl! IIt:llllill
~;tlllll'~it:lillii~ Wt~i'o I)I)D, I}1)'1' illlll ii:i luiiilli llyiolysi~ lll'oliill+l ,1, l'
clil:h I+l[ o~t ilbl~llC> linil N mothyiillt~d ilillolt~ lliid (!all hllT~lll ~ ( / ri,~, 1~!11
The lililjlility ill Ih~ ll/nllll" IIi'lllllilll:lt~ in Ililllif'(i) Iiil" I'tHiiilill I(1 hi!
idl!nlilind, 'l'llnv3+, inlqud~ Ct~llllill liil4h iliOlt!t:uJili Wi~il(lil IlliiDtXlllt+lll~>
in llie ItiO~l lifilal il: lit:ill i'al Jill( I i<ill ill hi I lit! LIX~;(llilblt! lillf I t~lll
( Jol:lirPi lillglf n~
I"l~lclitlllilliOli ~Ludies ilf £/)bill~lo ~llltllct~ IlliJIi(:lllllll'~ ii:iVl! ~ili)V~ll
Ihlll ~llaiilliini~ll,llLillll o]" Ihl! tli:ll{r[iJ illid W/,iil¢l7 iili0i(: lilJliillll.h
I ili~,o~ tile I Illlillp yi/,hl ill IIl{llt~ ~khi u :~ Ill' I iilll'll L:] ~il(llihl>lliill7
itiliJvll
Ihl! illlll]h(~l' {l~ ttll llllFs ()hlilili~d I I iiill t!il l!ll I'l'ii( I illll illOllt, 1 7,+1~
~7, ~!O,I)
i I el~ z<l] ~i ]lS~ I o lil~ {IllilI) aL {1 (l(l~i llt!/'CC'lll. ColiCl:lltl iiI iotl iil)pliud LI
Bft!l h
er with il ,~ lilld 11} i)t!l't2i!i$1 ,~lihllillll ill' the wclikly zliidk: liilllillli ol
IlJhlllll!li ~lllOkO Inllli~tli;llt!~ ill:~ti yii lll:i LIIiiIill~ ill i~lt:ilh!l ]lllll)Ollillll
~IclivJty of ().(~ ~ 11~'r c~rll [IJll~ whell ~:1~leJBrl ilt i~ t i!i i~II wifh ~hI! c;Irl i11~l-
~i~rl. "~nrl lhJi1rc.rl I~t ul ~!~Jl were lhc~ lir~ hl qh~nlcln~er~II~ 11b;IL
~'~tle~h~l, (]I~ ~II:L.ilJr phl!rIIllic ~oi11III~lili~I ill Lob~cco ~nlolI~ (~rJ h~ 4(~I)
~i r l~ilII!rI1hl~ llUtI1bi!l¸ or i~(h~r cIlnli~iln~tl~ hnve kl~t~ ~i~ntili~iI in ~ ]i~
c~u ~r~'in~enlc w~ikly pchli~ ~I~IIrnc(ir~l~. ~Ilrlc ~r th~e~ howev~r~
y~L te~tI!iL Th~ J~vc]~ ~ir th~ (~itcch~iI~ l~Iiln~ I~I~IIoL ~u11~ ~ir Lhc*
c'clc~ir~inilf~enic i~cLivity c~h~erve~T ~r I~! w~ik~y a~iiIi~ rr~etir~n, hu~
~ r~le". ~i ~iLlliiI~r rlI" iIlelhyI~i1 n;lllhIIeIll~nii!~I irti~i~I~L e~irbn~oI~.
~i~ ~ilci~i ~i 11r~j~el~ h~ n~utrn] ~lJ[ifr~u:( i~ns ( I ~,~. I !~I~. 2(II~ 2f12). leur ther
rilli.~f J~y~rl~.~ll l~in~ n~ w(~Jl ~i~ ~yl{i'r111tc,rl ~rpen~. which l'~nlzuin Lo
e~11~]elo~eni~ [~A[l nre Ilnt~.nL ~'ilc~rcit~u~ens IX~. ~2~. JIilwr!vI~r~ lhi!
~1~;l~!c:ql ~inlJIce 11~ wi1xy ~illiil~ with chnln ~en~lh~ 0~ (J~-~:, ~Iml wilh
n (~in[II~a ~ ~ rh~ I l'e hlrnlnl It p~I'~f[in f 174). ~l'he n~u~i'ii~ ~u~Jrr~ic~ion
~h~l~ i.oll~i~I~ iiIilnnl-i]y of i~uT~[nn h~.I]rr)c~Irbon~ ]L~ II~ iIi!ii~n~IiLl~
1~le. cr;~reini~gunic ~i~tivi~.y. In llii~t~i! ~1~iu I~io~l~ly~ oJ~ ci~irelte
~'~ ~li~:,t hle ~n~l ~Lher ~dk~lh~id~. Sh1~e ni~ti~e i~ highly to×~c. ~nly th~
lli~tii1~ free bn~c portian h~ I~n ~i~i~,e~I f,~r tu~u~i~ei1i¢ n~LivlLy
~i~ 1111~ h~is h~rl f~luld to be in~c~.ive (!ff~ 2~). IIowever. wh~tl nic~]n~
~.~ is ~iv~il iE~ Io~v ~lo~e~ tn~elher with 'J'[~A ~cl I~nP. it a1~l~ ~ ~
cuc~ii~rl,~i!n. ~uch ci~¢~rci~lo~eilic ~l~livlty i~ noL ~lund ~n' ci~tilllne
~I ~Ind llic,Lir~c~N~oxi~le. ~hc two ni~jor riletll~oIiL~ Or nicoLi~e. In ~c~,
I~i¢~JLin~-N'~JxiiIe i~lhlbi(~ the cIl~:~irc~r~f~culi~ ~icl~vity O~ 'J~I~A (/4.
j# -' ,
E
Oil nlld nJlr(ll~en to I'IWlIT ~I IIl('l~)lyllllirll~ nloiL, Ly LIint re~lct~ wilh
iJl'()[q~tt~ ilnll i 11 i(:~(!iq! ~lt!illf~ Iii [he hll I(,r, II1~ N-7 DI~([ 0 (~ po~tiolt~ ;llu
nll~lckoql. I1~)111 nlhhJel~ were de[(,clet] rehltlvely ~f~ln nlLer tllhnlrli~-
h:d iDJI (,f I)MN (131). q'he denlet]~ylativ(~ enzyme is ii cy(~:b r(. n(~ I'-
,l~(hll,llt!n(h!llL illicro~f)lulll illixt,~I.fllllllion oxitlo~ Lh:tL ~,glltil~
NA1 )1 q I ~r~] ()~ :rod enrD I~ inhil)ile(I by (~) or by i~rett~ul merit o[ Lhe
~L~lil,i;~l wiLh ( ~ot ~1~ which inhihils the ~nLhesis of eyLochrtmte I~ ']~0.
~iJlce ethnrlol is ~)]teH conmJnu,{I in ~l[~iurlcLiun with slnolli./~, iL i~
Ilelli~lunL [(i Iit~L~ [hill. itl i~lts chlon~c COll~Ulnl~tion (iF ~(h~ln(~l
enhnell!v~l Ihe mt,lld~oli~nl (1£ I)MN nl~d] the ~)VlllaLiml oF mul~l~(,l~ic
~ll)~lJiJ~ccs [hererl~)m (/~ ,r:ll). 'l'hi~ ol~Rer v~tiou is oF .~l~clnl in [(,r t,~L
i~ view OF hllnllul (hlta ~howiiig iul illCl~,ltsel] inci(Iciice (~f CUll[!f~J¸ t}f
[hi! or~lJ ¢~lvity 0nlJ e~oph~lgu~ ill ~lll~lkE-i~ who lll~(~ drink r~ll]~
nJt~l.rn(~ of nlctlhnl (I~),
I)iel [lyllllh~J~utlino, the next hil~h~r Inellll)or fir [he ~;erJe~, i~ ',xlst~
ii~el~d)llliz(~ Ily (~-oxillnLiOl] tt~ ncelnhlehy(]e n;Id nu t!thyl~llill~
species, hi conLl~l, (,~ exit]nLiml oF ~h~ ~lky] chub1 of longer ch=dn
~l[~liV:l(iVt~ ~Jflle ~f Ih(~ in0tllh(dile~l, ~ oX~lllIIIo, i~-ni[rl~o.]l-
bll]yl (,I h)/(h(ixybtltyhlluine), W(!le Ii]OlO ac|ive ~l~ bhl~J(l~r c~ttclno-
~l,n~ I hnn f I1(! It~ll~!n L N-nitl'l~etli-n-bllLylau~ine (5:lk
f,il{e ~lher ncye]ic lm(I cyclic calc~loKenic niLr~n~ines, NM()II
ulldori~(~.s nleL;~l.~lic (i-hydroxy]nllon h) e]ectl~]>hille (]~,zohy~Jroxide
i]ll(.rluedi~des I hz~t tuny ~]t:l, a~ ultim~d o cn relnol~ens (73, 127)
~N~lt~ml~t/~elh(inld~ln={tle
AmonK Lho ngrlculLizrnl chemic.Is u~ed [nr Lhe eulLiv:~[irm z}r
'1'1,.~: inr:hlr]e dinzeHzyhloducyhmdne IPemlrL nmleie ]lydrazide
Illetlm .(thlnlin~e, held c~Jtlmryl (3evhl) ;1~ t~ rellresent ~tive of (he elhy]
IJretllml(!~ (l~iKure 3) (~ ,~{J211 ~ilmll resillu~l amounLs of Ille~o
~ll~['nL~ werP Iound on hnrvo~ted t~d~l=een (16'9L DieLhLtnolnmlne h~ls
I..m slu(lied .~ r~ l.lSMlde peecul~ilr for lli[r~o(f]e[h[~llolalllille
(NI)I.:I.A). a elueirlolXen found in lob:tacos (O.I Lo G.8 ppm) thnt wine
tn.tded with tile sucker growth inhibitl~r maleic hy(h tizide dielhnno.
]~ruine The .~in,lle (~1" tobaccos tlltt~ h euted cont~tined IO Lo 40 hi; pr'r
6.8 ppm ~1" NDI~LA (.'HL This nillOSnlnine indil('es cnrelntmln i)[ Hit!
kidney nltd liver ~" rnts (~7..r2.';; m~d cnrcinom~ ol the fr[leh(.~ oF
hlmlst~.r~ F~dlowiiig sul)euLnn~ms inieeLion, painting tile ~khl. ~r
swal~hing (I., ~t~tl eaviLy (/~3, ,q7) NI;I,:I*A penol.rlzlcs rnL (122) m~d
hunmn ~ldn (~4) nnd is prinmzily ex(t etcd via (he uri:lm'y trnct 1122.
I.r;3L
+,
CII3 \ /ell3 0
N ~ O'C "N-CII3
t + tlOOC -CH3
CH2 H
CH3 CARBA~YL ($EV{H)
DIMETHYLOODECYLAMINE-ACETATE
(PENARI
011
I~ + HN ~CII~-CH~-0H
• "~K/N - H -~
0 CH2-CH2-0H
MALEIC IIYDFIAZIDE -- DIETHANOLAMIIIE(MII.30)
I~lliOIIIC 3.--Agrle~ilturnf (!ll~mlenl~ for tobnveo e=llliv./hm
(
~Prcelll. nlklllold~, ~ to !)~ i~,rf~l!n'( r~l" wh~'h i;~ Hi(~plil., II~ll)(llhull
• n~rHo]" ~pllllloi(I~ ~l,e norlli(!oliut!, $1rlll[tlllinl!, ;irlall~l~irm i.()lil~ill~ ~11.1
I~ .f~rmyhlllrnlco ne (}'~i~ttre 4) ~evellll of Ihl,~(, nllI:d~i<l~; ~u~,
~o{'oll(l~lly ~11(] ~Prl~ll.v }1111i11(~ iifld, ii~ Riich, ~11(, ;lllIpll:l})l(, ill N
rt. ~rtl~lt, CD l]nll [o})~l(Cl~ ~lfl(llle W~,lO ~hf)wll h~ t'llIil~lill Nr.
nihn~ono~licotine (NNN), 4(,t.,Ihyhtilrr~s:ln~h)(~).](;ll~,rltlvl .hi.
fnnlnle (NNK), N'-IrJ(ro~lmnldnbine (NA'['), Jin,I N' Ilillr~o;~=,=lh~,*d~.,
(J~All), Jn l~l(~dol exl>eriru(,llt~' nlh'l)~tion f)f ilie~line nl~f~ yit,hh~l ,I-
(moth'~lnif 'o~n~nini~).4 (3 ,yridyllh n (NNA) which ],~.~ n~l .~
yu]. buen ilh!llti(]ed in t(d~ltct (1 n(]l¸ in Ihe slutllte (71, 7,~)
In exj>erin~enl~ with I'(~-I;ll~t~l~'ql nleoline, {)(IIH~ per('~!fll of Ihi~
ull(ahlii] i~ nilro~t|oq~ I(~ NNN " II! Lhe curl.R ~Jf Ihlrlel, h,l>:~l(n
Ihe NNN in |()b;ict:~ y I'~ll~l~,l¸ :u.I (he rt!rll~lill(let i~ )yro~t~iithl,~
i~!(I prinl;n ily frl)ln nlcnlilte I~II)L
l'rlhl(! ~ i)l+e'sl~lll~ t]~l(n ~r Iiil~ll¢(.{i.~]~,cil]e N.l~l,o~;tluilte~ ('I'~N/~)
in (lie htl~lle('o nnl~ ~ln~ke I¸¢iI,~lr(!~l(,~ ~ll]tl t.i~:l)~ .~[~p l i ii if
mil~[ Iio nlll0(~ I~lgt cif~Iil,~,{l(, ,;lll(~lle coil[fill1~ Iril(.e~ (,I¸ [~/~11 (irl~ f~l
fr'l~lll the IJu e ,~hlle~ l)ot~umrl(, (;ermnl~y, and ~w(!(]l,n ~l,l,(,=lr~,~l
5 5 Io I(ll) iqlm o1" 'I,'~NA in H.,~e nm(eriilI~, Ihe hi~h(,st h.w,l~ .I¸
l~fl!l
NICOTINE COTININE NORNICOTINE
+'I'-FO RMYLNORNICOTINE ANABASINE
AtaATABINE
I,'It;IINI'] 4.--(~<m0ml)lt lobate]+a £*llcaloid~ In tt)l)tl+~¢o ~i=¢1
I{)btl(!(!lJ ~Jl)l like]
~,= ii i1¢1 .k; i I,,Ib,=l,+q =q ~l 4~J+
'I'AIII.I'J 5.--'l'*~h~=cco ~I~CIN~ N-slitr(,.~uJnhlus is) tot)~Lc¢'<)
1)='o; hnc:t+~
+~N~ ill ;l~ 1}~ 17 tlI~ +
(14+ i+J 43
N N ,J + + =, ,,,+,,,d ,I,,,+* C++; . I:I 11 I% . 4 +
13 ] ~J
. p~t+l~ I +~+ 4nn~ In,H+ ,=~+n++pn,,o l t i ~,~ 4 ndj I+ l l,,,l+nnnu++
+d=I i++,l ,~+ 1, 4 +l,lk,, =l //
~:+~l'¢illl,l~+nJ<! ]~itrlm+mtill~ i't~pllrt<~d in +a c(+n~+~0[l+e=" Inrod~II't II~l~L i+
+d ~:~+l~:~:lktltllion=+ oJ" ().(l+~ to (~9 Ilpm (77)+ 'J'J~se oL~,c~w~tioil~ ~H+ of
i t!IL, v;llll:cJ to t h~ ~,llidcmitflot~ii!~tl [il3d illj ~ tl[" i llPl'~l++IPIl I'i~I¢ I~I¢ 4~+t
ll<'Dl"
(it" tilt+ 4*l=tl <!~Ivily ill +l)tll'i dippeaS (2OO), The i=llpon't~ll++O (+I' Lht+
li~+ £iii tllt+cl wit Jlil+ I h~' I>l'+t I ~ +~vi~ +ll+='i~++ ~IIIIIT dilll>illl~ (1~,4).
/~L I ili~ l iliLU' NI~j+4~ i~ lit} u X llt~l'illlUr)i~l (~vidui14:~ oil lli~ ~)l'lil++ I
ilJl I lJ~"
'I'HNA il~ the [ItJtl~ ~il~t)ll irl]l~tl~LIilm tJl ~:ii:~ilett(+ ++l,=ol~u }[4J~q~L+~++=l'+ ;I
~llHll~t+r 411" 4in¢ <+I" LWll llll<;k~ oI" (~i j~z~ l't!t i+:+ dilily 14~i ili ll~ ~l) It+ (}4)
IJLI~ 4)I+
ll~t'~>l ili~+, I ICJ ,i lllb+ Ill ll()l II It oLhl¢+ I.~+ [<l I~ lill~ l)f illlztl;Ibill~, +tiBet
O ~ Io
4FB nnnp~ ol'4nlu+ibil~Jll4:, lllld illhllk'~+ (Ill It+ ~i III~ <)I Nt)+ ']'lltl+, ill lt/l+<~
I[>t lll;~l i4)tl <ll hll )~ t l:c:+ I~lll~l: Iil ~ N-I ~i [ I'[l!;+u +1J liU~ I~ +1 I C'~LI
I~o~ibilily.
, ,Hr
'I'AItI,E 6.--Carcluogcntic activity of tl+bacco+~i+ccl.qc
~i|ro.~amillt~s
ii+,~ ~c N~ ¢++ ~ill i( ~ r, illul,b++l
NI~II NaM,I ~,Vil ~ (( ~ + ¢~,i+~.1)
¢,,h il,,,=,,~ J
~ NO l~+b¢ dad, r,.Ohk
t'.~rchL,~l*,~l
NNJ( ,:,,, iiioi,i,,~
+l'lie <t+ltll flir Ih+ c:+lcil+o+~¢+nii<:iLy ~+1" NNN+ NNI{, +u;d NAIl +ill,
I'l~ll+llletl, NNI( i+ IO' I]Jl" tJl( Ill<+'+l I~+I<~lil I:~llt:illogt'll Ill till! 'I'NNA. JII
I~OL~IICy ll~ NI nJtIo~Ol)lOI]litlliilIO illi¢l ilbIltIL I-wJt'~ Ih~ ~II:LJviL~ Ill N-
~-I~itll)~O~i~illyl~lllln~, whic'h i~; Illl, IIl(I+l+ [lllLl+n~ l:ill'~iliil~l!lli~+ IlJl IO"
Lh UIi Jfl4~ ill II illl)~tl~L ~,
'l'he i[Ifluellc(! o1" +11~o1101 ++~ +~ clil!Llln~/ COlLIl)Olll~lit I~ll NNN
~lll!llht]l 1)11 NNN I~lll'Pillll~/,lliCiLy ill Ih+ II~tl, ~lllillltll~, WIIO,,+II i<+hd
c'alo~ic itltake War egtual t~ tribal. Ifl tl~e ~L~I ~i~d~ {t;lfl 'll~
Ilill()MZlrllill~, tile lll~!Llll+oJic OclivllLillll lie t]l<~ 'I++~]NA i+lvtllvL+~ Ill¢l~t
lJl~ely al~t> oi¢~ <~-hydroxyhtJ<~il fT,'], /;PT)+ l"i+++lilc= 5] ;kJ~d (; d~l+i~:L II+(~
,,r1%
LI,~.
h! IO.JlIILI JOpl.ll(i lllItllIllI II! ~Oll!llllI ~l!ll~i~ou!~,llI;l IO X,%IILII ~Q(ll
"(#H '!JOL)~.Sq i I' u°.1
.I,~11o.I mltmo:~ ~lu!iIIII ~,'Fl+!~!lJU ImlA:*id ImO +@UO!llm~old .llll ~llOql!~.~
p.m!.lqO al,le~ ~mll olnl!~ 'm~!lU,lU!...... ;~J!ldta~ ~lmiOqdo.I)!u .imDo
ml ~'~lllUl'~ hill o~;lu [ImI Ioqa~tl!>Oll!U.F Ja dlp~n!,'l!~/~u ()(l~ jr, ~iiin~
l~OtIl p1111 FOIl!trill ~l]l!tl~(IJll IIIIU ~lltiI1111~Od~[IO~1$!ll ~!)lJ[llfliU Iii[lq
{;~01.'t4~,5(;
"VNS,h °ql Jo +~l!aU!o,~Ils-ut!~JIl atll uJu[dx~ ,IIO~! &q 1ou ~Ip mlin~tO
~11!~od~ JO suzi~!l oi[1 o| ~o)!111ql~i~lU Jo ~LI!pU!q o(nl imll olu,+!pli!
t:wp o~oli,~ '(gG[ 'P~ '~) ~+~o aql Jo tr!UlZlOtL4 pUU '~li~ml<hl~O *~pta:l~
,Oi!ll!XUulqns pOu ImtJJu!lq~s '~a^![ *£otip!:[ O~ pun ~o~rllu ll~m?u lai~J
palaqHI omiql jo sal!lO+[l!1,+tu ~+tll Imll u~o'l~ ~At~i[ +KL~+~!l~oIl~J
,s,~imumI l]UO as!u+ u! ~[NNI~,,-II puu NNN{D-',~,J jo ;~o!Inq[.qm!p
ol{~ Ill) "~lO(IO,I ~I?~!tUOtl30!¢t ~UO llll~J ~O!pll]~ ~[£[(/tlJ2hJ![in.Jo~nu OAf,f,
"(1;9) u°!1 'IKx°~pXtl+l+ ~[I uC;!la'~!l:*[;
ua~oulaxl?a aULl j~ UU!l.qtx~u[ ~+q D~u!.lq~ s,~l!Imlnla LU NN~ JO ~'(ll~ V
• ~+~U!UlIJSOJ~!U ~!a~tl~ O~mlqO| Os+Jql JO sueloJ ~!UO,~O~I!;i,lU~ ,~II~lll!1111
~III glqt)qo.ld ~a mIo[ uin!ttoqJn+a ~u!llnsol oili ,Io 'Klo+~ !13~llf:~IJ 'l[; pill?
JU ~lII!l~UUalU] ap!XO~l~+~q('zt~!p ~!l!qdo~Imi)a aLl+l, "o:i!tu V u!1~l~ u!
K~/LIJ()II,IIiI~ ~UII[ JO IlO!l~l]t)ld llO II+)~IP~ 'KU@JIO[I!~)~I~+) ~]IZ 21all!l l.~lJ~ll
o,llI '('~ u[m£1JoJ '0 OJl121~'{] )INN Kll u°[l:mPaJ ~II I)+luIjtU 1°Iplaln £1u[1
UODOR itlJ~ ~EI I]#A% SO Io~l]xo-,H-~INN pUlT aplxo-,N-NNN '+:nl![+l(Ir:l itu
illqlqs ~llt ~uo~uv "l/~L 'L~) )iNN I~llll NNN ~(+ "gKu~tll~!d a!luqt:l'lul
KJ.~I~Ult~q
Ualili)B IlUll~~ liUii liill,l III 1"4~]N Jli lllO(liillllll~ ,"llllIDI3
• ~ • N .
i, 1 ~+
"+CI (~ "--- i
..... 1' '<
%;jl~ ')
N
~'l ] ,,~ I ~ " ; IL31
' 'fl
X / ~ c,., t
']~ " - /;i f! .... ; !~
rAl~l,l~ 7. N" roarelzc~ ;lll(I liill.llph~ll01~ ill ~il~lll,¢{lu ,~ln()Ji~
t~Jliuq,~i~j~ii~J ....
iigJ~L~t~J~
5~
53
N~I~,3 ,nelh~h,i,~lml
~ ~lll~r~: ~ ~,,~ It ~ .~h I~lmmm t i~L
qlt¢]Mimmble, even if one were to ~on~ider the total of Lhe aromatic
i~1111;~ un(I ~ht!ir zl~live IIl~tzlb(JliL~, w}lit!ll tll~ly be I~glllled ttt ~Jil~tJ
Itl~lll ~'l)lnltLi~ tli[l~hyt]ro~zlrL)otls~jf L]l~ ~lll~l~e ~ lowered, Du~]J I.l~}
(:c~lLchuled Ilu~L 2nallhLhylallline ~tnl~th~r wiHi ether ar(~nlllLic
;unillu~) hilly ~,ttl]~c~! LO ex[ll~ill Lh~ illcle~l~e~l I~l;~(lller can~:er t i~ll liar
~:i~;~ll ~l h~ ~lllOllur ~ Wi~l-kinl~ ill I~*~i f](.~|ioll iJlan{~.
Atlhliul4h II11~ illll~l~r(;lltCe ur hal:~ ijl¸ nl,(llll~l~c lll~lille~ ill ~lll~k~
li~t¸ I~ il~(:j~:~t~l~t~ L~l.lhll!r canl~t:l+ li~ll oi' ~t]llllct~l~ i~ tli.~ln~l~d' thett~
ill~ty hL: i~!;l~Oll ~lr [;qJll~!l.ii l~h(JllL Ihe i~l~te~inl~ Ii~vlq~ L}t¸ ililrlLI~ iJl
IJr~:~l d;~y Cil~qtt~Ll{!~ (|E ~I 1~ Ii~:z~:~lli)+ TwenLy y(:ar~ ill.'o, I~ie~e
h:v~h, wt!te Iltt~y ablnlL (),5 lll!rc~:tlL Th~ iltL:te~!~l ib~ll!nlilll I~t¸
The II.~hll~(~li¢ def.(ix ill (:u I.ioii ii fill nt:l~iv~ii)tl or ~-na phHlylnmhle (2-
NA) hart! Ii~:l:ll ~LLtllied in~elz~ivi:l~' (2~ 1,6,5). M~lny tl~.lt)×ili,::l{i~rL
pll~(hl(:l~ have b~:rl i(lelltil]~(~; tLllJ~,l ~Jl'e Ily~ll(~xy~JL~ll I~eriwtLiw!n
Lh~tL ~'~itl I~l~ ]be e);clete~l lJ:~ ~,llll~lt ic ;~i(I O1" ghzc.:~idttr(~mc ;ll:i(I
I;~nljllLlL~h!~ I~telllel.t,;iphll-i~: and illel.~:~ll{~lri¢ ;t~it~ h;w~! ;11.~O Ilel:n
d~ iv~Jliv~ ibl¸ 2 NA ll~ Lhe ~.tive t:;ll~mol~l~l~ i~l~het¸ Ih~l] Hie p;u'~nL
~:l~llllJ(~lll~ll I*'urLhuttlltlr~, ~ln N ~hlcttl~lliiJiJ ;ll~llt,~ite~I hi [)e Lh~
h~ul~,pln I ~)ttll. 2.NA ur Ihe N hy~h~J×y derivaLive I~tt~l ;.hhl('ls wilh
I~u~ll~itt~ ilt tlLu:h!ic at;i([~ II(~), and ulher ~ldducl~ have ~ll!~l~ Ile~n
i,l~J~lific~l (I~L Ily ailal~lIy Io ihe :~illt~ltic)jl wilh I-I~yLIJl~×~,lj:~l~llllly.
I.~ltinl~, tht: {I 6 I~li~lll ~1¸ I~lnll~mt' i~ zilyl;inlill~ll:d (IDI) 'rl~
:,,., , t:PTOI]9
TAIII,P, 8.--Aromali(: amines i~t cit~arettv smolcv
3ND.~wthyim~hn~
2E~h~h,,~d,,~=
4 E~hyhu]dltJ~
4 M~Lhux)*.,ih,w
I N,~phd~H~mU,~ 4
~1~ 2;
An,muh~l,h, .)4
t ,~
I~hdol.dC~,l ~ignil'icance of th~ dilTt.ent uddtncl;+ h~,~ n,~l i.~,~ ,h~li.
AIIholll~h N-]lydl'o~yhllidlll ~ll~,l oL'ctit'~ iI~nitl~ .lehll.~li~m ~1¸ 2-
~lmlno~L~ll)etle (I.15], Ihe IN-hyd~,y gll~UlI du~ limb( IJ;itli~!ill;ll~: ill
I~rlll;~l ion or lllle[t~ic ~l~il~ il~l,}u~ I~; [iL~;l~!~nl, LI.! ~!l}lyh!llil! I~n~d i~l II~l!
A tli!l~rli~iv~ i!xltt~l'iltl~lll, nil thL! II~t!t~llltlli~lll (11¸ o ~llhlltlilll: ~,llt~w~(I
l lla~ ;~:eLylaliotl ol¸ ttlt~ imlinl~ ~!r(l~lp ~llld hydrox~v]~lii~ui ;~ I h~ I
(I~). M ~tillly ~llllilLe LIIIIJ tit ~1 I~!!~;~:l' ~]d enl ~uc!urlmilh~ (!llnitll~l I l:!; ol¸
~lx i(hlt ion i~r Lh[! nlet hyl I~ r(n~p Ii~ a hyd r(~xylnl!l hyl (ir t::J rlll~x vli~ ~ll'i~l
Aiiolll~r inil~oF i)~thw~y wil~i o×id;l(ioll (Jr lilt! alnillO i!lll~lp, ,~lll~'e
;l~txylolll~lle ~ltld tlilt()~(~l(llLll,ll~ W~:l.~ ill~ll{i~]l~L}, WJll'Lilet" II1¢:~'
nlt!hllJ~liLl!~ Wttl'~ dt~l'iWd fri~ln ~ul N.hylh'lJ~y.o [~lhlidilLe WLt~ II~JL
PiJlOnhmi.+~lO
I. 19111, I~,lrm.d and ]hmf (l~/) ~lrl~esteMI IhaL l)rotlehol.'enie
carcilulnnn in rlp::lrP[tl~ :~rnoker~ cqmhi I.~! induced by thP ii-pnlqiele
I"mffl('l pen I 12] F"']' ) ~im'l, Iheul n nulllber (fl" ~hldies hove
el' u)lh,d vzn~linl qmtrllili~'~ (11 ~'"1'o irn line ~nl e II 0 A In I t p i I r
.)~m. / I; 20:?~ Ilar'le, el. nl if;I,) galhcred dnrn foe :"~1'o in
eil~~lu(~lh! ~oh;l('q:q~ rlom litany ¢otl)llli(!~ ~lllll ~lflCuhlh,d 0.45 pCi oF
!~l)Lllet,~. leo- :n,,[Jl> itl Iob~l(efJ IIrL" 11~dlOlllO II~l'licl('~. ~qkl.n tip by Ih4.
glnn,lllhH h:Gi nl finn Iol>aqccl) leal, I1~ well au~ lead-210 (-'"J ql)nnd zlr'J ~(i
blrl~ ~<)iI Ihnq i~ tel Lili.'l!d wJfll cr'rtahl pn,lsphlfles (/~/~. H~7). Tilirl.y
Io lilly [)r/t,(,nl o[ ~1'11 ilk t)le (~;irt,Ykp IiiIlltc~O worn /el~lrle(~ 10 be
IJn:l ~ ('r~l [1[ ~'l,I ~o ¢lnh ])(. I I!laint,rl by I][h!r [~[9~ (24j,
I ll.m Jnhohlihlrl. ~l"i)l) [~ro(lLlcl~ In1 ~ ( f Lilt hlll~ [s~ rzll.~ (~01)
go[dl'rl h~misiel~ I~vP~lh,d r ~e- eSl r I)Se rcllltioe~shill i~ rel.~r(] IO
blotil I~oc:lr rPIllml;I ~litl] llllclln('*gli:in(Hnli irl tJl~ pt'nqpill3rl)l hL]l~ (/0,u~.
~lllnlllinrle¢)l*~ 1111Jllip[~ ill~[illtllhln~ of I)enT~)~zllpyrene ((Ol+l] IIo~P 4 ~)
It1~) :lIlql :!IUl+<) Cl.hll dose +rdFJ)e)<) pCi) ott Lhe ~llt~l~ '~tlii!c ilx~Itlc'~,d
~d)lm( Iwice Ih~ nuinber of I Inl)or~ (@:[ll!c[~ql irrol~ (it@ ll~diIiv(, c~])?l'L
• ' '~t t'" ~(12. )
l~,nd EIO (:"'l'b*. lhc ,~][mdpalenL oi" ~"Po, is found in all envlron-
rnc!nlznP nhno'qlhctcs (001 p(',i ~]"l'f)/rn:+nnd 0003 pCi ~mPo/m'), qhe
<h.ily cx phmnl c tl[ II cigar t.l.l e mn<,her In ~"~['b has bt.en csrinurtfed t+] I)~.
/3 t> ~1 tilm'~ ~9 miter thnn that oF n nOnSltmkPr (66"). IJar]ey eL hi.
<1;10 neviuw(.d [~ ~hndlcs iFl:It had (h!lermined ~"})o in tile paten
eily Jll~l oF i lit> hlng~ and iJt l I,. i] r.orlt.T) i~lI Lis~tlc~ of ciiff~ retie ~l~1oVlers.
.xs I s, I s k rs+ll.~Itllesslowedge e ]ag~e e
Ilmt :n"[~) i~ ~hllt,d 111 ~.h~ I)~TlP)lChylllI~ q~f snlok~rs IlL L[l/'e2c- llrno9
highcn" It,v~l~ Ih:lrl in ~oll~tllDli~t~ ~llltl titllt it nl~ persists in l)le
l~r'Orlthlul t)ill(!(9~[] oi[ ~rllolter~ in higher COllCelll~l~(iO~l~ 111~ ill
alqlllSllV~l~ (q'~.
i,'llilll i:ollipi~ri~lH)~ of t'~dotl-lkllq~h[l.r ~xpo~ut~ or I~nd(!lJ{i*tKl?l(i
nilil+<!rt+ wilh 4 h~'iv relutlve risk of lur]K cnncer, l ]uu'ley eL a[. du[ll]cell
[h;It ~:nn~l)o i:~ /1 qun(:s~ionaV)le ris~ I'acior for ]unb, C~Ullcer in Ci~lli~?lll.
-'~"1~o I(!v(:l~ in I nbllceo shotLhl be conlridt!r i.iI (.';f~).
Niek+'l
hlege ulunlber of stu*fie~ from Ihe ~nited Bl.~tes mul fro], olher
(..c)Li iiLr i(...~ h~lve ~hown I.hl] f. ~h~ (oh~lcco of one ~'J~i~ r~U ~ (~orll Ilill~ ~ I o
1.1 Fg or rlid:e] q141. 202}. Analyses Inave delermined IhaL lO In 20
[)t!r'l't, ri L or I he iticknl ii1 Cij[~l r o[ I~¢ is I I'll I1~ f~r ged ~Yi]~) []1~3 I11~1 [1~SI
i.e~m
l; T089
or lhI' niellt!l ir Iltem,all i. Ihe fftlr Illul~e 11,~.'1), in,lie:ditlll Ih~lt
¢ig~t I"et ( t! SIIIolc P I)ltly co n hli)l IllelCrq (:Ill I)oIlyl.
The l~+~snlh]e exi~leriee +mrl telnrive :rla])ilily o[ ni(!lWI t,t~)br,nu'll ie]
c~hq~relle so)eke is indiuectly sqll)l)onled hy ~evernl oh*:,,rv~li<,P)~:
,~lmdcT)lltlll el +11 (181) ~]um[ nickel c~lrl)lmyl ill 1he +,xhnrell ni)¸ +e~
• ,~c[hmlrllhebh>odofmtln.,~lllhl./(17f;Irel,~)rh,+rlholl~fill c~+ F)+~)I
nlorloxide throllI[]i Ilil klti[i(, t~i,g~llt!lrt! rohlulm relll~vell nllll h of lln~,
nickel Irot)l 01e h/hnrco, NiCkel ]ul~ ulst) })ten [otmd hI IniPc h~lm<'ro
(O,fi At) 10 In~/cil~), ck~m s (I.9 h) 15 pg/cil~o] I, and in 1 IS. +;I]lirl¸ (2 t4) ~1
~lg/~)(141).
The T)r.e~eul¢'e or I~icke] ]11 (o]Jn[~co ~111oke i~ nn ir)lporllllll [i)l<[irn~
rcl~nr tl~t'~s nf v~he~.h er ~t i~ ~n ~le ~o~1)1 t)[ nlrAt I,I c)~l ~lm~yl t)l¸ ~1 )11 ~1~,)'
f0Flli~, v)(,c~lJ~e ILicke] ~elf tllld ~t, vel(ll I~[Ckt~l collil)olll)rtq ~)t,
?~li~cill(~llic it1 kll)orl]loly nll]nl:ll~, it)lrllc[rlJ~ ~lrC()l)lo~ hy ~LilJCIII;I
n¢otl~ illjecLi~ I~ llltcl rhlll]+[mny(n~lut!4)ll)n~ in])r)r i))~llllntJ~cl)l~Lr ii)[e(¸
• ~i<)n 11 al~pc~rs that nickel sul)~ttlfide (N[~,) (s It strtleq~l'¢ sat etq~etfie
"al(enL (96, 141i, Inl~arena] ini(,eli+)n of a sinl!le <Into, ol¸ 5 ))~1: Ni,!~,
illqhil:ed £1 hib~h lille nf leeull (:olciuloitiW~ iri rIllS (l~/I)). ],]~l~o~lrl(, ~)[
Itt(~ I~r ~]O I)linllle~ I~lr0e tinic~ wt,ld/iy for ] yPttr II) nrl ~ll)ii<),qd)(,t r.
c01flnining Bi) to riO lug of nlellel c~rbonyl I)loriuecd I)ln])not)nlY
CrlrCinorlla ill two Of~iX nlli)nrll~ I I 7!1)
workel ~ ill )l[Ckej iciin~rir'S in [?,rll~l nn({ nnli ~tlnnd~l were lel~oa fl,(r
1o have excessive rJl[e~ I)~¸ c~lncor oH¸ (lie Iltl,*i+l] ellvity ~nfl ()f tile hlrl)[
~tl]dle~ rronn ,}+~I)an, the U~s.I~:~ nnrl I])e (]erl)lnul I)t,I)]o<'n:tti(!
]~el)ubli¢ also reporlnd ir]ere~i~etl ihciITences 9r Itinl~ cnn<'er nnnoinl~
ni~[[e] wolkerg. The [)~rgh'ttior)ll] ~[(etlcy ~1. I{(,~t,ltreh oll (~:lnrer
(~) conchlded on Ihe basis of epidettli, k~icnl sllldi0~ lilnL w<)rllet ~: ili
lli¢;kei le[illtorje~ hove nn III1!) (,llsed tick i'r)r (;zl tl~el. (J[ I ]le n:n'~:i] (:41viiv
~ignlfic£1nl rolo it1 the eLio]ogy <)r Itlrll~ CarlUel' in c~l~+lu.ellt! ~lllr)l{(.i~
(141), pr~ldcnce diclnfe.~ LhnL eriot(s :~hollh[ [)e made I+) Ir~hlel, Ilu,
arllourlL ~f L[li~ r)lelal in lolnnc+'o [tml (o nvobl ¢orll+~rnl))tlli+)nl ()r¸
tx)bucco with Itick~t ([Ltt[~l~ cLIIt[Itl~ ~tnd o(ht!r |)ro,~e~e~ itt ci~;nte~(~~
lllltnlll'~let III e
tob,eecu Fronl 1032 Lo 1951. arst.nic:~l Wsllcides wcr~ u~ed orl h~h,rco
in lilt+ [Jnite<l ~tates llu]ing Ibis Ibne, tile [ir~enie corllerff of tIS
eignretb~s rn~e from 126 to 42 i~g/c:i~ntette (¢~) In 1952. ~Irseni<-*+[s
were tom,well fuom Lhe li~t tlf r('e(tlllltlelld~d it~C~ir[(h'~ l"Ol C(It~tol
01" }1orrlwol iil~ 011 tol)~cco. ~ince I hi!if, n ~ill~ri141 ecrl!~islt ill Lhl~ It re~cil iC
cot)tent <)r ci~nref te (obocco [Ins (~!(!u) t ell. (~utllrie (if)) conlrhl<led iT)
1968 that arsenic residues in |iS, cigarettes do rntt exceed 2 r)pm nnd
~ll'e normlllly i~i)ollfl ] p]liii OF le~ told Ilult tt)llllV~) in rio l:)enf~,r
Sollr('e of ar~elliC for COl)~ulnctt+ lhnnl frnn(l The k)n[ l(.]m/leql dnl;l fl)r
:!1 I
1
n,,J~,L~l ~I++,¸,+- ¢ .
F~,,J~,j,,,I.,'~I++~''+ u I1,,
~,,,+b~,,¸~'~'~ o • ~ ,,¢
Hn'L'~+'~L~'+" ~1~ ~u I,~
~id+slream ~m~Jko
, ,, ,
'I'AIII,I~ I().--Tox~c aml Lumm'iL~enic ItL~en(~ nr ci~nr~tle
~lll4>lte; r.~[ilp (if ~,il[l~ll-('i~ltl ~nl()i(~ U(-;~) (o
iiinill~(rpfllli ~nl(ihe Ihl,~)
i,,,F.J,iq,,,m,,~id,, 1~5 ~ ,i,~: ~M
:lVmrl~,~rlm~ 29 i,g 2~
m,~rl,yla,,H.. 4n n~ 5 • 12
H ~llr,~ q,~ ..,Iblm,~ Iy} ,,~ :i . T~
Ib~li,am, FI . :Jl p~ H'~ ~7
r~*'~l}ir'~d(Iry lx)lhllItllLS L~ the hm~:~ IIlan does norlll~T br~,nLhhll~
09 L,I T069
:!I I
k ,,
I^0 .,,n r~ ~ ~llpd .,nI
.... ..........
1~*0 --
~o0 --
~n
O0
__ :k F-s--- .... ~
I"%.,
-- -- 01)
FIGIIILE 7.~U.S. snlc~-weil~llled itverlt~ hu: nn,I nir,dh~e
yleld~
(llll illl~ n!,~tl]~l r TIOIIO~'CIIDlil ]<11111 ] Itt:livili~+~
'l'h¢ Lxenll~ hit the +~nh,mwI~l!hh,<l ItvI'r:tl~t' t~lr" ;lil~l lliI'+~i+i('
dI'livct iI~ +)[ t[,~ ci~Iz I!l [t+~ ~i I~ +'t' 1955 (~;17 .I/~ hlr, 2 ? ml~ r)h'l)li,l+,l
*Inli[ 1!)1~) (~]4 ~+Ig tier, l.O il+l~ ]~irrffJni!) mi! ~+h+~wn iil ["ilgllt, "/ (ll
])tlt~rq: lhi~ Iii+tl~, ttl~ p+'l'It!ll~llI~<' Ill" [ilkel Liplli~l t!il~++1~'Ik4'~ hi ll~.
ci~!alelto i)roducth)n incre~im!lr ri,)nl IB,7 h~ ?)(I per t:t,nl
'['lit! ~l/,~l'iCtl[hlr~z[ It~l~e(9 ~lltd l+It,lilod~ <}f 1+,1)I)(.<!~1 1~i~(!~,~,11ni( rltl,J
pro(l~lC*L iT)HDD~'Iif'IU~i[~ ~Pfffli)l~ ~(~ CIIIITIJ~('~ in ~Itlr}lLf! i'rlltlll(l!li~l,,li,
(I)xi('iiy, Ileltl C+ll'(il)¢]l~'nicily Imvo h(,t*ll (lisl:U~;~(,r] in iit(,vlrlll~l ~,Ir
(~r~llll (,'~rmrlzl'~; ]{oplyrl~ (1~, I~/!)) ;Still P[~(!Wll~.'rl! fiR) ~l!/) 'f':dd,' I I
crnl~plm ent,~ for Llie ci~glz(,LIt+ hc fnrl! I!)(;O ~t~l thliing 1!)71r 7!), +,~ wrll
1~8 Ih~ llVt, l~l~e y~lllPS lop II IO~l(lill~ ](IW-(llf U.~. (:]j~III"¢*((P wilh Ix
perrnl~t eli I~lter L~I] (hi!)).
l~ ~il~lli~ican[ redlzc~ion ()r Ctllb(ln i]lOIl~ilr~= jR c~l~nlo(l~ ~n1<i~(<' did
IIO[ or!tilt tlll(~l Ciff~lr4~l(c~ Will1 p(H h)r+~tl,d [[1(~!I" ti]~ w~!l~ il1114111111-l,d
I']'~111]~ |~ ~)). A rVCOII[ I)llhlh;+lLiOll telJ(>th'll lhnl I~10 lIVl'r/II[I'
:+r~
TAIILI'] 12.--Carbon n~l)n~i~xiiIt~ in ~mok(} ~,f .~igardto~i
(:u f i~.~ i~ldMlull,l~ Itl~?c,J~J,f~t ul
t.b
'l'AJll,l',' I I.~(!han.~:s lu ~.nlllhe cl)tnl)iJMtilnn (~f cigarctle~
x;~ulllJf~:ltJl'eti in lil~ I)lliled Slat~
ilalw lur t itg,~ * ittl
T.I.,I ~,,l~l, tll.,h *ll.,It*'l ~:1 16
I'h, ,i,,I ~l*t,~ IIMI ta~ ~1
uigatutte nc,ld ia tl~ U(q(ed Kil~gd~m Imtweet~ 1934 ~d 194(1 { >99
la:ll:t~l~t jbl~lJll cJgaretl~b) de~i','ured t~lldt~r ~;tun[lurLI ~l~tokJ[ig cl~luli-
(l~71 hi c(~lllr~t, in ]979 the avel'uge cigar(~Lt~ Jn tim IJailed
t~.i~ph~l~l ~9 i~c~c~llt p~i~ ten,loci), 7"/ l~r~c~t ~lnve~ti~.lte~l filler
hi and:;, ~l~cl I,I p~rcent wlltilated filter ~igulutte~} d~liv~l~d i{18 mg
I~ll, I ~ ull4 i~i¢(lth~u, and ]~,G nlg cntb~n Jl~t)lloxlde, The aulh(~l~
ih~li~'~ly ~f I~tt" i4~) l~Ul~:elID uJ~d nicl)Lhm {31 i~rcct~), but ~nly all 11
i~d.t~'~:ltt ~ut:lt:~t~ ill c~lrbOl~ i~()ll[~itle delivery. The uvt!l'~l~ I.].}~.
~il~v~nli}altd liltet cig~relle of 197~1 llelivurcd IU.I Ilzg ~Lt'bcm
UlLnttb~idd: n~bd IIn~ ~IV~I'LI~: velllil~dtn] flitter cihquctle lh:liver~(I 1:~11
Itll; I:~Jlbi~l* elL(lll(~ilh! (l~TA. TIIJ~ t]~lllilll; ~Lud thu v;Jhu!~ of T~lll[u I:3
:;IblJl~lUl Ih~ ~:lJ;ll~l!pL their I'iltt~l II~i~tJ~litlll J~ the Inl~t hlll~l~lt~Li1L
II~v~'l~bl~lll~llL li~t¸ Lh~ r~tiuctJull t~l culJl~nl illl~n~Jxide ill ~ij[~ll~tl~
Jl~llli~le ~tlulllJlll~ l)l¸ (:i~lll.(!lle~ Ul~lol' ~l~il]d~tl'd ~olLdi{Jll~l~;. A~.
di~Lt~:;~t~d I~e~l~Jje. thu~t~ ~l)lldJ{[llll~ Iluly Julv~ relh!~:ted |lit! ~t~er~l~l~
~lt*d~]t illl~ h~lbils o1" Jl]divillu~ll~ ~5 y(J~ll ~ ~t~ll~ but h~llly lilly ~t i)~;l!;It" tlJ
lie luplt~¢nt~divt! (d" Ic~:~ lhuu lIJ i)cl~ullL ill¸ [J.~. ~ulnl~{~l~ llus~t~ll
~uld i~t~wl~t'l~¢~l~ (II;I)L ~t~ well ~ ul[~tJe~ (~, 7~*"L I'~pl~lled {hat ~lu~
~lJil~l,t:l ~ ;Jl¸ h~wt~ r I ;1~'~ I~lwuJ" ll[c(lli¢lt~ t:il~a rul t e~; will ~111 t~nml)/~ltll}]~
Jltl~
itl¸ t:i~l~ t I {t.~i wil h llel'ftll~tl~ll filler tilb~ wt.l~:, iJi ~cl, I(iwl:r I h~ll; t iul~it~
~l~lJt~lll~ uniil~l~Jy th~L ~l ~l~m]~r ill iJUt[~lr~ll(!lJ I'illt~r I:ig~u~(it:s rltll
ill~:rt!;l:~t: hh~ ~ullllciJtg i~ll~ll~i~y hJ ~41th ~L th:[~lq:t~ Ihat lie (:~n lully
('t~llll~L'~l~dtt~ ]~Jl¸ lile Io~ In I~t:{}lill*~ delivery wilhllu[ :~il~tliliczlnlll),
:~ll;
,j{b 16(i 1311 iHo
u K ipJT51* tN ~1 ~N-I[~I
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6N 71 IN I~J
(~lll~al~y 11~7J~l ~5k[~9 I~ 1~15
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USA
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13~ ~0 I:ll~ ~t~t~
1~5 I:1o
USA (I.']'{~ . 19BD i~ ~ 4N ~;/I qN 1~21
• ~. ~ ~,,,~:~ vuh,L~ f~, ,,u,~llll~ r c,~r~te~ 1~ ~ .i,:¸ 6,,I hh., ¢,~.,,tl,~ ~l; t ,,,jI
~Jnokhlg hlten~{Ly by Lh~ mliMct~= (}1 ]~nlOl~lll!d li]lel" cit!aletle~ may
III Illll)iliiltl to these c]l;lt)~e~ ill Lh~ ]I~IL{U[ II ~lr ~lll(lllhlt~, ~;tl.~]~trt ~ ol'
~Hlll}]II3 c(InS~&tII~NI~ l)v~r L[I~II~ ilr~dit:h:d hy iIHl~h;ll~: illl,~Ibl~l't Illt!lll~
~l~ld (!~llb[If~ Izl~llO){ide ill tlllO bl'~lll(l ol It~lv~l" I;ll t:i~;~ll!]lt~. ~Vith IIILI
iiculll~ilm, he ro~tnd I,h:-It t[Io Ilil!lll me yield ul~t e;l~,,d I I1~ lint c~]~~-, tile
t~t yit'ld ilm~eus~Jc{ ]lff; ll~.rct~HL, und £he c~nl)ml ~]tC.l~sxide yi~hl
i~l~c,l~( (!)~ ii(!lceJlt, ct)nJid~:ll(:e Jilllil~;) ~1[ ~(IW{!F I;ll" ~lll(Ikt~f~* [Kid
bh~cked ]lllit!~ with ['Jll~(l~, lip~, or tape. I,'ulthc~ I"l~(~;llL']l i~;
ii~!ce~zl~'~ tl~ defillt! Ill(! i~lttl;tl JlUi~l~L ol o~:(:Jll~iml (li" v¢~lll]l~tliOll~ ill
~]l/()~(C i]llVt)l~ ifI Ojll£!I- ill ii];l~{~ the pl'(Icitl('l acceplnl~h: I~ lilt!
iii;l(~l'l[ll:~ th~l| ~1~)' i[l¢:hldt! t'lHi/(llLlll~ of Ii~lv(It [IILCIIP,tlI~; dl
[Hillt!l~ I'J {)111 ~lJ I;ll'Ct), ~ik'tSii{~! ~!~ ~ {~{~111 I~l Iler
[lI;lllt~,, (w 5(*llli~i~li
:!t?
Ii;tvt~ llt~l hr.*,11 11I~,lhlllit,ll, qlll jiiLir~itpl 111 q ;ill by 111;111~. ;t~ h~ ~, H, if,, 1
IIn'y i('~uli Irn Inu%'/ (~(gi1111(YillITl~ {)P' ill Ii~p{hvr co11(,(!11{r~111(11i~ el
lm~Ju'duu~ Cimil.menl~ hl lhe m]ildi(.. 'lhe l)J.etlee ul" ITllvor Pnlieh-
nicilt tequhe~ d.{.ilvd h)nicolol~ h'nl ~hldh'n tiroL lile lint av~dlnlde ~lf
I.'(!sent fiJI sci~'nlilir" evnlunl loll el L}leir heallh in]ll>ncL (/~, IlIgL
Hesenrch Needs and Prlorilios
*i'ilI~;~t't'o t.n rr~illi>l~ell(!P.iR h:18 bo(!rl inlen~iY~iy Ht tldiP(J for l]li1r(~ I h;irl
~f~ ye~iI .~ fly ('pldi.Inilpl(q~is(~, cIic111~:~15. [l~och~lilisL% toxlcoit ~i.~l S, Olld
l~nll]iil~i~l~ As n it.suit, lilere is o pot~ch expnnd~ knowledfle nf Lilt!
In~xi~,r lilelIJi~ contlilmLinl~ Io lhe t~xici(y urld carcint~enici~y of
cij:;t,et(e ~;~lii~Ii~, NI~n0thele~% si~tliflt'~urlL i~;~i~ iln th~it k,]i]wlet~p~e
i ellltlin.
IIellip~ll l~rld nll~ligriNnt £1JInor~ ]inv~ I.!01) indlJcel] irl £he ]~ir'yllx ~ir
hJiInnh.r~ by ]~llg term uxpo~ure ~o dihnled cigarette snuoke. AL-
Lelnp~ to induce sil~nific~inL tlltnlburs ~fl huenc]te~enlic cnreilmmn ill
[ai~or~ILIHy mlim:t1~ were nr!l~lliv(~ ill spite of nt]:uor ei~rL~ wilh
~t!W!l;ll ~l~(~ci~ nl~d stl~lhls. Ne~Lher lld~; nor ~ItITI1~t(~l~; nor l~ttbl)i]ns
iu]h;il~, r:ii~:].oflt~ mnoke ~t~ d~!ply ~r.l llr interi~lly ns i)le ci~u~Lte
:g11~i~]lef'~ who h~ive prI~vidI~r] tile (]iI4~t wilh ihe conseqUCllC':8 oF tile]r
"~x l)eI'iIl]t~ILL'+ ill Lhe l~.'nl of clinicnl i~vi,le]ice r:~it hered by ellidel~liol
e.gi~d~ hl vit.w el¸ ll]is conlpi!llinff i!viiI0nce, it ~pllears thnt the
l~xlp(~lilln(,~ll:~l iliihlclion o[ b1~)lleh(~!tlic cllrcifl(~lll~ s]lou]d i.(-cc~ve
lin,il~.d prior iI¢( ~s ~L n ~.sen i ch gonl
I II~w~'ve r, llnlic~r el'~ilr ts s]lolt hl bP d<.v~iL(!d to the elucid~t~ml ~f tile
sl,..l~; ii1v(~Ivcd in (.he fol nl~llion i)r lUl~l; L11nlois. ~tlc~1 ii1vostiRaLinlls
nilJ~l :l(Li~IZllpl ftl ¢]llSw(!r the i~IIilwin~ qnr.slion~: D0~ cigarelJ~
slllolie Jndu~ce enzynle.~ lhnL ;ictivltli. Junior iniLintors unt] cu,cino
l~eli~ ~o litr:il¸ n1~ inl~ile lit!live rl] rlns? Are ct!rIJliu e.'~rcino~rm. 51Jch 11~
I,~Ii:i,.~ ~t~t,cili¢ N.nill~tmil10S. f~l-111~?{I froln st11,Jl((, cOlnF~Jllei1[.~ irl
lh~ lu ,ii~? (~Jrl 4ht~ ilt I~it,r~ i~r nl;d i~m ~iI such co r(:inoge ns in Lhe Jiln~
be llr~vi~rllt!t]? is it r~isil)le 4o inhibit nlehlbollc ncLiw1[~mn nt~d DNA
hhlditil~ of t~ll)nc('o slno]i~ e;tlcillo~eil~ by c]H!rnDt)revenLiv~ itle~1-
sti1~,~? lhflh lU~lli:c Live nnd roLro~iJeel ire studies hilve i mlic~led tiroL
cip[nnI.IIi, nnml~q,r~; wilh hlw s~Itnll vilumin A leve]~ huve ~ll
inc r t.~is(~l l'i~k ¢,~," lung ~'itnlc(!r cl)nllm red with ci~l rol Le sin]ok ei~ wil h
u]iJrmnl tlt" high vih.nirl A levels (18:1. 19H). J~videnc(! from in l,ii,~
nnd iiJ ~It~ sLudit~ ill curc[Jl~enL'~i~ I1tls supported the protoclive
role of vil~mln A (115). ~Ludies of lhe Sl~cii~c effecls of" vilnnlin A
und retinolc ncid on file inducli01t of lung tunnels by tobacco
Cll r'cinog~lls ~Iro titus n~edcd.
H~) Elf, only limited nttention hns been gLven Lo mecllnoi~ms of
~nduJc|(ol~ of ¢iirluel¸ or the esophagll~, ponclen~, l{JtiltPy, arld 11rilltlly
[)l~l(l{~er fly hJ[,ncco slnok~, ]nlti;ll expelim~nL~ ~upport L11e ~orlcept
lll~ll Celt~lill IHLtritiotlol (]e~icierl(.ie~ such ~i~ 1.ho~ o~* zinc ~lid
~)l:tl¢llel ,~ ii,;~)¸ ii1~ iq,~l: t• iii, hl~ , r ~,*liplln~y ,~ iiw d':,+lJ,h:lrW;~l I I,e,i. JI
Ilnl h) ill~llll~; floen 4olJnVi!o ~moIi~ CnlISIJ[LII!Illg. ~A]hplhf,i /¢lh:ir,I,(l
sn~olle ns nn ellzyme ill,hll':~l IIIIly ~e i]~llirectly r('~lmt~ihh, fl.
ine]ensPd Inel~holie H~(.i~/lli(lll (hi' f)i.~Illl.~p~cil)c 1,411(!i71{iI[i,11g ill if.'
e~ophn ~e:ll epitl]e]itlln m'l!l]~ to be Itvl prrnhled.
Orlly It few ~ftl(lio~ hllv~ bPPII I oll(!erlt0d wil]l 4]le erFl!(~l, er foltllr,e¢l
~rllo~l' IlIId ii~ 11i~Olill~ level .,, ((IP ]lig~h~lni~lfy ;IIHI tulll,¢illn III thl'
ponCren~ ~n slllolI(~ r.~ ~nl(I ill I~ll~el ntory Ilnirn~l~ ( ~ 14t]~. It lleed~ to I,e
~r{!~el rnillt, d W]L~tIIIlr II~Cotilt{! II~l~ II IiireCL illFIIlell(!(! (111 Ihe illdll~ilon
0[" II~elWrefl(i~ cltflrer irl CI~IIrPi((! ~llqOlll~r~ {tr whether il I~ivt, s rise hl
L~ller. j II~ ~.ltll~l(l:lllol~ n~ Ihese (]lll~(Ion~ ~ho ]
~ r I I+l II]
since it~ ineiden¢~ in Ih~ Ur,iled Shules I1.~ inc,i.;,m~d ~le:~,lHv
Iit, hveen l!tS(Pn~ld 1970.
All earlier P:I rt, of IIl~ ]l~lru I denll, With tile wit i~ltr colwepf:; oo
]ll~ Co11~,l~it~on Ill (:i~nrello srnoliin~ ~ll(] hJ41dq]tll ('IlIIITI!r (!ill ii,nlly,
tlne nm~t vllljll I.h0ory tCInl(,~ Io (lIe likelihood that fl.! nril., o~
~¢T1~eI~ corltllifl~ LI'~I('E$ Of br~li~iI(!r eillI:iill)i~pl~ I]1;if d~I'Ii~(* fl¢llll
inh~iPIl slnokt~ con s~il, tlPl11~ 11ii ]Ior dil ectly or ~i~ prl*i:Ul ~i Jl H. ~VI ll,l iI
PF tlCil~ ~Sll]o~er~ d~R in fill!L con(~lin i)recnl~ol~ ~]lll~ l(,f)(I lid (11{,
fo~n)~f.~on of" cilrcirio,~eti~ ir~ (~le p1~F~nc~ of" hlJi!i!I~olr~ ~ii~c-ti¢~ rlr
IIFII]Pt lh~ inl111ence oI" oLJii!i, l.flholo~Ti¢ eo,lcliih)ns or wh*dh.n lhi!
tlri]i~ of ~nlol{er~ CIITI ~.rt ~11~ eIW.'1 r{'~ r 1oi~i,ns n~ds [o be ,~xil~of i.e~
Well~iy t~cidic portions of Iolmceo Rllmlte wllI llrso r~(l~l~r,n inll{ h iiit)l t!
dnhlifed irtvesti~nlion As to t:h~micM tl,qfllte,, [IF~CllI~OI~, Jltl(~ bleleld
CIt] il1(eZ~IC[l()l]5 (}[ ~TJCh eotll pen lld~
In view of repeutedly exln.l.~sed clmeerus rc'~,tlil~f~ the i.,~ril,r~
intensive resenrch in lhi~ u]ea is ur~pntly lieOiIcd. *['lie COII(:~'[II iH
btlSl!¢l ill I)tlrt I)rl I.Ile obsel vntlotl thllt the fol~sk i. or lll!wbern inl'lilll ~
Ztll[l]pyl'P/le (4/', IY]), Furth~,l in~le~ Jl, is 1(nowrl illnL nicotini? rl.nssP~
lill! phtcentu (lit4) ~nd nmy thus drive rise to l'()I ITlll ti[)[l O~ e~l ('i/l¢)I~I~n
iC nitTc~lililleS itl the r(,~112~. 'I'll(! hzllll~J~r nl)ll~ll~ to I)l! II ~?iif;Ijil¢-
nlodol for sn~oke inlmlnlion shltliPs tle~ilXll~d Lo ~Xnllline Vllli(ll)S
o~PeCt~ o~ Lr~T]sp]nceot tll c~lrelnoi~e*lesis { l l, ,51).
The otlgoiog n1(llliflc~lit)Ii,~ (1~ (ohncco I>rodttct~ orG!r t~lrtshnf
eh~IIPfl.~(~R t@ t.~ ~11~]yJ.Jc~1] 4 hurll~I.~ ~ind (oxJcolol!i~L¢~ will) H1OflifOr
tim chnracterlsLic~ oF Lllese In odtjeis. 'l'h~ [nCl eashq; ni[l l~Ip eq)f~(,ll(
oFe[F!nr~LLcs rui~os concur ii~ 1A.l~ill (lilii~ lhe pr~:Mllility o[ hi~ile, yiehl~
ef w)h,(ile mul tolmeco-sp.eific N I1itlO511111i11(!5 ill Jll~ mllllJle ;111,I
ll',~tllIlinb~ po~sib]~ fortnaJioll i~[ tlrlmlntic llifrohydlocnll)on~ ~]lld
Uln Jile~.
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I .,
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I ..
PART IV.
INVOLUNTARY SMOKING
AND LUNG CANCER
INVOLUNTARY SMOKING AND LUNG CANCER
Introtiuctlon
'rile ~.ciM i.c~urc ha limit smoking i. public place~ (6l reflects
c~)nc~rn li,r protracting nonsmokers from tim mmoy;mce~ of oflmra'
cigaJ ettv sJnoke, as well as conc~t'n about the possible adverse health
cl'l~cls Of involuntary smokhlg, 'Jr ~coadlland exposuro Lo otllers~
clgal etl# slno]~ ~, lls a cause or" disease ant] dis~dfilily
• ~. IL'~l~t pub~icatiDn ]pVW~IIt~ ~.he r~el~li{~ evidel~e~ Ihlkh~g
i]lvollmhary smoke CXl)OSute to mlveii;e hea[Lh vffi~cis (.II) ChikhclL
(fl ~nlokJng im,ents ]lave mlll~ bl'oac]l[tis mid imeummlia durhlg {]1(~
first year of lif~ {17); and acule icsplrahary di~;~ase accllunh~d fiw ~1
higher number of rcstrieLed activity [lays (1.] day~) m~d hod disabilily
day~ Itl.l~ day) in children wll~,sv Ih nLilles vnlokud t lmn in those who~¢
i'mllilic~ did not (3). A reducti[in in exorcise tolonmc~ wilh e~p*~:~ur¢
to slticstrellfll cigoroLie SN~(~Ilo has b~*en demmlstr~t~d in [altiutl[~
witl~ m]girla pcctod~ (/). and a dccreu~e in ~maJl ;mway Ilmcli(m oJ
Ihe lung equivalent to thaL o])~e] red il~ light snmkers ( I I{) cigzu ett(.s
{I d~ly) ][~l~ be~n [~l)or LelJ ill lid [11( 3 w]10 never ~[ll(]]{ (2( [ ]ll[!lll~L~ I v~4 i1~11+
livt~d wh it sa'~oke t ~, who ~ure Lhu~ e~pes~ !1 to c [£'.lu ctLe ~ul~4~ ha~ ultly
in the workplace (4'3).
Only recently ]las attentinll f(]eu~ed (m the po~sibilily of hmg
C~ll(~illl]~('l)t~;i~ by iJlVOl~n(~lly il]]i~lhl[iOlk (J[ ~l)l);il!(~o SlI][J]I~ 'l~hi~;
I)ul.wl!elt acliv/~ pllrl~) and illa[itbt~emll smoke I~mlld~t! m'livl'l~'
vtdll[ll~tty cit~lll~4|c ~[I)okillg ~lztd ltlll~ CatlC(:l~ ~md (/1~ III]:(~ncv t)l
evhle.cu cslablishing a ~llr.~sh~4d Ibr ulduci; ;md Ct) Ih(~ I'~l'(.ll~
elddtmil)]l~gic ~Ludics '~'hi~h examillcd hltlg c;m~(:r mmhllity in
Smoke Constilueltls
'l'ht~ avel.~l~c~ i)efson ~11011(1~1 Ii/(l~l ol¸ [ht! liltlt~ il~tlo()l~ wht.re Lht!l.~
I~ll) I~'tlr v~l;illll~; l~Ll~otl~. [ha~ t!×llll~llr~ ill ntln~llltd~(~r~ i~ ill[lid
t~illi(![llt [i) qll~lnli~te |Jl~tlL Ihill ol¸ tile ~l]~ll~l!l Th(! t:~Jl~:Mi[t~l!lllt; ul'
iliJ~lJllih~(ivcly mla[yzed ill ~ew~l~d slulha~ I~ ~2, 32 :l~) A~ i~ ~ll~wll
ill 'l~lllu ], nllllly or I~le ~Jl~llli(~i~l (:t)ll~lilllt!llls (d tll~lill~[i t,;~lll ~lll()kt,
nlllll{t:dly Ilil~llt!r ¢OllCel]lr;di~ln~ ]it ~ith!~lrl!;ml t)l;lll ~11 lll;~ilt~hl~tlll
~tnllll(: hllllv .~ I(i M~ r;llio); hllwvvul¸, si(ll~ll't~;tt.i siJl~]~ i~ rcll!~ud
iJiIo lilt! ;ullbierlt. air. i~!~ll~ling ill di]tlliiln (~t¸ c~)ll~titLIt~lll~.. 'l'~tl!
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:!:l'l
TABLE I.--(~umlituenls of ,~lgarelto smoko'. RaDo o[
~Jd~Lruam ~411to]~o (~) LI) Illa{n6|r~um slnol~e
~lnolce genera{cal. Ihe volume of ainb]enL air. and Lira type an,]
arnounL (~l" the wnLilaLion el" Lhnt sp:,~'e (2. 4. 2'/. 34. 44L In addition,
Lhe cl~emJeal c(imjma]ilon of emohe ch.n~es with the pasaage of Lime
~xl~s~Jle oF inwluntary ~m~ke~ tin,trusted wiLh the intermittent
o[ ~rlmke conslituents to the biolob, ic effect~ to be expected with
The u~'tua[ ul~tpti¢m oJ~ smoke constitllcnts by nonsmoker~ Jn
sJuoke-lilled spaces ha~ not been iZOll~pr¢.teJy characterized. A few
studies ILUV~ ~amil~d tb,¢~ ull~lpti~m o[ carbon mDt~v)xh~e ~2y
nma~urirlg ear[mxyhemoglobh) levels in exl~Sed nonsmol(er~ (,I,I);
Ilowe, v~r. lira ~Jl~orption or mouL other constituents has not been
~Indied )"lathurmore. lhe prLtu~a of h]wlunl~uy illhulnlion proh,-
bly dil]e~ h'~Jn if,at of" voluntary inhalat ion of smoke by the smoker.
• affeclhlg tim lultteril ~nd am(mitt of d~positiol~ or aba(irpt[~l~ o1"
rhemirnl cmlstituent~ in noll~;lllO~.el'~ corllrlar~[ Io 8nlokpr$ Difff, r-
n$~*y ~lso o:<~t; ~[(l~$~ream ~lllr~ll(* ['olldl'll~4~lLe i~ [llor~ il31nolilwJ)Jc
I)12r unit we{~ht. ilt li~Oll~ ~l~ill ~ly~ LIItlI| J~ [lllLi¢l~[t~lLIl~ slll~lt~
eon(h!ll~;~t|e (50)¸
~,~nl~ ~vi[l{.llce {~xl~L~ W]li(:~; .~lll~{'~l~, Iiow0v{~r, th;t[ illvl)hlrllnly
~|~o~ur~ to cigarette ~mo.k~ (h~ r.0~*J] | ill (t[!llo~iLil)ll Ol¸ ii~l)l plioll ~j]
('{)n~Litu[erlL~. t]tvolufltl~ry ~lllllll~li0n of {-Jgnrellt~ Bmol[e hll~ hepil
showiI Io produce t r~lcheoh~nch inl ~i)~t}lelilll me[n pl:l~i[[ i~tt,I d ~sllhl-
sJa in an[inala (~), The uppllcltbil[ty of¸ Lh(!~ ,iota h~ lllllilllJi
exp0$Llre~ i~l i)oL ~-I~1", how0vel, ~inc~ tho levt!b; ~f ~llloklt I~x i~(~slel~t
LlSe(~ hi Lh)~ Drlimnl study wer~ SllbSl~mlh~lly ~lil01er than t)lo~e
iio¢lnal~y ~'Ti Cot] illcr¢~(I by hlllllzol$ ill {~llC]o31.d s]b~tc~ wh~*l ~! mllr~llillg
is ulh)wed (3~). ]n a smoke-I]ll~l, unventilated, u noecu pi~d t.(,(Jltt, ~he
volll[Jl~ [~s~, [o~l p~rticul~ll{~ m~LLt0¢, ~tn[I ]llCtltilll!. r(~lll:l~llVd
Ft~l"L]l~r, $~vei,L~l vnpor pltas~ t:on~Li~lJ~nl/4 F;UC}I i~ NO, 11¢141h!ilL ZlJld
}llmUl[l~ w~r~ pi~lced in [he r(]{~ln. ([~])lt~ [r'l!~ll t;ilh,~l~(,~lrll ~111[~1<~
being generated to keeI) the amhienL CO level slt*lJl~ (211. 'l'l~c
enL CorlcerlLrl~tions despiL~ t]~e clmtirluin~ ~u],lili~ln ikf sllil)ll(~ Io I h,!
eJIViFD]ln~ell~ ~;llg/~[~S~ Ilil~Orl)i.iou b)' hunl~lll~, llllllOllgh ~he I~lll:ll
~[(l!(s) o~ t~ello.~J Lion }l~s noL b(!l~rl d(~{~rlliill~l{,
Dose-Response Rolalionships
I~x0nlirlaL]olq of (.]z(~ IIII~P-Ft~]NHt~O r@l~tillrl~llijl Ibr vllhllll[lly
~111o1~¢~1~ ~llgg~'~Ls ~111 il)cl'<I~l~t!d risk WiL}I Itrly ](~v~l o1" r(,~lll~lr.
(:IL'ILreLt~ snulk[ng (43). NIl 411~(~ll~tltl h!w!l Ill (~xl)o~,ure: ibr Ill~
d~ve]olmlellt Of lung ~a nC¢.l¸ hlls I)ce[z ea{~llJli~[mll alld, Lhul u[in e, Itny
]evt, I of exposur(~ l~ of ~ol~C~rrl. I,'il~lHt~ ] r~l]l!cL~ L]I(~ (l~ll~l Illlbt h.~cl I[)
th~ ~¢i~r~tj [iC Coll~.x~lls [}ul~ I ht!re ig I~<) []lJ (,shold It!vl!l 'j'hi~ ~i] )~elll~!
o~ [1 C~e~l r ~11 re~h~l(~ IPVe~ o[ (~xl~k~tll ~ l'~i~ Lh0 i~tl(! o[ Wll~,lln,I. II1(+
](:vols o/" (~xll(~L~l~ re~lCh~d {hlollJ~h invr)hJIl~zlry ~illol:illg nl~y zll~ll
])To~hi~l~ all) j IICr('n~e(I ViSk el i II IIg ~LIl~t'r.
EpldemJologlc Sit,dies
The use of cpidelnJOlogie I(!chnilllll!S LII ~emch [hi Itll II:~o¢inlJon
I~Lw~o invoh)n~lll'y ~mrlk~ ~tXl,[e;Llr~ ~nld ILIrl[; CllllCel' h~i~ ~1 nlil]ll)~,r
Iff nlet hodologic dill icolties,
Ex IHI:~ II I'(J
/'~]l ilsdividmll'~ ~cLuid ~mlilce exlHu~uire do~ i~ diflieull. Io qmmlify.
I:hHuli~: di~l!ase ~!llillemio]ol[ic ~lllllil.~, Lhe e~llll~lllo Ilmllfllfiellli, n
Illobh'nl~ lil~ mzll:jlil]ed. Ihl~lqle. i~ d~.Pelldent IIIIo1~ Ihe~ [lllloullL I)[
• %lllilllill~ iiy [li0se /llolllid llll~ ilon~lllilIC~'. []ld~ l;ll~lliil] Ili~lllll~
h~Wl!~ll Ih,~ II(}fl~llliilll~r 111)~[ ~lilllk[![.a ~11~ dtil'lL~IDF~ lind fil!llli~lI¢~ l]~
~illl~Llll~I lind il llllllllJ@~ Of (lillor [~ICII)I'~ thll~ ~{llllli]icllll~ lilt.
(]111111 [i11¢'11 ~iOIl OI" ill vOillfi|~l I'y ~illlll klj ~xpiI~III I~ ill oil her I1,1
I'llSi)l!CliVe
t~]" I I1~ ~1mtl:~ of lhO IIollBInol~l'I' I1~ II II1~1111~1 (11" illolll il~/i~l! t~vcl I~ 1"4)llj
I~
(Bil}tl~l]llli{l~l.~ .~/il h B fllukj n[~ Ill- l]4Hl~tlIOkjlF~ ~Pllll,~). r~']li~; (,SI ~lllltl l!
ill"
I!~lil)~illl'~ i~l SUbjeCt Lo Illi~hl~ilil~llliOll, il~ tim Ilon~nlllkl:l" lllily lll~ it
[Ollll~l' I~l]llil(l~i'. 'l'hi~l inJly I)(~ ~l'~le ~Ol- ~i(h(~r thl~ lll)llSii]ol(l!l ]ll.illl~
I'olhlwed or lhe~n.ilmi]lfl{illt~ ~l,lll:~u ill I]1~ ~mll rill l!IIlli[I hI I,hliliim.
ill ~(ll:i~lil~ wilh ~1 high rill[. I)l" div(ll.l:L~ or nllll[il)le IIIIII llll~4:~, (]1i~
~llllJkilll~ hlIbil~i ~)1" tll~ curiu/iL I~litlti~e iiiily illl[ tifllllilxi+lizill~ Ilil:
IW[Ilill I~Xl)osllI'e. I~utl]ll~r. tlll:l~ is ~ di]llToll:ill.ilhle I.llll~.iillilHI
bU(1,M~.0tt ~lje ~tlllT~ill~ ji~lbi(~l ol z~PoLI~i,.~I ~ghi[-il dL~l:li.D~l!~ Ihl~ ]lIOilllB-
I,iilll OI COIllllt'~i llvliilable liH" Shl(i~ wilil lll-~ discocdilllI [ill ~liitlkiillf
[,(nll~ |,lli~lley Perlail~
I.IIIl~ ~HliL'I~C ftiihlws ~lill~ll(l!~ I~xllt!l'il~llCOd (Ivl!I. 41i,¢,IIL~I,~ ilnl],
(hDIOl~JCO, ]1. iB /]~@S~ILI'~' II~ ob~l!l~ jli]ll,~nlOa{l!J~ (IVllj" ilfi I!,~ll:llirl~l
I[I tl(~ ii~ 0 l,d I) I- Io @~1 nlll[l~ [I II~il. lu:[llzin l,~ jllA~il I~!
I~]~PI)~llll, [11 I~jl~lle(l~ slllol~l! Illily I/f~(Hlr ill I'olljllJl[:lloll Ivifh
I!X[)1)~111 I! Io (llil~r o(~¢UiKl(iollll [ ol e I] viI'ill) I)ll~nlill ('111Cil IIIl~l!lll4
I']Pid~,
mioh>l~i~ ~ll,lil,r ~hemld ~onti'rll lln" or illw!slilf~lle po!¢niblo Irll4!JIW.
]inlillltilllls deiidy exlsL hel.e li~ ~w!lJ. AcYul.llh.iy ]l~.n(!~illl~ [ili,lillle
I,xllll!;ll I (~, lllld llll I~n]ll~ill~ 101~4)]1 [ I oi lill ~iJl:]l I~X [)(Isll] I!~ 11](!
dii]il'lill.
i[ liOI im ponsild u. Ill I I~!l'l~ll'lll
Cufrenl EpldemlologlG EvJllollco
'i'll illil~), {hl,el~ i~llidl!Jilllllol~il; Zllillly~es hlive lil~l:ll lillhli~ht!d wllh.h
i~iJlllhw t]l~ hllll; I'lln~!l!l" i.j~k ~ll~ invllhllltllly ~nlolliiil!. ']'lvll o[¸ ihl.:~u
o[¸/Ill:el~l~ lill~ I ,]u lllin; LII~ third ~lllllly~ig Iv~l~i ~olldll~:[ l~d ill Ihl~ I Jliih,~l
,e~l~il~ by (~lilihll[e] I1~), luu;i!ll llil iI~llti ~llil~iil~illy t'lllll~*!ll.iI by
I h uluil~uld I I.I}.
lleli~i,I IJf ~lllemller 1[17~I thlmll~h Juul~ I!J~ll}+ Th~y i~ll~llliliL.~l !i]
.,11
t~litt+il~;itnl IU]llill~! Itll+l~ ¢Itll~'i.l" p;lln+ittP+ £uld l[+:i iltltlll It,lll;lle
oriht)l+di¢ pi+tietlLs in Alheslm. All m+ll)j~,cls wel+ qu,++tionetl eli Lht+ir
[J/,I,~(nlnl snllll(ill~ hnl)ils, lind hll~hlllld~ Were ghlPtSifiC,~ tlS IIl~Fl~ln()k-
CI~ {n~v(~r +lmoh(.d (J¢ I]tii~b II~ole IIlall 20 y4~nl~ [lli41rj. eX.~nl()IIol.~
ly +;mollizt+: or +rz+olletl within 5 yenrs llrjor to [tlLerview). ~giIH+'lo
wllm~.n wUle cl~l~.rllied wilh the I~rllull havilll~ II~n~ilt{~]~ i I1~ IIIj~;I)ll~ tl~
The C~l~(l+ lllld ¢~nrlll+ll~ did IIo[ tliffeP ill nr~+. thlr£)litltl of Ill~rl'iIt~e,
4J¢<~tlpniiim, (P(lll<:nli+Jrl+ or Pill¢~! Of ~'t.~idence. nltlloql~ll ~[+4~Cil]C
exlHiSlll'(! [1[ Ihe wife was e~tirlltll~,ll ~l~lil ]ll~l" Ilu~l)+iilll's (llli[y
¢on~nrll[I[i(lll. tl'olil the Ikl~e of Ill~llrin~o Ill, Ill their divoice. IlCl
htlsb+md'+ de+llh, or elmnge in his smnklng hilbils; mlllliI>le mar
l+ia I!e~ W(~ re* nL~o Con~ld(.rl!d.
ICxchldin£[ I 1 volunLmr~' ~3+lokel~ frt+nl the 5] female hmg enncer
ell~;l~, llf~d ~l Slll~kers [r<#nl LI]~ Ili:l enlltrel~I idle relnltinln~; ,If)
)lOn~ln(jl~il],l~ hl]]~ clltlt+t~l" II[Itien~S II~ld ]~4~ IJon~Jnokill~ Coilttll]
~orll<.ll i,l~ere CO]l]])~lpIEll] by ~hei~ hu£~biilldil~ {tlrpell~ ~tliokinff sti]ltl~;,
lin+l < SlJlllntlnJ Lllllll cliln rl.lte~ ~ltlokerl liy Lille h ush.'lnd by tile tittle <it"
ill[¢!rvil<~. 'rht: remilltll nre $]lown ill Tallies ~ liml 3 respectively.
(~lillill[i i ell ~,il h I ]1o taint tel I~l ou 11+ n[ interview Ihe ] LI Ill{, C~ nl!~f I~ ~l~(,s
sll,,wed 18 f+dtl grelltor prtllmhilily <IF being marlied to nil u×.smnkor;
2.4.f~rd ~ieatol odds of IJ~'iilt~ milrllell in a Iil~h I or moderato ~nlokel
(~',ll <ll+ f~!wel" eignl't!ile~ per day); and ~.4-fold greater odd~ of bell*l<
Ill,ill Jell [I) It hl~avy ~liioker (more thnn ~0 cigarettes l~r dnyJ+ "]']le
lln011tl I>b++t~t v(~l in tIle+Is l indinICt+ wt~m sl ntistleally stgnl/ieant, wilh a II
villil<+ II+~ tlilln 0.(12, Exclusion of slnt~le women from tills an£1lysis
zl+odilied the Ich,tive risks only slightly. 'lPzd+le 3 show+ a +inlilar
[I ell¢l of ill ~1 iP~l~i nl~ rL, lntive ris]t s ill liorIsn)okin~ '~r ire8 with IlIcrelir+
ing ~esiiill+llc(I+ L++L+jl nlzmber of ci~irelLes /mokl+tl by the htlsbaml
Stlmt+ limiLnlitms nI!d strengths of Lhi+ slu+ly were rec~niP~.d and
discussed fly tile. tlu thol~. AlllOnl~ the! Iinlltlitlon~ were: the liumber of
cil~es wilil slnilll; 35 percent af the tlllllOrB I~lck~J lli*~logic cnnfirm~
lit>n; colllt'Ol++ WIll(! Ch(~.st!ll flgolII II dills!rent }lo.~l~itlll thnil we]~ ~he
eclnll<ll~. On Ihl' liLht'l" hand. Lh~ lllllhnr8 Btl~es~ed Lhlit lile
cnll.~erwltive ~jot:inl +etLi ng ftlr this stt~+ly may be less subject to el rols
of rlliscln:~sIficn Lion r~ulLiu~g from Lhe I+xpostlre of Itozlsu~loking wives
Irll~ 114~ll~lll(~k~*t~ I,O ~lle ~illOke olr lit hl~ [ ~ Ol lipide the hlilne. 'File i~ tl i1
tl~,z~l+
of + t~ ~'.<~ of atletloetlr~i~nmtt ~+v [xiell ~el'~ e:'.e ltjdu+~l [I c~ltl Lll~ lilxlll~i~ [s
lloL given. A ntjlymis inclutlinff such +++sere would I~e of inlorest i Iti). lls
mlilly Jn~esLilgl]lol~ hiiv~ g'Otlrid eignretio smokillg Lo I;e ii cause Ill
ntlolll~,~ll'elnolll~l of (hl~ [unl~ as w,.[I ~l~ of ether hisl~logl¢ tyll/!~ of
Ilznz+ emIl:or (4~TL Adtlj~iomtl control groups for compllrlson to the
+ns++ ntighL jltlw enhtt t;c<+d Ihe I+tt(llt~n el" this study.
f,' TOt;9
242
'I'AIII,I", ~I-~l~lllllllilll~ Illlhil~i ill hil~lllnn[I,i lit illill~illlfllCilll~
I%'liillt, II wilh hllllf ellllPOi" lln<l Ill Illill#lillllllilll~
Co, lilt ill ~.tOlllel i
L,,i,ii,~,~cer H i; I£ ?:1
4
' .. I'AIII.I¢ ,'l.~lDi~trll~iiilon of llOlltilililtinl~ wllilIPn wilh litnl~
~nnl:l~r nild of illintillllkinl~ ¢olllrlll ItXl)llll!ll
lll~l~llrllilll~ to Ihl. t,sllmnl~.d Illllll nlinlhlbr ill
¢l~fnrellet Ill, lulled lly their ]lu~linllll~l lilt. Ihl,
thnl~ lit Ihe Inl~!r~,,il.w
~nl~ie i~1 ~1 , 16 I~
i~l 14rl
,rrt- l0 I:1 ~ ~+1
[lifnyillilli (191 timed a prosl,ective desil~n in 29 henlth tli~lrlet~ ill
Jlllliin river ],t yl~l~r~. IFiotTi l!illfl iN 1!~7fl. ill which IJI to !HI lleieell[ i>1
Lhe CellsiII ilollul~lllon Wil~l inlt.rvit.wed tie anlllyzl,d intei'viPw (Inlet
[l'nln 785,118 ndull.~ n~Pd ,If) yenls alitl tllltt.r~ nnd round thliL 7~,~1
]l(,l'f'ellt nf I he collple!l had dllla I)11 tile ~lllOl,{ill~ lllihit of hlllh tllllu~t'l,
Al'llOll~ ~l,.~ll nlnrriell wl}lll(!ll, 2~ de~ltll~ froln Jung pllll~'er Well!
recorded, of which i74 wt~re ilnliftnlilkors, lie relml't(~l n ~tllli~illt:lilly
BiRnlrlclinL eret'~s lllte of hlll~ Cmleer onloil~ ilOll~llmJ(i~l~ wlvl,~ nil"
Blnllkern i~l fonllll~l-~d to i)Oli!qitillllln,l~ wivt~R Ill nollSlliol{i,l~, 'l'llhie ,t
shows lh~ stand~lr+lizt!d mortality rates f~.r lung e~n~er itl IIOll-
smtlkil]ll wives, nttjusted for llge nl]tl i~cu[liltiUll+ 'rller'e i~l lln
l~lllpart'lll [](Ise-[osi)¢lIINe relnliollShlp Jn e[Icll Of the nrlolyst+s prpNt!lll
ed, CerDiln meLllo<lologle del~il8 le.g. the del]nll inll of nn e~ ~mohei
lltisbnnd, tile method ofnge nml +)celip~tlion slarltln)>dizn Lklll. nnd Iho
~,1:1
Ilit,~ytlltut ~tt~tt ~atlt[tted (he eli~t!l~ Ill V~tLltd~ry ~;t~t<lkiL~ iU
I t~ll hlllz~hill ~tl il~voluldaly i~:l~tlliz l~nd ILOIteXllCl~lll'~+ The ~t~llltl
;~l~lizcll ~tlllllll i II;<)l ;;lilLy £ ~ltl~ ti~l' IllJll~l)lllk ~ I'~ W~IU Wl!l~ noL inv~iLIil-
tariiy {:~l~OSt:d wa~ 8.7 llel lllll,~ll){). For Wlllll~l; who I'el!Olled beiog
C~l~*si!d I{) cit~alulte ~nlultu o~dy il~w~hmhnily, the zill~ndardizu~l
J~III~I~IL nlt}zl;di{y r,~te wa~ 155 per II]l),(l(10. t"a£ Wllmelt who
wdunhu ily ~nmkud, thv ~1 u ndiirdiz~'d annual mcrlulity rate wa~ 32B
i~el 14)~ t,()l)l 1. I [u C(lllCludud tllat, the ulh~ct i)l invuhirltai'y smolli~g wa~
aiJlllo~ilil;ilel~ I~11# half to ol]e third tllllt o; auLivu or VO]lii;t;lly
The agu and occupation stautdanlizl~d risk ratio~ in I]li~ populatiiln
I~died t~+ ~how a~ty ~iati~Lically siglfilieanL efl~;cL el' ~l~U~d ~n~okhlg
<~il nuli~nl~d{ing wolnen'~+ starldnldized rk;k rutio~ for deuth~+ from
ulJ+er caucus, hlchldJllil eml>Llysuina (~ilLlulug]l L]le trend in re]iltlve
tick wa~ il~ th+~ ~£JJiit+ dileution u~ for hmg C~tlluer luoriillilyh Cel'viual
(;tti4*t~l*, ~llilllll(zh c,*l~eer or i~cllelliit: hl~lllL diseasJ~ |'J'~dlle fi); hi)
sil~llilit31l it role o1" sj~uu~d II[COhO[ COII~ U m ])Lioii WUtl dellmllS[ fLtted It+l'
'l'kt+ imLdtc i~'ss h{~ rel~r~ed t~ t,~t~le e~r<+r |~ lli~ayamt£s
¢~lJlll)ulaLiuil ol (11¢ cili ,~(llilll+e ic+~t td" ~;taiistlcal ~[,~ltificaitce CI,'/I.
Jl,+wt~w~t, tile ucientist lo wholit thi~ linding v.'us iiLlribuled Ii[is
~ulJ:+equenlly slatt+tl thtlt he raised qtlc~tions about Lhe ~+tudy but
,lunJt~d ,uaching ;lily C(llt(:J tlsi(;ll (2tJlxl
I I~lli~ and I)~t~vlu~tcltel (IHJ ret:alculatc(l the chi ~quare u~ing Lh~
o~ il~ililllly I~ u~tmlt~d dnla t)[ Ilil'llyamlt by Unlllhiilin# 'l'~14e~ 1 and 2.
'lLl~ t:;d~:nl~tl*:d chi ~qttill'U O[ ~J(~) yit:hh d u sl~dislilrally Sil4111l]c;ult
I w+p ~idutn ii v~iu~ ~f I) ()()(I t.
l~llt~ CtJllJillil4!t~ i~lt~ ~L~iti~lic;LJiy Sil]llili<;;llIL eX{JU~S ill Jtlll~ {~;IIlCCI"
th:~*lh I~*l~+~ ill wiVt~S tJf SlII<~II#I~ whull ;Jlliush~41 lill [;tlsb;kllti'&+ ag+~,
I~t'l:~lll;lli<nt imd snli~llirlg h~d>il~, hi Iltl~ r+ni+~,U,lt~Ulfi ailldy.~is, Ilil+~ya-
llllt it::illit Its41 Eis ~illal~uJs ill tlaLll Ill,Ill (llle plt~lut'hll~ d~ll tt I~t+~illlU
di+:;u tUSl+lln:~u luhdiell~[lill cd" iIwtllulll~i~y sl/lld{il~g arid luJlI! I!ihllU&+l
intnl~Jily 'l'l+l: U~lltlSkll'e o1" IIOli~lll~lltillg wiv~:S IV;IS ualcuiatmt hy
mLdliplyiill# lltu htltll~ Id' tile day ll~e hu~llunJ wns aL ll,mle by Lllu
llllllllilH" Ill I'iI',;ll¢~ll~ ~lli()k~i~ [)~I" ]l(#Ll[', ii~l~llILlill~ Ill;It Jill! llllllih(tl"
ill+
'l'l~l u ~,+ta ~l ~:lt~;~l dt~c-,'u~ponl+e ohza:rw tl t'l'ald(~ {;) Inl t~tt:h nl t hrue
tr;llt:l~llliu~ ~il I~ll~lll ill' ]l{)tll~ IilLll IqJl" ilillllil~l UI lli~ili't~LL&~s snlulctd
II~l dHy Tltu li~k IJl dt~;l[h l]'llln hl[ll~ (!;~liit(;I ill ll(lllsl]lOkil)~ wI)nll~ll
ill(Itr;;~i~:l[ wilil i~illler the linle t)l I~Xpll~lliO Ill" ill(!l'U;iNJllg d~lily
+lill~il;t~l ++1 t:J~;ll t!lii's, hi III;d t+t,t ol ~ulnly.~t's. the I't:l~dive I+l~ut;llity
li:,l~ (;lU lllL'il++llt{~l~ Ity lhe t4;Lll<l~tldiS'ial nl<irt.lily I'll[ill) UI+s~,IVI~il
iLlil~ilil~ ll4)liS;lllll~ilt~ wivu~ Ill ~lll[ll~ilig lllt~l~Itlds W~J~ illZtllIedly l<~wer
I ~t;q it { ~itL I~i~:~IPI Vt:tJ II;l" W{ltllttll t,v Illl ;ill ivuly ~lllnkt~d IJ"il!ul c 21.
£L£L'UTOS9
TAIILI~ 4.--Standardized nt+~rtality h~r lullg cancer tn
wo~n by nge, oeeUl~aLIol~, ~n~L ~n~ohing hahi|
of ,tw hu~bal+tJ (l+~iet't ILerse!l~_a '!°~nbn~°Iter)
~'l mn,,ker
ll++:,l,a~J'a +lliOk+D~ h+b+t ~4Jlm+Im+kt'r ,,+ IsHl?4+,~ ~.21ShL,y
f(m.l*,,~<'+ ~.~++ 4l~59 u.4+z
N~ ~[ ,I, ~t hm frl~l~k lung Cul~rer II 411
:~
t ~ c~iJ"lilJ~l ~t ulldu r tlk~l b4j4 ~31
1311
nlm t.hly/l(XllX~
Nu ,,l dc,,lil~ h,nlL lung: ¢~n,~er 2~ ill
ll~,.r h,lll¥/lid) IX~l I'7'# 214t ~td~l
~-- . ..........
~t ~n Ju~d~r,~ r~k reli,~ ~r all agv~ I C~l 161
+'I~
~t +a,~L,t ,lloyd l~k ~ ,It,, f,,r all i~ t ~ll,i,t I,,,,~ i ~i I l:l
~ ~MI
__+-- .
'l'ht+ {dlaervet] dill't!renl:t,N l#irlwC¢ll wives hf ~lll()l~I?l~ ;llld wiv(~ Of
it<ltlSln<Jkt~IS W~IS 4Jvjdldill ]o£ t~D(h (If Lh~ llJur" .~.(it'i4]{~COll(+llliC ~lill~tiS
II I~lylll ;1~ +llLicle ]l+ls :+lit+llil~lltrcl tlltlCh tllr~:llt~flit+ll+ t+vllith Ii;tN
ht!en I)uhlishet~ an [~lle,a Io the J,',4ilt+t ~1 the |tlilixh Medi~,d
+1 ~7+z .J(, ~ ;. zlO, .12it) hi llllt!t~ I'+q)liL'~+ In Ih/+
+l+~++tn++l (5. 13, 2,5~+, .7.
an IIIC jmll hill {20, ~1, ~/+z), 11it: 112;t{lt+T is I'lt+t!l I t~t ~. tbt" +p.~cLhc is++tiL~+
i.+iimtt ~ "+3SI }(lllltud to in i h.se tel I trim.
N(mell+eh+ss, ill(! Iq+lditTallilily ol sttcll re.~ulls h+ +lit+ II.~+ p(]l)uht-
til+li I c+lllltill~ [+l Ill+ e~t ttlJli++i+t td
:!I+,
'[AIII,E ~i.--Ill)w d'tell wive~ wllh f~mllldllg hll~bllnds Inhale
cignrctfe ~nl.ke pnssively in ,lapa~ I©alctllntiol~
b,,sd on a st,,dy i,~ Aichi I'refectur~. Japan)
I~h th 1511h
N,, Cll:,,J~,~ ~',e N,, ri~,rO~ll~ $'te N,, rlgnC~,lla fie. ~¢ rig,rl'tl~s
(hr[hJle[ (12) [;llbli~llet[ lid analysis of datr~ from lbe Alnericnl]
f!~Incer S(~iety'l; f~rosp[.~Live study cond~lcted from 196(I through
I!)72. 11~ ret,<.le<l resull~ ~n 176,'/39 nol~anlok[ng women whn were
[h{!n llllIrri(~l J tl) lo Illell who Ilever Slllok eli, Ii1 to gllCi1 Wile Ctlrl ~nl[y
NIiio~ [~ }l!ss/] i:1 rl 20 cigarettes I~er lilly, Illlll ~l ll) nll]l ~}1o ¢llTrC'llt}y
8mdct,d 2/1 or ~nole cigl~rotte~ per ihy. In lln analysis which did r.~L
~lll~'llll)l LII conl~[ for i~o~ible con f.Utlding variabIe~, the ohserv~d to
• exll(!dal [tllll~ e~llt<:er illor~ll~[~y rtlllo (~:ql~!cted IIIllllh(~[~ WeIU
derJvl!d fronl l])O [urll#cllnerr r~¢~$ of wl]lllen nl~rl'i~d 10 nOllNlllokf!r$
by ~ yellr lille gl'ou ps) Wal~ 1.~ [(t[' WOltiLql inll r I'ielt ~o ~l}~O~ ~,IN of less
4hLIn 2{} Ciglll r~l~$ per d~ly Llnll l.li) fill' WO rl] I#l I lnllrr [¢.ad t{~ S~IIQ~I s Of
2{I ~r inolo cig~retlea per d~ly. These illc~ellSeS in mortality illli¢ls
ly ~ign~ficall tp vahle I]oL Slleciflcd~ 'l'~blo 71, and no illlse-respense
eft:tw, isevlde,,t. 9t ~['~I0~39
i ~,~(.r vd ,Ir,lqp1s :¢I
E~ i~ q, hl, :,lh~ ¢f~ ~'~ ~lli~
41117
. ~@,.~ ~ ,~, l*~.q~,~,,~ i~{ ~. ~ ~ ~ H ~,~:'* ~'~''~ ~
~ ~ ,~
]'he |alll! three grott]~ (1( llon$lll°klllg WOIIlell "~121~ ~oIIllll~ll'l( ill
u~oLhet anlllysil~. In all IIIL('fnl;[ In eIilllillnte lionsi}llo COllflllnllIill[~
vl]t'il]lllos, peJrs or women were inatthe~[ oil tltllIIipl~ factors, 'Hie
nunlber (If (leIl( hs in enCll Iil.t{:he(l tlitl t~ was 'l~lljt)~lWI' ¢,~ d~g¢ ('i[It'd irt
'I'AIII,I~ & Mah:hcll l~rqHI]} 5(tllly: AdjLl~tcd hmg cal*cur
d~;llll~ UlllOlli~ wlllllCll with I~(in~lll(ll~Jlll~
[ltl~h~llHl~ iiill|ch~ll+ Wil}l Wl)lll~tl ~vi|ll ~lllollJlll~
ht~b(l~txlll~
N~,hLm t .i
~dj,J,144
lUl,¢ ,,,iw~t
(;r..I. dv,~lh,~ ll~Lio ~
NL"'~'L'. L''g J'" J,~O,I ~15 I IXF
. [.i~u' pnhlic,~lhm (15}. The ~esult~ (~" qhi~ ~nuly~is aru ~.]~ow~l h~
T~li~l(! ]~ NI;[ihiJ£ ~lo[]J) of I$oll~ll]ollJll[{ wJv(~s (}~" sjtlok{!r~i ~ho'.v[!ll zt
~ al i~[ical~y si6 nii'i~an~t di f~n'cnce (p • {I i1,5); l[lel e is n(} li{~se-~ t!sI)tm~e
~hl(dy JlllJlHl~*liuII, ]II~WCVCF, P/II~ I]o~ #*hOWIL Thc It[ll.hl~y c/)]lcludud
Iha~ anly ell'cot pas~iw ~nlokill~ had on hlng cancer m~.taliLy w(~uld
'rll~ a~lihllr ~ne~t!nlled tile JilniLalii.l~ ~)l" (hJ~ I ly~ s+ I r~L, Hie
:~n].J, JlU~ ;tilt(, tht.rt.[~lri2, ]lat] IlJlli(:lllly Wi(il {lie ~C(tlr i{~J ts~c~ i!
hL~:,l ,lUi'~lii~t~!d (It;) J'or Ihis It~Zt~llll~ ~l~]lt: ili(J]c~l~i@~ [itci[i(lu {lie
Im~iHllt~Hlhq~ll[ ~[ ilIVd)lUll[~l]'~ {:}~pIl:[tl~(J [H ~lll(l[~2 [IO}]1 pt:l'~Hl~ Iltht!l"
Ihlill IhL: llll~+h~lll*l, i$11tl 11¢1 inlal+iiity Io i~djln~t I(n" ci]~l]l[~i!~, ill
hil!,h;Lll(l'~; ~HIIll[iJ[j~ ~IIb~PI[LH!III [O it~:l tll[I iiIIUrVi[:W O[ Ior iJ.vpo~ LII~I;~}
I I t~lll [H t~Villtl~ hll~l>a Jlda J [e llt~tc(J I ll~tL zk ~I I~(ly ~Jltlu~d [,t!
;~llt~cij]c:illy
Ilt!~il~l~J [1~ hl(:~Lz~tll(, t'X[){i~llt'12 Iilld LII3tt!d L[IIL[ ]tuiihul L}I~ ~[~[I);ilHH~L~
(I!il nm Ihl! A(~N ~htdy II[t~l (]l~l[ ('* ilt'tiOll, A(hii~i/)nzlJly, ;tautog ~(il
~t~{ll~ lwl~ ~lvaihd]Je J(ll'~mly 153 (2"1 II~lCK~il[I.
Tlali~. I!il~:h oJ lie IlH'cc (!l)idclni(~h~l~jc ~ttltlie~ Ilell~lJahctl to (htlu
~iI{)W~ ~lll [llCl~l~4Jd }'[~[~ OF IIlll~{ I~hl]£'cr ~yi(]] illvllltllll~ll'y Slll(Ikl!
~'~1,~* ~: ('l'al4c 91 Tile ICSILII~ wui~ ~lali~tically ~lgll[lic;zl)l ill tw(i tit
tiu: IhH.. ~lu,lie~, whiMi al~l~ f.tnld ,~ (Io:;u lu~[.)nse el[~.d. Th~
G~
.,~ :~u[I~ nnmy i.c*ea~;e the I'i!;k of [lllll~ titlitttq" ill Ii(lllSlll{~l~t!ls, I~t31
[ilnil~nli.~t~ il~ data ~lhll ~;tudy deai~el (hi n(~t Illh~w It jlltll~lllt ill qlll
I ]lH;,;ll[I V ill ibis [ Jtltl!.
']'AIILI': I).--Obsurvcl[ Ulid cxpvclcd deaths frmn lung cancer
iz~ nlmsn~(~kil~l~ wol]lcr~ with ~moldng hushal]ds
Sun~mary
cJ}~ullica] Coli~LiLu~ni~, ( ~,] ~t illliLr~a nl ~11111]{4~ is ~llI[)k~ wh[i:h ] [h~
• smiiker ih}mles directly durin~ puffing Sid~h~am ~mok{" i~
fl'onl v(ll~lliL41yy Ci[~ll(!~(l! ~tllllkill[~ wi[~l i~l)(~c~ {i) (h~ C(i/t(!~ll
tlqll.iOI] ()~ ~lnoko Ct)IIII}~)IIL~II[8 i]lh;lht], [ll{~ (~[irLiLi(ll~ ~ll~I Jl(~
2. TWO ephh!ll dl=](i~ic ~{udi~ }lavu filLIlu~ iul iml~=l~u(J li~l~ .I lurlg
r*.lation t~ lllu c×lc~=L id tile Ihu~bmld'~ ~Hiokill£.. hi ;~ Ihi='d
~;hl(ly. the I i~]l {~f ]11111~ {~;t[l(:cr Ol]ll)[ll~ Itllll~/llOliil]~ Wil~(!~; oJ
;] Allil.u~dl til~ (~tllt~'llli~ avaihd,h' lwidelic~ i~ ,ml ~ut'fi-
iqt~;ll I(I ~'l}ll(:hlt}{~ IIHJL i};hS.~;ivt! ill ilhv4~hlll~tly ~llll)[iill~ ~I[I:~U~
ahl)lll ;I l)I~i}ll[! ~t~l iO[l~; pllH ic im;ll Ill i.~flllunn,
---
¢h
£w
C~
C~
~D
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rT
.Jo slolauJ I,UO!~m~!]OLU fij]~u.~p[ oI ~.'ldl]J~Do al['~ [lllll uo[lu~S;~3
UJILb!III[3.J] ~[Z;tl!8 ~lllO ~l[l!JoJJo oi ~]~lAaaJ~Jd ~q I[]~ ~'UUI ~alaS~la~
^cu[ ~l/m[~ qJ!,l~ mo~j a~mloud 13~!~;ll.)t i~J~oJo~ B J~31ouJ$ ~ ~1 [! J~l~JO
~q~ t+s '{I]lqff~!pu! lu~t~ aoj IIgdi~q 1sin, aJu ~a,h!llq~a~ uo!1;luua~
~t~,]~ all!U~!saP I~ Inul].~ ~Jatjaau~,saJ 'pgUl[ j~tjlo ~1 110 "(gl'~[
'~l.)) Ihl~[.ltltlll)30IU ~lll]lJ~OJ~ ;~tl~ I[~!1{~ ]o ~JO~lloiJu4oo [UtlD!,~![Ju!
llII~,+,~ "~A!I~IIJ~iIJI[I@~II[II)~i 041 IJ,)Aa l+lrm~ I!--+~+]]~I £lfl~q!,XaU! IOU
{~i!~L~'ht[~lj4hllOJ ~')[ lli~ki~ ~IIUtI~ JU!AIIII~{I tliJ~] ~ftlO~ If! a+xD:oJJ,~ ~I
IJ ~uoJ thhl dl,iq+jl,~++ ujti ~.'i!l! IIu
I" II'r i'+,'~l "I l>;q>¢h~u ii(l l+lnii~ +"+iP~!ICi ti°!II!U~ Lg"[ ';+!i~![;~ []a~!til~;Ij(]
FlUpU U.!ll!Un (A~ lmltlu~!ls'j im I11[.~ 'sa!U!l+) uo!l~ss~ [,a~!im~lJ,~ ~I~
IIt:tl I I );I illll ! lll~] p ~[ !~iU;~ ,DJOiIi ~1111 ~lllU.l~OJti II J~ll ] J]i+~i
+DJ~lJtJ~li~,lile{
"~¢:l!u !FI u<l!lus~+t~ i~J~!tlu~ Io +{q [)a ll.+ll;t l ~lj oi £1~1!1u" ~au otI~ fiuulil
dl,ll/+ll,l~ o~!lrl~ll~) jo Xl!l!rjlil!~ai) ~tjl oI ~flJl~al~ "lliJor; )!lltl ~)~ulI
I,IJ,~l F;tlul jt~ ~l I+~lJ3 p~p!I~lirl atII pu u ~J~i+lOltl~ jr) ~Jtl~iJ~J~lil 0~l<[.
~,lsu~ill~il +,+J(i~I~Ul J~ ,l~i+ p,+a!o;),~l ~Ja/iFI JO ]Ih]LU~i+%JOAII! ~A]I~IJ •
,~ll~) ;HII~]il hJllllili )lill II0]]Jir~I ;)q plilt)J IIMJ] ~JIl[l~iilJ4[ ~II~l ~¢IJ~IPJ~I]
I1() li~Jlldi>d l~l/,~l +l.I ;IA~ ( I II;IL~J~I(I 9(.') +;3]ll]ia I[liUalI Li!llltld [,~lu ( lu,l:J
I,Id
!lJ:~ Nllii!~yIl,i~!Jl ilntl I~) "(111+~ tad g~;) ~1~1~¢i u plliJ I~ ] Ilil,~ 1~] J~l) fftllOJ~O ill
"
(Itl!~g!~,~l,~[ '[]lJD.lhJl] 9!~) ~)Ll!,l!p~[[l 'lg,JSIIO(l~-~J ,~lq.{I][IJ+ J4) ++~,,1~,
Ithlll.>ll j~!)} SilO!IJIIJISII! ~l~'Olp ~13~f(lilli +~!JlilildPli JO .I.~J)itl III "{7,J')
"ll/tl!a!l ti~ll III ~hl!ll!^l illI lilllo¢~ ~'.i LI I IIO! l[T+;s+lJ ~II!~tlIU$ UI 9ot~;)lili~tlih~
Ill Itl ll,l!ll,',~ II! illl!,l!ptlI o] Ji~l}j~ir ~+ra~ ~ltl~ljlli/~l~ial I(l!ll.liij!jl~) {1!
"llil:lJlold .)~.!~tl~lI],Li4il[llF.) +I~D~!III!~IJIJ I1[I J~IU~I (1~ IIO][OU!I;~L~!~!I) U pull
~)IIP~]J~II! Sh~lilJlll~ IIIJLIII~ ~N~ltll +,~JOt~l loll] IIl¢l "(~'~'1 tlJ~Ll~(lld tH)!II!~¢DT~
"~!lih "i+~l!tI JJIL~/+ ,l~i)ll3 JO "lu,+-~.lad '3(; iu¢ll IlOti4,~:~{l~l ua,)il SlrtJ lJ
. • UOllOnPOllUl
~)r-J IJ,JJ~) (I~J,VA IJ,Ol~
-,+rl:,l,N :[IOOll,l,'lflllv NI NoIJ,]q~,l~?l)hl
Itl41vJ,hla I'~ ,Jr I~lllup 411" il]llJvi~tll~ll;,' elJi)J'l~ Io quit ~nliJll lilt[ wilII(ILII
~llhlll~ (CXCUI)L Jill III;llUl'jilJ~ llliiJ (ICCil~ioilill CI)/I~II]IIII][)Ii}. [Jy ~Jli~
LJCI]IlJlJlJII. pl'(i~liUll~ Ihitl. IllJlllllij~+u lJl~l'~lli~[ [IIV{IIVglII~j~~ hill izi-
<:[uclo J~ll]~lll lll~utjnl~l (it ~]~L~5 tlll~lllli~ed j)~ i~u~lllc oth~q, thilll tile
wILich levicw~ I()11~ If~l.i]t nlLI]]II~I]~LJIC~J Ill ~lllllkjlL~ Igl2b~liL[~ll.
PI411~I~II)~ l]lZlL JlIVOIV~ IIl~l~ II1~(1]~1 ~liilll I]i1¢11~, ~1{11~1]1111~ wJl]I 110
[I~:l~l~ll'jtl [lul~llll CIII)JlICL will/ Ii'lljllt~d ]t~lld@l.S (ir pl.(ij~.~iJlllltj~~ alld
JllUl~l'lllll~ WJlJl lil(~r~Jiy ~L sjlIKI~ ill fill iil~llillll~l] C~II[LIC( ale Jnci[lllei[ 11/
mdy ~ll jll~lil~ali~lI LI) I:es~ti~li] til a very ~Decjjic, limited ~i4 iu
lil qllJllJlil[ A~ alncb, th~,[i, tlle~e Jll/ulveJlLJoll~ Illily I)e llllll~i'~lallLJ Lts
Re~l#w of SelI-IteID Approaclle~
Jli I~Vi~W~ IJf lllllllllLl[~ ~0I- ~lliOllinl~ Ce~,lLi~ll [llll~l~}lelI lll'iOl. [CI
I~'J~. IJllJ~ ~ll¢-cc~ WL~ I'c[~)ll~l[ Wtl~rl ~tlch nlliilLllil~ ~v~Je tl~lI
WJlll~llll ~llJll~llll!~ ill, ~|l[llcci~ltsl# [llllll( I'r(lll~ ~ Clill~:illll ll~" ~r~llp
ll~i~h:l¸ (1~ ],~tl. 'J'hu llll~ ~:cc~-.lllillll wil~ ~l ~/ulJy ~:clnllllcl~J ill WI!~L
Jill:ill ill~nllllJ, i] i j.e~i~)ll~ lill¸ l)~lllt~ii)lllJ ~llill lll!l ] ii1~' (1I- li r llnll~J
ll~l[~(lll
i~l Ihu Iwl), <l'lu~u loll Io ii !ID llt~j,l~l~llL ill~JJJu~ncu J~llu ~iL il ]~ lillblllll
I~ilhiwllll, wilh rio ~lill~lclll:t~s altlllll~! t[l~ tl~ilLl~lclll~ (2f~, ~1~ i:ilt~l IJy
/~!1 'l'l~i~ ll~lllll,t 1~l'l)vjdl~; ~lillu ~lllillli:~ni rc.qllldilq4 ltie llulunlilil
I nllllll I I~l ~elJ I il!J ji iil~l~l li~ll~h c.~¸
hi I liuir ~liJiillill.i~0il ll['~VCl.iiI lii~lniJ~ll~ lill, ~ll~ll~ ~ lll~ ~tu~.~ill ~elil Ill lit!
u~,ll ujllll~j¸ Ivllh lit wilhl~tlt Ilil~l~ij~i~l uiiillact, (~hl~l~lllv u~ al Ill)
I <~lllll:lll~l Ilu~ [~llllk ~ ~l[ I )i~ll~ll~l¸ ~ll~l I.i~lilell~t ¢il~ II~ iili~l I~lllll!rlu~lu
;iJid Ibllnil~l h~iiu (27) wJlll tJic "1 (~iiil I{il" ill till! Ailiuril~liil (~iili~:t~i,
~;~*L i~:ly (/j. All ~llltj~:l~ ijlli~l il $1!~ ~lulJ~l~iL IJ[dl~rJull,h~L If;ill ~ll¸ Ihu
llbl,I I lull Ilil: lillll]l,~lln wlllllli hi! liu~L clil:uLive il' u~l~[I i~li lh~'il ~lwll
T~u! I~:lll~tlllill$~ .~ II~:l~ll£ ill¸ llle ~lll~]~!l!ls. Ivlu~ lvcil! Illl~t Ill,it
~vl~i I~illl~ Iviih ii I huJ,;illJ~l wllll Ill lil~:ilil~ll u ll~ llt'ih~ iliad el Jlih~, I~lq~[ hi
ll~lil:q~ ililtil!~ilull Ihut Ihc llvll Ii~lJJi~ lvcJ~ llulie el]~.~'livu wh~,n Ll~ull
~i~(I i~ IlwllllliM lli~JJl Wlil!JI ll~l~l ill~lil~, ill I:l~llhlt~L, I}ic "[ I~uil I{il"
hui,lvli Ill h~ ~lil~hlly lil~ll~ ~ll~:ltivl~ whI'Jt ii:~l:ll Ill,Jill! I~l;lii wilh ~l
c
|]ll~lil])i~l,, ~llii]y~[~ fl~ Ililslilli!lll'0 (Jillll [Nl~l~(l Oil c;Irhon 111OllOli{]o
le vul~ .~ howvl] li lllirallcI IJ uii~l
Al, li Ii lillhll]l follllWUl), tile coniilinaliali o1" tile nlliillltll received
111]l~ t] iel'illl{~{ C(lllliic[ wt!l l! ~lill Si~lli~ll!i~ tit ly tirol rl~ ~tcce~ful ll~ ~u[I
I'~llllil. (lll[ii llliii fll" hol~l~l lillO ~il~liil]¢ance ([) <~ 0.10) I(ll" ~bsLilieilce
iJdel'lnillclJ li~" clirLIoll Ililliil)xliil' ie~li~l~ Al~ilJll, tlln I1Liliel'li ~'4~qB [or
t.lilt~e li~int~ Llle llooks Ll~ lhl ll~lloJ" in tile t-[lei'lll>i~l-iitl[ilJlii~llslotl
whl~li tl~Jll~ it aliine. ~l~[I I'Clll)l'tell ull~LilleIl¢e I'at~ IlL Ihl~ (l ill(lli{{l
fllJltIWtlll l'~lill~d I~1"o111 0 llCl'¢~li[ wiLli Iho Ih~l'~illl~[-iidlllJnJ~Ll~ll~lt "l
quit l{it" llll(I the ~elr-illliliJni~[Ol.~ll tl~O ul~ lii(~ JiOili/,rie~lll ~ili([
I~tilierle~lu b(Iok L() ~4 i)~1 cuill Jn llie Lhl!rlllllSl-achill[il~il~lelJ ~l~o ill
file lllllll¢'rJo~lu alld lllllll~liClill IJi)lll~ J,'lll" Ihll~l~ who ii~d the
ixl~tel'Ja]~ oil {heir ~Wlt, [11~ ~ell'-I'cli~i~L c[~llii illll{~.~llt,~l 11 7 ll/trcolt{
ul)~Liiil,liC~ l'~lt c (,3 of 41 slihji cls) i1[ (i nlllillll Jil] JilWllli,
'l't.~:~e ill~!ll of (llaslfaW e~ ~l. Ill) flirt ~illlel'iiltf I't~tfal>dilllf Ihc
p~]il~llLiiil I1[ llcilLJlulll ~l[ijll'U~i~]lc~. However, ~i!Vt, lill C(Jll~illl,rll{illll~
~llould I~e I~cllt~ ill lllJllll, Ilucllue¢ ~Itllii~ ~lill](~l!t~ Wt!le Ill I),. ill
Ihlll illlJ~L ulhliJliJSI Ol'~li [ I'~'li[llll'lll~i~ s~lici~Li<lJl~ IiIucl!tJ liiil~ CI IIII[~-
sJD Oil the lllJ~slbJlJly o1" ~ull'-holl~ Jll'lil'Odill't~ The il~llli:~it lllitl [11~
[.liJUle Ill I~lllllll~l~i~:e ~ellqi/,Ip ill ~lliiC]L~iLi(lli~ Iliil+~ tlliVl! ill:Ill indivhl-
ililJ~ IJitl~Ul i-Ill" ~1 ~ul/Lilulp Iil'llt~£iuil I'l'lllil lloJlll~ ~llt'Olilil~llll Io joJll
}"lil'llini'llll)l'~. ~/ll~el:l~ w/,le I;llllul" hi+livy siiIllJ;i~l'~, IOli~llliiitf ~l
[llUilt~iLllll~llL [itoiln ill ~l~! ~{!tl't ili,~ ~ll/(lltttll ill!l, ([kt~ LIIl(I [Ill LlVt!lll~l!
~>lilllililll~ lii~[Ol'y O1' ]lJ yi:illH, Tlitl~. :Ii~h,clioli Jll:h~l~i IIl~ly lilivlt
1~ ~(:lll:ll the iin lllll!L o1" IIl,~ IJl IIC~NilII t'~ {!lllJ Jlll)'t'li
~tiltjeel~ rl~lllilluil Lho t~h!lil ill ~liiilh [lliv ;icluillJy ic:ill Ilit~
lll~llhl/(!lll Illilllllill~ ~illli lilts Jll'il:l~lll ill IlVl, ('lilJl,~iJ il~livi[iu~ lllcy
ILClll~ill7 ~(ilnlIh~[l!lJ, 'l'JiOllilJi~>t iilhiiJlii~lliili~lli I,,I Ill hil41it~r I~llitt~ i~[
I:lIlllli[l!lillll ill lilt h4)liJl~, wliUlUii~ :~lllljccl~ ill lilllli ll~lll~i'~llil~ wilh Ihc
"1 (~lliL I(i1" I(!illJ :illfll'll~.iliildL'ly I'(llilll klllllllliil~ Iii Ihcil IliillClill[~
]:Ill' Jllll!t~ill ()1 ~elivilie~ illllllil~ll~ll, Ihl,llllli~l Lllhililli:JllLIIJlln IV~i~
IIItlllll l~lllll~ll Ill Clilill~JJlilicl." ~lilll Jill Ihll!l~ IlilililllJJ!i ~ultjecls
lw~lliJilt{ wJlh Ili{Jl~illJ~ls I(!{~il'l/'li Cllllillh,liflll Ii( IilJ lil!l'l:~liL i1[ llle
ii~llvilies ~ll~l~i~:~ll~ll~ bill IllllDc 17ill I(Jlll! illllllC II!l)llllllt (i(llllllli!liiill
fl("
llliJy '11 Jl(JlY~l!lll 'l'llc~i IIII'II~III'C~ I~l" iiINICI%!ll(/' WUII! I:illlt!illll'd willi
~,ll;l t~ll(ll [ ill IlllllllIPI Ill til,~lil~lll'h ~>llllikl!lJ lll!l" It;ll/ ;11 illl~l[l(!ill4iil
ill
I1" . 1)4L~ illllJ t).,l[I J{il" Iliilh!li[ll l/~l{J illlll illlJviliu~ CItllillli, lt'll,
il~l)(!cilwiyl ~ililJ lillll~wll[i (i" ;- II ~t] ~liill -II 2.1i, Till,~t~ liiidhllt~ lilt!
IIIIII:~IHII ill Ihe [~ohavillli*l IIIClliCillt! JJicl'~llllll~; i1~i Clllll~llllJllli~
I )l~l i~ t!<,ll <llill'lllliO iili~ r/,j ilil I~ ill llil~l!l v~ll ilirl~ i)l ;ldllel I!11 cl~ Ill
:~lll:¢ ilil
hllilllllJll[ I i!~.'llllllilonllillilllib, hlli'l! Illll llllIHI lit!i'n lillll!lJ, 'l'lic~
Jlltlitl~
liJ lilJJl(!l ~!llt'o wt!i-t~ ~lllilo~lllil Illl)~ill i!~l(!fi~ ill hlllll{ i~'iilJ lllld liCl'£1111
ii I~l!hllvJlll'~ll Ill011~Llll~ (iJ liillliVillillll il:l ill Ihl! illillill:l ill" lilly ~Jll~fle
Ill fll~lillil I~h~llll!lll-+ '£hoJi (lllll~llilillllH wilh (lilh!lilll/' lllil~ i('lJllc{ Iliu
ilnpokt~lllct! td pZllLi~il)~nlll (.[InlL i:llb~.r t]l~lll ul" ;l(,tllnlI ilqllnlJcl qll
]);IJ~ r~'~id (}1¸ 111~1Jvil i~ ~lLf r]l,~ i jilL.
Minimal Irl[erventlo;~s
twlp cI~l~;~es of nlJllirll,ql [llt,orVelllJl)n~ I~llly D[so i)~ COll,~il]erell wilhin
li~e [iekl o1" ~el~l~elp: I ho~e in¢|~Ld[iL~ hr~f exllortuL~ou ~l~d ~u[vic~, oL~
q~liLlill~, ~lL¢l LIIO~e wi{il IIll1~ Illelli~l or pi~blic edtlell|ion .~l)l~l~¢lle~.
The inlhle~lce of ~iml)le ~dv[ce tu cl~iL wl~ f(~uud sil~tlil~cntdly
i'el~llc~] Lo [)(!l[?~tl[ll~c re(hlcLit)il ill ~nlOkillg in i1 ~LulJy i.~]~lll(.tl by
Ilnlv {~//) [*'ot ty ~nl(ikeae~ iiLter~dill~ ~ che~L (']ini¢ wee'(~ inlervh!well
ilhy~,icilm hlld ~ld vi~ed Lhem io quJL ~lllo~itl~. l|nJ[ of IhOlll wcr(! ;11.~(I
provided with [nE~rlnutilm re~:nrdin~ the risl~s of ~mc*kin~ ~nd the
be n ~l'iL~ ~f ce~.~u Lion. A 11i;~her peree.t~e reduction [n smokinl~ ~lL 3-
mnnlh ~)]lowlti) wzl~ obLnined nJlloll.~ [h4)so SLII~ecL~ ie])qJtlin~
I~hy~ieian~' dirccLion~ Ix) q~iL [:l!l per(-~t[ camp~rud to Lho~ ,,.L so
ud vi~;~t[ [ [7 l~(']'c~l~l.). ~]~llux, 8hll;j]~! il]~r Iii;iLjort Or enroll r~l~er ilel~t [t)r,
pl,r]l~p~, i~lntllnbel'Jn~ SLI¢]I) i~llly lie insLrLh]leJ~tlli in ('[llln~il~,~
~;ll(dlill~ ))t!)l~lvi~)r ~llloniT ~oJt~ people. ~incc* reducLioll5 in srelo~irl~
r~ll~ iil~ly I~e ~liorL.liv~d ~lrliJ I~llrLU~lLJll,~, iL i~ un~lr[oiw)Le t}l;ll
,~ev~r~ll fitl,ii*~g~ from thi~ ~ttl#y shed llgllL on the [~ue or
ii1¢~1111i fl)]il)wll[~ OCCLirrc~] W[lell f]le ill|erv~]w~r wore u W]lJLo cou~ LiL
Ibu Lim~ uf hi.~ inLerview ~viLh [,~tllel~tr, irrespective ~[ will[mr he
w~[r ~ldvlsizzl; Lhenl txl quiC Thus, the ~ulhorihd.ivent.~ of the wllo]e
[lio(:~!dUl(! ~(,et~.~ t~ iit~lli~l~e J[9 illll~icL A I(ue's[ionllniro llleiJ~nl (, ill
~nl!jccl~' luolivuticm h) quiL uL lhe [i]r~e [hey ~rrived ~t the che~t
cliilic was correhded will] IJe,~ent~ reducLion (r ~ [[,~3[, *J'hn
~dll!lnlJl lo nloliv~lt~ quilling thl~lugh inf~rmnllotl o1~ t]l~ hel~[~ll
ri~l~ uf ~ml~ld ng und betlefiLs ol- quillln~ wua [nu ffecLive, lemlin~ only
to ~ ~tl I~e~cent redtlctlon in ~moki~l; ~t LJle 3-nlonlh followup in
(~l)nlp~lli~orl wiLh t] [l[~ pereenL redlzcLi~nl ~ltllOng Lho~e nol. rereivitl,~
~lze itl~lrucLi~ns ~ntcmle~l to be itlolivr~ting, 'Uhi~ difference w~ls noL
siKJ~ificanL
A inoi~ conLrolied ver~i0n of [~ phys[e[~n-ef[ected ]lll;~il~:11 irllrl'-
vul~tiot~ Lt'ful w~8 c~)ndllcLecl in Lhe o fri~es or ~B ~eneral I)rnetitlonel~s,
~l~vol~h~ 2,1~Y~ cig~t~tl~e ~m~inC paLier, te ~3D..~lf-r~l~nrt~ o~
~iTtoking ~lnlus were co]lecled vin mulled nnonymous qLiestiollnn[re~
lneJ~: group l, none (non-[ntervenLion c~nlrols); group 2, que~tion-
nairckoIily ~ol~Lt'ol~; i~roup 3~ phy~i¢iBl~-o(tv~ ~ quit. smoking; l~ud
grotip 4. p]lyslcil.l-zldvJce to quiL ~nl(~klng, .qn in~ormaLi~rl~l lenflel,
;Jnd t~ war~[ng L]lnL 0 ~oJlowup would I~e perrorme~. The o(Ivire to
Illlil I~:I~ d~*livI'l""l ,li'i I Ir~ 2 /iliilllll"4 dUlilll; lhI' vi~:il ii* lhl.
l~hy~;k J;u¢~; ~)wn ~.ly)t.. AI I t~1~I]l~l [i~l[i~w~ip. I~ l!rl.;iler i~f.ii(.ui:ilff, nf
ll~lii.llt~ relrlrh!I~ l~lli,.illlini~ h~ ,iniL mllCllIil11! in lh~. lw~ l~hw~ci~in
~1~Ivi~.~. l~IX)Lil~ II]~ii~ ~i~ I~i~ ri,lll~i~i~ll~ t~ ~i ~m[l~ l~r.11~ ~ ill I~I ~>111~
d('u Ull~'q t ~iII'~l ;I iiii[hl.r rnh! ~il flyilu! to qniL [I ?~ p~.l c(.~iI i r~blill~;i.~ ql
~tl ~[I~! c~1~hi~l~ cI~ll~ 1 III l~vI~l~[~. :i~I~I I~ ~I~[IL]~ ~lil~Ivl In~lL ~I¸ ~1111~I~lll~
I?.~ l~I.tc(.nl v(.t.~IJ~Z ~I imlcetll) I [t)wl!vi.l¸, lhp 1~el.Ct.iil~H~¢, of l~tif~.ll(~
lliII~tetlL illlllnii~ the ]~)nr l~ri.ll~.C Thlls, l)hy~ici:lll ~,Ivic~.. with i)I¸
willu~ut Lhe le~L(leL. ]~iI[ ~U] f~[[~'l iii~oll the ~i~,:ii.~;~ r/ale ~[ Ibm.i.
tltl~tlilllLin.~ In ~oll. '~'[ie j t icr~.~.~(!li 111111iwl[~nn t~l ~itlll wl~ ~I i ot~l~i.~l i11
lhe I~i~L niilnt h ~fler IDle vi~.il In the [Jhy~ici:nl, p(.l~islr.d I ht oili~h ihl.
~I Ino111)i ~ll]ow1~[l. z~tlt] wn:~ enli;lllced in lhi! Ii.nllt.t i]III~. [i)ll.wnlr
f IdII!ta I o he ll!e pe r~'t d~tI~e o[ l~n? ienl~ in ench l:]~nll~ wll~I llnd ~ hll~pr'i)
~tnokill~ wilhitl I tlii~llill r~f fhe piLv~i(!i;Itl vigil. ;i~lll wJlo ll~.t~, ~lill
td~sl[11~tH ;i~ I-ye41r I~iIIilWllp. '['he~ p01~(.llhlt~i~ w{.t~.! /~rlnll~ I. II;I
llercel11; ~ioIII~ ~. [.I~ i)~r~!etlt; t~t ~lup ."J. ;]~I ll(,ici~rlL: l~l~d l!to*Jl~ ,I. ~i I
j~i!r(!i!tlL (~ < II()I)I). J"uilh,.iJiu~tl,, l~hy~ici~m lu~vh(~ t'i~;nllt.,l ~i~ ;~
~iffn(~c~irtlly lolw.r t'¢~It~[)se r:ile ] yi!nr ]lller Jltnnt~ff ilupn(~ wl,, hnll
ilniL ;IL [ nlon~L ~J~lei'e w:i~ ni~ difIi!retlLi~11 ~leeleTiL dot ~vt.() hi,nl I[.'
]e:ll|i.l~ ove~ I Ire Io IL~- r ~(~i 111.
*Yhi~ stn(~y in,llcatc~ lhe I~(m~in~ for ~r1~17 mh,h))~i I~')~, i h~ '~.
nlinule) inlerven~inn~ by I)h)'~i.ciml~, The I]lz~,[)()ls ll()int onl I[ini th(,
wl)rkin~ in I])is r~llll(!r wouhl I)r(~[l]c(~ ))l~)'e e~.~i))oll¢!r~ llni)n~dly
(.licit wl)tzlll {llt~lxs(v~ sluoldnl~ re.~.~tioll cl~l~{t'~ which. ~lll}lml~h
¢)l)injll~l)l~ Illllcll )i~F[]I~ ~tr(!(('~:~ rnf(,s Ihnn lhe ~ 1)(,1(e)11 I(,pr~lh,d
]l~le~ ix~tlcll Ill r Fewer ~lnohel'~ t)tid incu r f~lr Kr (.z,l~r (:(~ I
Anol]l~')' ~hldy of It ri!hH ivi, ly )I~i~il)l~l hlterv(.l)lion I h~d hlrh,b,(l
~¢1~(,11~11~ lind lltlvice tO ()111L ~nl(dl jnl~ cur / i(,d ollt ~n 11 IIl(.(l~c:l[ ~11 irll~
wns reported I)y [lose lind I lnn)ilh)n {~1)). ]~o]lowin~ s('rv('e,lnK I[l~e
nl Jli~h Cill(lior~f)it~t)ry ri~k, IIl()se II1(,rl I1[ ri~k who tli~ 9iil~)lIl!¢]
wt,l~ ~lsHiI~jl(![I t!jther ]o ")lolnllll c/lIe" or to Lhe hlol vellliI~ll, rF'hl!
I;m mrld i)ractitio.~l~ of H~om~ bl "l~or iit(d C~ll ~" rereiv(~l U full )eputt
I)f l[le ~cl(!ellit)b*, ']'lie illen I1~i.~11~[ (o (,]le i11~ervelll~(lll wel.l! iliv]lel]
by lelhlr ~o nil .~l)Foielfn)l~JIt with n plly~ician to revil.w Iheir
~cl'eet,il]l~ nnd the ))iKh risk ])~)se(I for the]tl [)y mm)J~inl~. The 15
li}intlle til)l)Oill[n)(!nl~ [tlCllt(lt,d ~1 i.evie,,,~ o[ JhP I)en(,[il~ i)f Cl~S~';llilll~
lll)l)ointit]eel~ Ihe fl)]h)wh)~ w~'('k, I)y whi(:h tin)(' they wine in dr'rid4'
lllld ]low L¢) ~ni), [)ul w~.q.e told []1~ (ll!ci~ir)rl wn~ Ill) II) ~ ]~el)l
AL Ih(! ~,col~d ~ut'.~rv[ew, dec{~ion~ wele rev[cw(!d, the hl~lmtl,ttee
OF qt)r(Iil]~ rit[~lt~r ~])FITi CL)ll, ill~ IIT)WI1 W;~ elllJlllH~izl'd, llti(I [h(, i)lPii
w~te given ~1 cnrd Ibr reco r~lin~ d~t jly ~(IIisUJIt I)t ioll~ lO J)t! I ('i tll IH!II [)~
2~!t
lllilil (fill:l" ~ ~VCUII~, i.'llllhl!]" l.~,lilil]Ui~! l~i~i~ilJll~ Wl)l'e SC]II~(](II~II I[)
wi:cl, ~ if(i,( i; il)( Jill hll |liter wilh ~ll]lil] ui!lJ c¢~11 |fill by re(~ )l'll c~ ~ i.ll
llllll
i)i~l~OJi~ll luli~l, ii~ lie~lIui]. 'I'll(it% lhi~ illlel'v~riL]on iiichliIed lii(il.O
l:illillli:l li~lwui~il liIiytliciilll ~lllll li~iliulit tli~iJi jllol]~l]>ly llle~Is |lil~ ~ll%
llt:lll (:(if,:( i~in, llow~ver, the s(lhj~i:i~ wui'e i~'ivuli ]iLlle dilei:L llill in
qllillilill ~l}Jei' Lhltn lldvice, Lwo In'iL.l'inunuals. and u po~siDly ]li6lily
JJ~LniwiliiH] i.ll Ul'ituLi( ill willl ii j)hy~ichlll
l"¢llh~wllJi Wil~ ~{)iiihl(:[i~ll hy cliojc l~lilf~, alld tl qllestlonlll]ilo wils
uoniOluh~*l ill l>i~i'~on or r~iuln~'d by .nail, I~o e~}jeeti'~e valhlaLi(In of
~lil!jt~cl~' sell:r~po,'l~ w[*s ma,lc The im/hoi's cneouri~gcd tlulliFill
rUl~iillg Illl'o~gl] lllo use i)f "*impoz-~onul" lind "st~lll(lal(iized"
l~lll(}Wlll) [)I IJt Olllll'l~ [0 "~void i)llt~.~t ii.1. tO.. , [l~lly Of L~ildoi ~lilnalt~
Ini*y h':il~ht~ll lhe teildency Lo (li~:ll)sa (Ic~llable m]lconles, zlml
y~ilr ilIIPl' lIHa ~( ICOlli~ Wei~ ~| ~il~) Ci3Zlt Ibr the illt~l W!llliol~ ~lou])
lll:rl:t:lil. JO'~p~cliwly, tl!liOlll!li 11o CJ[~ille~le ClJil~Ulill}~i~lll, TIll~i~
Wilh z'e~;Ji'¢l Io l)r~diclar~ llr abstinence, Slil[)kinll less |hall 2{I
(!il~ill~Lh~s lluz' dily> nc, n-Jilhali.IB. Use of (ilLt!r tilL~, i.~nd I)I~'4i(IUS
itlli:ll~lJl~ h+ s|lll), illcr~+ilst+II (hilll~'e~ ul ~IICC~!~I. ()ii |II~ (i[ll~r llatld.
lll;llii~ll ~,[Zilli:4 tlI" "(iLhl~r []lilll lilill'liI!il " ilild l]elll'+)li(~iSlll iJ~ Jll[!il
Whlh~ lIIil thrill Iy wilhill lhu ui¢Ii.l~llry l J|" sI~lILhcJp iMilll'l)~It'lle~, [h~
+II,+l ll~ilililh,l (L~J ii,(Ji(:~il~ file lJi~ll~rlliill ill11~,¢:t ill ].it~J c<Jllillcl~
wilh l~li$:.iciiLil+ .~il¢:ll i'liiilziul i+ it]J~)~lli:lli~y t'llh+lll+~'(l l)y il+ tilililII[
llli:+t! ililll ]ilmlillIIJL Shllil~tl l'llldililt~ nl'l~ l'UliOrt(~+l l(~l' lllyl)CiiltJJ~li
i',,l>lic i.t~,llo ilI)]H'(IiI~.IH!~ I(~ ~IJi,dlini~ ('*a~.~;ILit)ll Ill,re h:i~tlll l(i
ill:lli~v~! si)lil(~ Iil)pIliili'ity iil l'e(~lI[ yi!ili~ [)~!l'liil[)~ lhllL l~ei!iviil~ [h~
I;IL~ll~l Inlhlicily is ".rllt~ (|it.ilL AliU!l+ililll ~lllllklrlilll+* Sl~,ls, nt~tl
I:il'h YILilr llY lli~ Alil(!t'il!zlli (~.llll;l~l ~il(:J~'i~+' (l~(!~). ~ (]lllhlll I%~11
~,III VI!~ l~ilt~i,l fill l~l!l~illlill illlel'vi~ws wilh il i'l lll'(!tli~i)lli[ivl lllllillll~ll
:;~ill~lil(~ i~] I/~!il Iilt!ll illl(I Willllt~ll. Ill yi:lll~ ill ill~l~ ~JIIlI i)hh:l.' Wll~l
~lllill.liJiiI {21 ~l'liu iilh~lVii:wirHl i<*l" Ihla ~tllll.y W:I~ l'lillel~l~>il~li ] ill Ill
,i
if.. tl.lllil'tlxinllllely .']~1 pt~rL'~lit I]r slilOi~ers interviI;wl~ll lilirlll~il+~ill~ll ill
life I)l'{il~rlilll- fl~ perl:t~llt~ l+l'l'+ined Lol+lly frOill +lnlikJill~ a~(I lill
lid~[ilil~illil ~1 '~ DOPCOli[ Clll~ dl~l'¢ il on l-It tl L filly. I)~liiOIf J'iillhi~ 11 II lily
~l'~
~ll(Iwell ~ lilrll"l~ Ill or~oun~(I iillJllicf of Lllr~ ~nlokeotll ill ll]l ills ~lf I liiIJ
of i<)~ll Li ¢ill~ll [o n IIIIIOB~ WOllll~ll. ~/oII I I~I~l" llt~op II~, llilll hl!(l~ r
o(hl¢~lf.ell
ill,oilily, colllp~'ii'l~d will| lneli, liludiuill ill~ell iilld c*ldel' ll~opl~, iirld tli~
les~ w~ll ~tllll~ltell+ l~iri~lll~. IllO ~UCL~e~ ol" Llle prOlll'lilll, ul~ jillIj~i:ll lly
lewl o1" l'~rllillaril)' wilh iilld iloLive ll~lLicil~llLilili lii Illu 29111)
~llltikOOlll.. wli~ i]qulll to or ~lL~il~Of fliarl tiroL licciifl'illl~ in lli~ 1~)7~1
'rho use Oi ~el~vlslo, i~ l~lllOkilll~ Ce~illillrl htls 'Lit!eli eXlill)i'nll iJy
several ilivestigatOlS. OI)o I~ll'lllilt inv#llved Coll'yilll~ Oil{ ii ~llloliilil~
~l.~ilion ])i'ol~l'~llil ll~i pUl'l, ll| i1 nil~lllly li~a%ws prol(illlll. 1411~ll ~.vt!i~ltlltly
t~vlJnili~, for 3 wcok~, tim i'~lll~ir ~olon~e i'epoill~l" dcvlill'll L~ nlillllhs~*
iiiotiyatinlf pi-~etlllles un(I buverlil wliy~ fo i>l'epiirl~ llii 11 llilil illlle,
ill~ludlnl~ gflulu~ll ~itllllia~ill. Vi~ci~ "~/-rc ill~ll ~lil~t~ll ill ,Itlit
llcl*oll~ file quit d~Le if Liil~y f~l| ~bl~ Ill (Io so. ~lilll)Uli~ ~'llll}lllS Ihu
ilrill |o sel]d LJ illiSt cal,l to lily ~[~lLitln if they wi!r/" ~villiiij~ i,, I,~
ill¢ttltl~l in (l~ ell~lllllti~l~ of lh~ Ilrtllll'iiill. (klt al" t~lliitll. 6 (KI(I lill~{
Cill't]~ I't~ceived, a ~lllllll/' lip ~#l)[) %VtI~ chliwII fill JillliiwIIIt ()tic lllOlilh
lift el" th~ final 1} I~l~(.ICit~L~ ~i lier cetil, tl[ {llt~ Sttlttlile rL~llOl {~2d ilhsl lll~lice
t7)> This s~irlllilirlg procE.dlirl! ~li'lllialJly illlrlti~ll~ll ii ~l!II'('l Jl~li i>ill~ l/Jr
ILil~tily i]%otiwited inilividll~il~.{ lllJwtr~/~l'> it ~Jlllill(I lit" lilli~.d Ih~ll
~llllject~ sonl~ in iil~ir lll)~L t'[lii]~, rlliiH' Io Ih(: SlILi{ ill Ihl I)lU!flillli.
bol~ll'O lift"7 I~ilOW h(iw ill|fuJi (Ill!7 tvislllil Iikl~ Ihl! liJ{il~l'illll, ill
whl~tliur llit~y i'~llli h I ~llCCC'Ull 7if il
Wi/ll~illl~ wiLh liii. ~iJllll~ h.ll vi~l.ll i:t!~i{iflii Iir'+ll~l'illil. I)ll[lil~li (~l~J
exllllliod |he iililliit!l (ll i~lliull Ii~Jlllhl)jli' Illl~;g~ill41'~l h) I?lll~lllll'ilj~l'
ill:iiiili~illo(l illl~Lilll!liI!o. [.'lllhlwilllf ~1 ]illllill/'~l~]l. illvillilioJl, ~fl(J vil~l.
o1~t ~>Olil. Jll ~lrll~ iiilli/'~lLiril~ Ilil~, liml (Itlil iT11 ill leli~l ] illl)'i ul>lJio~t..
fi4 wei'~ ~il(ll/.tl I~l |lL~liiil(~lll ui> I.(lllLilll i~lilllll~. 'l'h/. Ill~iiLlill~lll
i~ i'{lu]l l e~l'iv~ll iI ll!l~ll h(]lil~ liUilil;l~l [LI cllll, blit Ih/. L'I ill l i>l)l ~i
i'l~l'l~ iv t~ti
itll hil Dhl!l' ~l{ll~liiioll oxl!(.lil lili. I]lllllwlili l/Llli i~ilt:h wl!t!llllliy I]li" .I
wel~l ~. Iho 3-11iillillo t~l!li!l~lililit! lil/'~illll'~ ~Vllll! clllirll(L~t Iblilv. ~;illl
jl~l!l~ i%1o1"~ /~ll(.i)tlr~l~l~ll I~l) f!illl Ih{~ I./.ll~lihflll(! llllllihl~l IIJ ill!Ill Ih~.lii
~l~l vf.s i i~ niilill ~ill~Liliell L I h i {lllllli~lllL Llii~ ll{!r |lid. A liilIJit4 filll.~l~
ilil~i t~ll
(he ll!h.lllilliio llil~ltzll~l~~ {ivl.*~ lll~llL.ii{ iOl)~llluli lil~l ~lillll~illl( ill Ill(f
~iiJ (if Ille .I v4o~k rl~l.io{I, hi ~lilll i Li~l. llil[ V ;ll+l ller( i!lil <ll fill: f!lilll llll
i(ruul> ll~l~lliIc~J ~llisI.iill~ n i~l~. ~t vl~Jlly i!il~lil pOl I:l~lll ill I ]lll~/. ill I~!l
i!ll i ht~
I~ll~j~li{lll(~ lill!~L~ill~ l'l~llllill~ll i:illiril( ~iL l(.~l~l i)llf(~. 'l'wt!lily II)tll'
liPl'Celll, ll~l~(Ji-li:ll clxllilllf I]lr llll 21) ill Ihu ll:curlhli ilil'll-~ill~l~i. 'I'll|!
liiCilli ntlliihof ol iiir~il~l~.5 iillilllil~ {hil<i(! i~'lil> cill]l~t] ill It.lil~L i)iil!/. WiiS
Ill.lk ']'h~ vlllilliLy I)1" Llle~la it!llllll~ i~ :~llltlfc>!ilell b~/ Ilil~ I~i(:~ Ili~ll. Ihl!
iiirlililof olI I.lie Ii!ll~lllli)il/: iill~%~¢!lilit~ ililit:liiill it!~'lli'lloll ~.~)tl ¢~ill~
t ~'c[!JvA!d llrll[ Lhe ~ub~ects rei~)ltetl haviJlg nmde 245. The n[Jstlncnt~e
riling; Ittll[lng ~h~$ {~l'oUii ~tl~2 inll~lc,.c~[,~e. II~lwcv¢:i" 11 shllll]l] I1~
¢(!cnllc[I Ill;it tile group WlL~ ~;el~cll~ll f~lnl ~lltl[Jtb{~ t]lt)~e who h;ifl q~liL
li*l~it~l t~ th~sc rcsidhlg withhl New Yolk (~ily, ImL (rely 67 cllrtls
Wl~l~ £tu-t!iw!d fl'l~lll []l]~ itre~ TJlll~, th(~e i(.~l~[~ (]t~ noL n(,t!es.,;~lrl]y
[ll,~*.,i~o illl ~tC('llrIlt[~ iltlJ[c[it~]n O[ IJll[COllle to b~, eXl]CC|~,t] ill ii Ill(lie
J~t,$L (,~/~ ~1~ r ellOI I~'ll i~n [i [ [~l¢'~i~]llll V,21"S[O r t ¢*f~ HllIOkillg ('( .~t I iqln
clinic C~]nsis(ir~g of ~X IluJlLh¢lur ~lmw~; [J~(~tt[cust w(!ekly. ']'hi,
pl'(~gl'llllt COllt(!ll[ W~IS Irt,vt~]op~2d r~Oll} st!lLrtl~n~(yll)*2n#. COllllltJnq!lll~
~f n clinie pl'ograln al~o tlevelol~(I by Ih~st nt~tl his ,'olle~lgues (78).
sin~lihll(,d il~ter'vi~w with a p~lrticlp~lut). A quit (late wns ra!t ~t" the
~l~ly fin which the ~ltlth ~]l~w wll~ t~ be televi~ell, btrL i+nrtici[I,~rll~
A "e~l~lp[inll~n ~e]{LIt[21p {~u](l(~" wlt~ (ll~'cr¢,l'{ |o ~l[ who wi'otc or
c~llh~ll Ih~! sl~lIi~n~ The I,~{O3 sr~l(~kc~ wire di~{ so were folh~wcd for
tlriJgl~lnl (!vll]Ll~ltil]ll I"ol[~lwllp i.('~]X)ll~e r,']t~3 ".'~ri*2d ~rOlll ~J ill ~7
Alllllllg I~ll~ [~[ltlndill[~, ltIJ~l[It(~n('c r;itt,,~ w~['e IL,~ p~r[~ll}~ zlL [~1(~
entl ~f tile s~ ¢ie~ ~an(I ] 47 ranll J7.8 p t'~'c~,lt t 3 ~]n(I G tl~oitt~ls Iillc¢. This
~ll{~g~2s~ ~ l~ "~.leol>~ r i~l f~,cL" (If'inel f.~me[I ~ll~s|~ll~llce or?l- Liln [!.
~l~l~t~ltc:rtt (:~l~O IlL ~.mor]th fol]OWUll, h[gghe{* Ih~tn ~e:vc2i'Li] ~Lh[!t,~
reHt'wcd heJ'e, i~vrhaps because (~f Ihc limited i>opuh~ir~l~ OF thv
~cl tillg--Iletlingh~lm, WashingLo11.
Also [~lJl~rc(I in ])cst's ~tu~ly wcre pr~rict,~rs ~" sttecc~l~il
t}}(is~ wllo wl~l.c ~N]~tincnL G lnontll~; I;lle2r ~h;mtl ~nglng ~hos(, who
w~i'e n~t (27.2 per iI;ly). Sewru~ other pr~li~Lol~ of outcolnc wer[~
prev~nll~ lIttc21npt.~ {~1 I]U[¢. un{lltl~'~[, i'(,tttlc¢~l{ rote Of ~nlolling (ltJring
the ]~ivg~Jrn hut I~l'iOr to quibdny, nnd subjecL~' perceived ]ikelill~(~t]
ol" ~tlt~('s.~. All tl~e tlt~ly }}~ V ~¢1 ',W'll ~J~; I~l(~a~tl~-(2 ~ nt" mll{i,,,riL~C~lt. 'I'll
i~;,
t(~, i~ L~u~islcnl with the I}I~ious ~tlldi~,s reviewed ul)~vc. Subjecls'
rnting~ ol¸ the extent to wll~c]l they ncLually tmed Ihe pll~cc~ll~tl~
nloll~Jl~. ~gzlin, ~lle]l ril~iIl~ o]'~ i]ln~}igllOU~{ tt~ to wh~![]ler tll(:y
~t~f]ect the sLIh]ecL~;' motivutiotl or Lhc ~llCcigic e[fccts o(" protst'~tm
L'SSL'{ TO 9
,i
'J'Im illlpOlllmce i~f limlivnti~rl i~ ~u[}l~{'~Ii!l{ l~y ~>11~, [imd :i~:l.'~:( Ill
I~L~ llrOl!l'~lll3. [~ Ilchievori lll~ lll;~I~nt!rlc~ r~ll~ ll[l(lll[ lwir'I! lhlll
~.'IiJ n t~l l>y Lhc 1~rogrllm rel~ir h,il I~¸ J)~Jllt etl (7). ~q~h~( (ir~rl f~Ic~I~l ~ nlrly
'JLhus, il luny ~l~ivo ~cllievml ~I hiRl~t'r ~t}l~l ill~!llI'1! t ~aII! (ht~ IE~ ~i h~gli~'i¸
tliIlt ivnI~I>~1 lovel Of it~ pnr t icill~int~
l~r Ol~l~Inl nntl [he North Rnrelill l'1~ect it~ Finlnnd (hlly tlu~ l"i~1~li~l~
pvOieCL rcpott.~ sltifls [tt S~ll~Iiillg, obtn[ncd [r~)in r1~e~iTll~ ~lilh~rt,i~l
inq,di~l (~neilu~'~ij~!nlcnL o[ ~nlol~[Iig c~t~iol~ li[Dltg wiLI~ I~Ill~'l¸ lll~ i,.
IlUt'eS ~J1¸ ~II!~trL di~ClmO ri~l~ rq'lhJcLi¢In, l~ll [!xf111~l~l[', n~ I~Itl I~l 111~"
~(;In~wd pri!ioct, ~!~irlc~l~ i~f (~I~' Ii)wrl ll.Ct![vii~ italy Ii~;I~ rT1(,~l[;~
illI~1"vt, ntioll ~]in~c(I nl~ ~ l)(~l~!llt zl[~sLin~!itci~ l~II~ IlL ~ J~lh~w~ll~ :I
ye~ll~ Jlf~!r L}l~ ini[[~LLioll t~[¸ lll~ eIITIllllU11~ly l~m[~rrlnl A I'*lll~l~ll
h[14h ri~k ~r cIlJ~lt~ry h~irL [li~e~l~e Wele Illl'~!tml (,(lur1~t.litlg ~it¸
~ll ir~Iiillg e~ [iOl~ in [I L]t~rd eotlll~lu nil y. T]I~ oVt~l~ ] I ~tll~(il~Cl~i L' l:ll(~
W~ 2~ l~crcent within thi~ (~Irllllluni~ (~4L The itll~lillt!nI!I' t:~II!
~l'CeJ~t at the 3-year fH lowl~l~, ([ep~Jld[ng ~itl wllet}1~r (li(~s1~ ~1~i~pI~[li~
~IL the ~|~ii'~, bltt liI]~ llvn[1o~)t(, lit ~i11owiiI) i~t~ ciJ~]rlt (,~I i~r ni~l cr~ill~ ¢.~I
n~ ~lUIIIIcrs (~3). 'r}l[~ sht(ly ~iiItnirnhly lltJl~ illt~b p~,l~ll~I'li~(' I~t~,
((>nLriIJ~Lioll elf n nm(lin i~l~lliiirJcl~ rel~ILiw lo nr~ ~ii,filrlwIII IttItl Irl
~l~11e [~e11~ o[ the NOI'~I l(a r(~)irl study was ~ eXlll~a e tllv ~I1111;lt~ i~(
II tcle~i~e(l ~nm]tirlg c[!~llii~n [!llnlc (~I). ,~Tt nr'l(ll~l clilli~ wilh rl
sin~llc¢~ WCle CTICOtlI~gCd I¢~ '~iLch [he iJr(~gr~irl]~ ill RlOtl[l~. All(~tll
201) ]c~d~'~'~ vOltlnlei~t'ed ~n [orill the groLlps, which the al*ll~f~is
~ll]Cu1~aLc~J ti~ [m italy laL~tJl I h!~1(]er l'~r every .~{)0 ~(i 4~) ~nl~lIIf,i~
w~1,~lin th(~ l~l~Virle~. ]~'~iIi[in~it ~llV~yS Cr~lldtlcLCd b[,fllrc nl}ll I nIIlnlh
'f5 t~l ~.2 ll~rcclIL ~lllong 111~ll~'~ nntl [roln ~.7 tll ~4 [lel'Cl~lll llln~)r11!
r(!ll1~lles. Howc, vel', ~il~e t~ClIiI~ W~'t~' I~I~L ~:trl~i~li(~l]ly ~iI~nili(~u1(.
~,}lOlIL 7 pCIC~Ilt O~ i lll~ Ilnl ii~n[ll ~lltl[II~ wIllc}1~d IlL ]~,~st l'~llr ill¸ I Ii~
~?~n ~-~ioll~ Only l() llOt(!orIt ~*f tho~c ~ii~ ,~tlI~]l~iP Ic[~r~(.~l
vi~Winl~ the Ill C~l [~nt in zt s111~[~iII Live l~rilt~ll ~el {iIll~.
w~le ¢l>tllili~ll lid lllll,~ illl~:ll ~li llilll~, 30 Lll 64 yellt ~ ll]ql, Jlll~ll~iv~
publi{:Jly L~[l~l* L~ wilhin NuJLh i{llluli;l I'~'SLJIle4 ill 9 puJ¢cllL Ill" [Jlis
~iillilll~ viL~wili~ J'IILII Of. Ill(if'f2 4If [il{] 51~VI]il l)l'~l'~llii5 itl CUIIIIIZll Js[):t
wJlnl 4 ~ ]iLtrl?( ii[ ()I [hl~ S;IIII[iJu ill tliu /i~i~hLiol'iil# [)rlivJllCe. F(ir h~JiJl
~,mldC~, 27 il{]l (:~t;l {ll [hos0 W~lO ,,va{i heLj [iL leil~ [~LI i. ]Pl'(}t=vralllS ~all([
;I[Ii~IIIIilL~Ii i(i ~I()P ~lltilliilll~ l'eJ]lilled IAisiinellCe llt zt {Jlllillill;
I~ll.wuli AIIll¢~u~li 23 percunt ol N~ttll l(arclia Sll)(ike/~ i.ellOrllzd
llli:~lilil'llcIj ll~ (lie 6-nloliLil li~llowlll) ijI (!liilll)~tl j~ti Io 1.3 i~l~l'¢ellL ill
I lie (!ill) { i.lll 131 (1~ iJ iI!l~, I]li~ djj]~].Oll{:e w~ls Jill[ ~i~ll i~i¢~l I L,
'l'ilil It!ell ]ll()ll~]is lllier Ihg ~lirJJll~ i~[ [he ~[iow~, li i]il~jiJrliiJ ~iil.vl~y
W~ ll:l~U;lle[i ~lJl({ ill(]iollielI ii I~lil[Zll~iliet[ uLisLill¢lll~l~ r;lio ol- ~t})ollL ]
lll~i c~lIL ill" lll{ISe I~l Ilii~iil~ u[ LII° Ill it4ilill I liil'llll~- ]#u I'lile J IIIOl'e,
~ik(l~8
w~l.l~ i{!ll~illl~d ~l IIiOilill~ prior [8 Lhis liii~ll ZlZlLioilal ~lll vey. ~l)lij'oxi-
lllill(;l~ lill°liler | ilez~elll" leparlell ill~tilieili'e [llllll this 5t~COIILi
ailiatf of tile slu~wa Thus, the two broadcll~l~i of the plligt'lln] led to
liplll (,~iill~lieiy 2 JiL!l'izeil[ O[ ~iJliokers ili;LillllW~e I eliiZlill j I]~r Ili~[ilIUII[
Jill ;J 11)41lii}it$ ill J ye~ll', 'J'li~ zl[ILhl)l,~ e~LJiliaLed L]llt~ I~lljS {Oll~[i[llh;s
14),lJ()ll t~l 3ll,I){)( } illdivJdual~, all ajllll.ucilible lltiJllllel, esl~eckllly wlluli
[[lU ]ll+;lll]l illll~ eci}zlolll[~ itll~t~ of liis~iises l~];l{i,~I [0 5ill(IkJlll~ .tile
{,*l,~i,h~l*~,l. The illltii¢~ls I'llrtiie£ e~tililaiijlI L[llll i>l.~}d~lctitlll u[ i}ll!
~l~vl~li slssililis ~ll~t only ~8,[)f}(). 'l'hc~ IJ~iilcs iliilicilLl~ ii izi}~L licr
P~elliGlltf~i i)l O~lll;alllt!
A~ ili~ illillil~ll ijll~vilpll!~ly" Ii li~llllllul lit¸ ~lullil~ Jll~ve ~lll~JllllLeli Ill
J~h~lllily t~l~l:~Ei ly i ;llll~lil~ [h;iL lYllily liil! :~ililll~er, Nil 11i iJyilll,
Ib~J:4111ialily Ilalil!ln ll!~lllui~llJh~ I~u ~Jiilll,illl~' hilll I)~!ull lil~lilli llml,
Illl'i~'ldbl~, iIO I~lill+ill~l~ul'il]C Iru~illlll~lils have I~ul~n ~l~vl~illlll~ll A
JiLl~ltll~ ~illvl~ ill~ii ]llllllll {o (Jil(;Ullllll~l~ i, lli,~t~i~ ill ili~iJlll[!l)lililt(! ol¸
i!~ia I il~Li ( 15. 2~ H II while ~i hi.lot y ll(¸ "llL'i~lll ire zlll~'{ I" ~lll~lk iiil< 121;)
llil~, pilll llJ¸ {Ill! ] ~l!] ~lll { Illl 111ili ill (:1 illl i~ ,l~ liB ~1 t ill]{ illl~
~l~,t,llll(lll )
Mdu~: ~lilulq[y pclliill~liL I~l ~ell hl~llI ~lllllrl>;iclil~ w~l~ il ~llilly ill¸
{!ll~ll~,lll~ j~l> ~l;iy Jill. ~l lliiililllUlll {,I (i tll[llil]l~ ']'u I)~ clltltilu~l ll~
:~nl~l!~lill, tlll~y had Iii hllve 1~411~ i~ll Ilil:ir i.im~ulllllLi~iI ~ll ll~,l~l ,5()
All :~li~li~l~ wl~lu iilulil ilJu~l i e i i ll:~lll,l,i i vl!j y 'l'liu~i, Ih~!lh~ i~;iuli ill
ililil
Ill" tilt lJ[ilwn Bill[ Ihl~ III;llllll~l" ill WiliC[I Ihi~ Wll~ [iCCOllllllisilel] WUle
rlol ilil'luell¢l~d by Ille sut'vey.
~il(!et~;~lul inlllviltil:ll~ i'lzll(irtt,d gl-Olilttl, ill~l~ ~lf s~lf-reward illli[
lil'OlJlt, ill ~oI7inl=, or soll'-Iiillnill~lllCiiL i)r~cl~dui,~s {h;lli ilhi Lilt! ilil~ll{"
i'l~shll liOl~ilns Ilowewr, they did llot report fr~qlleJlL llSl! oH+ sollL
illOnilolinl~ llrot'OdUl'{,~, l:l Ill,lily Liilivei'slil Cillllli(lll~llt 0[ I~(~li[lvim;ll
sull £flll[l'{ll lll'l/l~rillll~i, l~'inally, 4() lll'l'{-12ill. 0[ the ~llCl~l,~>[ll[ ~llllj(!l!ls
ii!lllilllAd IlSl~ i~l~ leCllniques to ~oll[rlli Cllly~l rehlle{I Ill ~llllikilll~, This
~lil4y ilulicalns liuiL ~eJ£ rewald iilid a<~iiw llrlllllenl-sillvlllt>' i>il'ill~
gil!~ iil[ly ill~, worth elilllllllSiZillt~ bolli in ~ell-ll~ip and in 1114111~
{ll~;llliZod ill)lirfia¢'iles to ~]llllililil~ C/+~slilioll+ The Jlillifll I~lff'¢ of ~/,Jf
fewlil'd i~t ii1~o Sil&fl!f.~[t,~ by ]{ozen~ky fllid Ilell~lck (,'Jf)) ill ~lilllle~ ol'
s/,lltruwiirllilil~ telidenoios f~ll, IJll]~l~ wile had quit ~ilioklng or lll~L
Fl'i(.dllllirl e~ ill (I}~) ~11~o ~llrVl~)'iJd ~if.~V@l'ii[ IJeliavilll'al, ~llCllll, iliill
llS)'Cilohll~Jcal ~zIi,irilcti!JiSLil!~ ill lll0ir' ~lllIjerl~ ~lllllllinl[ lli;~LOl'it~,
ritirlllier of ¢igal~elle~ Slilni[ell ill!l, lilly, llill] i,I,illll,ll,iI ill!lilh ill
hlllalaLilln iil4Jl~at=ell ll~ss inluli~e ~llll~khll~ I1~ Ihu linlu i)£ lilO
~Xlilllilllilillli iullolll~ th~e wilo ]ll~Ciilillt [icl~i~l/,lll. iluiih:l,~ lllllll i)ll
Ill# Ilill'L Ill II]llsl! ~'4ilo rl~lll~lillld lll!l'~isll.'llL ~iliokel~, Thu lil!r~i~ll~lil
ijlli I h~i,s i,~,lloi+i el I ~ollll~wh;l~ Ju~ ill{ liiull (~lili;4tllillll ill Ji I ii~lll llt~l
~i~lulli
~lll(Ikl!lS llliililllJ wliil~,s ~llid iilllllllll ltlzt¢.~ illlllc~, Tilt, iil!l(l!llililliJ ill
~lll~ie{'Ls I'#lllilliJil~ oon~Ulllj)lillil ill inllll~ Ih;ill si× l iipb> iiI (,ollo/, j)l:i,
d;ly ill llie LiiIie ol liie irllh~: i~tUliilliilioii Wil~i ;il~ll il)lvt~l, iillilllllf
AIIllilll~ willies btll IlOl. dllll)lll~ lJlll~lcs, ;i 14li!iili i liill liilil ill liL~l~J'~li~lil
llilil [lZl~ lilnl Cl]llllilel~[I ;iL h:[iM i~{)lllt~ i:llll(!i41~
Inlplications
I"lli II di!linll!, Illrifle ~;llJllyiiq4 ~,illl)lciill~ I:l!~>~>iiliuil Jl:ive I\li lilll~.
i!ll{t(}lll;il~l!lll(!)lL lllllll til~ ii!lzl[[vl~ly j)lltl[, hlll~ll~llll i~llll;lllillt (i]"
inieu:4iw~ ~lnl~l£illl~ i:~s~llLilln i:lillil';~ With I~w e×i~Ul,li~ul~, r/*~tlii~
I~l~,/:l'illl~l hy IIIIrlt iinll M~il~ll~lzzu (IL;) IVillll! lljllillli~ln is .~llUJ tell hy
I]il! pll~lll il~l~l)llZlliS {l~ ~,l~liL~ll~llI [tlid lllli~ iil(,lli;i llll[ll'll~l(!h~ lllill
I~l¸ Ill iur iille r vuiil lolls Ily tll:~lll]i i~lldl~iu n al~, ~li~'ii ~illlli ll:il~ht~:~ hllvl,
II~e lllll~llilll h~ re~ich iiii'l~ lltllilllL~l~ ill¸ ~>nil~l~l.l~ wh~l liild Ihl~lil
zlll r~ll!live+ AiJ~{illL+ncl! llltl~ llltll~inl~ Ill,ill ~ Ill <ill ill,j ll~EiI hlIv{! ]lt,t li
llhl;linl~l ill sl!l(.cll:ll hit ill,viii lil~li~;~ J~ul~l! ~iul[il:iill,~ (,I, I I :!!~) hi
{!lllil'l~ jll)FiillZi[il)ll~l' ~llcii It}l~ilOil~:ht~i illilV iqlt:lltll'~ll~l~ L~ ill~l{i,llL ib]
slilllkl!l'~ Ill illiiL ill ~l year '~ liili~ {~1), 'l'lu~h¸ iliill;ll 1~ inllv I~ eil~i~u u'l~l
lly "E~ll!l!lll~l¸ i~ll~ls" iII which incre;l~inl[ iliuiib~,l ~i ill ll~!l ~l~ll~ i~x i~l~l~ll
[:Xh!lil h) whi~ll Lhi~o ~l[llli'(i;ich~>~ lillly ll~ ~lilllitll!li Ill I,ilhlllll.e (,~1~ ]l
~ll lll~l ~* illllllicls (21).
Whld d~'let millt,s tile illlrl:tl:L ~1 s~di.hclp llplJroacl.~? 'rhcu~e 1114J~L
t,J b,. pbysic;dly and i~qyuhcd¢~i(';flly ]lenl(hier (lf~i, ll~[ve tnihl(,r
sin,dlin{~ b¢llJils, in lerJ]t~ or lii~[llt y ;ulld intor]sily ofcLtrr~rll srnokili~
I;~ ll~ 2!~1, arid i,n,y be gene,'ld{y nwne skilff,*) in conlrolli,l~ Ihuir
(l~irl ip(*lltlvltpl., I1~ rn~.~lsllred ~y tbe it~ of ~]lLr~wnr'd .~lld itrc~l~i(,llt-
rl'be ¢)lll(~l I (dinide pre( ri(~l~r of ()ll[~({r~l~ 8eerTl~ Io b~ lnot ~viiI i~tll, ff~
qJtzr ncfiviiil!s el]CoLIrziged in t h~rti (14i. |[nluLivlltion fo qLiiL sii]okirlg
z¢l]l!cl.~ il]ct!ntiws for r~lil~ tiff, illl,n Ibc ~cL tlmt tne:lsnit~ id¸
nlolivuticm ilred~cL ~,ut['onie ~lll~h'~L that q~nliiy of llb, is ari
irill)oJ ~ltlt I~l(!l (ir+
A }lunlb~l¸ ¢) f c b~lr~lcterlsti(.~ of(he pr~rzl ~1~ revlew¢.I{ }ler~ nl;ly I1~
(,Jnld~U~izl!d {tl {)l.orntde }li~}ler }eva}e: Of It~otiwltiOll aJid ~e~s;liil~r~ o~
~t,~lkit~. Aul,(in~ Ll~se a~e nl~lelill~ (3. '2ll, ~r ~hltinu~ ,,p the
{la~itlv(, cons(!(lliell~(,s o~" C~sa|ion itl an ~lltiloril~llive rn{lllnCq¸ (~).
~w,r{l~ ¢~f the prowl llll~S incIt{de blldcry s v~[cnl~, but I li~se ~{)pnrl)ntly
h;~" i~t~ ~,~ e~llld~llsiT~ ~tlp)'~$ ti~ ~l~lD ~r~l~ (2 II ~ll~y ~l~o
;l~l~l ¢,~ ~,n ir~divid,lal'e willingness to ~rlow tbrougb will] is program,
.&li i~l" til(,~t~ i]J¢~j~J~llW ¢.lement~ inny be COl~llalrled witb the r{lll~ elI
ili¢!dia ~allllded Io deve~oI) in)ll rl~ved i1{ic~9,
~r} wilhr~tll the ~lid or flll i~rf.qlltlZt,d t~n~o]cin~ ~o.~stltlo{l {)lo/[r'~lln,
Jlnd nlot, t ciJrrC~llt .~in{~kei~ indiel1(e z~ I~l'e~reliCe lot qu~Ltlr1~
tlorl lo entel" nll or~;Inized, con11)r ~i~(!ns~v(~ l)rogrttln.
2. It~scalch evaluatbms n[ seJf-belp aids have ZUl~tLe~[ success
rli~t'~ [lip Ifl ~')0 ])el'Cellt Ct'.~;;it}llfl ~)t extended [(d}oW~ll)S 16 to 17"~
II~¢>nthsL Most estimates, howevcr, Full below this, a~ound 5 Io
3. Ih'ief alld shnple tt(Ivice tr~ qnit smoking delivered ],y a
COSt el fec~iv~ ill~l]~l ~r,
4, 'lk:l~viscd sn]obing c,,ssatian clinics re~ulL in variable rates of
nb.~ti~er~ee at followup, The t~se of television a~d ~Lher tnass
~llexli~ nre ~l cost-ellL.:t~ve irllcrveu~tlott becat]ge or thcir Jnrg~
potential tlulI[elIce~,
5. Relrosl)ecLive sttldi~ revctfled grea~er use or se~breward ant}
~leliv~ ~itxlll]ett~.$~l~'[tl{~ t;¢raJ:..gi,~s tulta~ig tll~ WII~ llttit (i~"
n~dtt~(,d slt.ddn~ on their owlt t]lan ~rllOllg tilo~e Wilt} were
ii nsuc~l!ss ful in quitting or i'ed ueillg smoking.
A t I kl.I i~'~ n ( '~[1( t~r ~dN i{ I ¢, I~11"/
d~lhsP (llj!fll~fl(illll* TIle, pllld Dnlll~¢~f,d h~/ Lil.lil,r?ll~itl I[q~4qlP¢ll II1,
(3i ITFb"r. ,I /% K%i~ lil~.~ri:i, N/,I[ i~l~lllp!(iniPrlL, ~llql NIIll~lll! I~l~mrJNqtiiJlplT Ill:
I[~,~lllh I*i[~lll¢~ Nrw ~'~r I¢ Iltlltltivr/Mslz~,l. I!l~r). r.I~. ~71 3!'41
{~! IIli!;r',J AI(IWI.:N,I,.I.:,'JIII,:NfAI)III~,L ('t~niis~trls.t, ors~tlrllJ~]lln¢~drrH,bl
~lllttkJt~g ill mil~ r.t ,p~ee[ Sliiq~n¢if?l! rnIs~li inHi litl~ti,/i~, Ib.h. ~IIpIIX ~1¢29 7 I
7flI
I !)?~1
1,~t [jet~l~ ;Ind tn]~,ir wl ¢(,~: A ~ot,Hilledi~l~] RLIId~ A ~/If,l jl f~l ,/r pHI 3tttl pb/
lSIbll¢
(b) D,~.NAIIIIIt, B(I, I.l{]llJ'l:N~l'l"lN. H Irec~m~e tt~t t~.ttmt,~e~ [,;r~h,w,..I
( llffi,. N~.,N .ler s~!y. I'rtnti¢ (. I till, Is78, ~:J7 I>I~
(~ ]ll/l!it]~N, 1{. I~alll~trlotl .f :~ I~ll,vi'~+tl ~tr~l~ StllOkhlK rjinie IIl~bll~ jh,¢llb
1~9 Fit AZ'/gS, CM, Wf I.q( iN, (11'. A rln~ml II..¢ii~, ~[ll..h~,i~s 7/t/'rrqt~ 77tr .~
end prfltllr¢ vorlltlpe V, NI,~v yOlk. tit Iltler/Mal~(II. I !177, ~r;5 tql
(I~ IFllll~l)IkIA N, G D, ~l{Dt ~(~l~'k~lll, ~ II i 11&Ll:~qi I,~, SHI 'I"LI,;I(I (' ¢~ { !l~a¢
(II] YfIIE[)MA~, (~ D, ~IFGI~I,AIII~, P~ rl, [II{y,-][ ]C, I(I,AI~{{y, ~ I, [~ tile
l~;ycht)logicllr traJl~? Ar~ *ln~lltl)reiI ~,x{)rr)rlll~rilt IlSJ~jT I~l'th¢llnI~i~Ii~{
¢111~
(1~ (:T,ASGOIV. II E, RO~EN, l; ~.1 IIch~nvi¢~rnl I,il,liodwrt]l,y: A n..~i~,w r,( s,'l~
197K
(13) [;[,AS(;O~ ]l I~,. {(f)SE~, ~ M ~<,IfIh~lp I~!htm'~ {llr dh~r~qly fllllr~llttlm lie( ~,pll
dv~[o~111@11[S ~ts~ ~]illi¢l)] [l~tl~ ~lilltl~tl XIthttPIo~ ~ltt~l]l) ~lt,liil,llt I: [ ~[I,
1~79,
i { ,/) (II,~SGOW. ~,,. ,'~A%,1%hFE,~, 1 ,i ()'NEll,, l{ ~. F~4T htqp brm%s r,.,{ ~]~,vi~ t,f
( IIt'rfl~li.¢( ['onhl~L ~¢1 g~tF(~kir~ f(,$r[l(i~[I [F~oi~[~llll~ ,h~ll/'llfl I Of (~¢tlt~ft
Ililp# 111111
(I,@ (JIIAIJAM, SI OIl{SON, R W O,sstOi~m of pati,,rn,.d ~.hnvi,~r: Willld~wtll
[ I~ LANI)(), II A E rf~:la oF pr~p~ri,ri~mi exl~rim~nt~¢ t'~ll(ne.L tl~¢{ ~ r,lpdliltl{iil'd
~n~ A~hlirllt,elZt.bn~,ior~l;r21: I~:l {33, l{l~l
II~ I/}IV I{. ~sT.~, (~II[.',EN, L,, I( I}lt JZ, ~MS, /~1 ll']Nll~]l{(]. ZS. FISt lid{, F' [I.
]!]~1]
21~7
4m4111mUN~i
zH~d hil:hJy ~:dilmL (I/~1. t~.als,,glruillly, ~(ll)p~c~tllel]LhIK it~lh0r'~dly
In;ly h(~llI lll~liJIl~li+l ~ll~illellc(~ t]l~lU~ll ]pt!lhld~ when ~tl(!t, lltiv~.~ lilr
i ~..;UlllC~l ~rnf~kipl~ ~lt~ ~1 i.Vil~
itOll~rnold+l/~. J~ irllm~?l~ll.y i(!Wul~l lill. i~dllt+e~llC(~ LO ~ i~l~l!]t+,ql
wltl~[l.~'~l ~.~lt~tll~ I(!d I.tn to() II~'(,IIL ~[ll~LLtt~lx~ t~v~:l~ ill I~LI~L~t'~-
I>+ltl(~; ~1 I~-Illlllllll ~l~nwlll)~ vCt'~tl~ '~4 p(~l.~'cllt ~11 ¢O]~ll~Jl~ l~)
~11~'~ ill tl/~ ~hli~l I~i~l~ ~ ~ll~tl~ I~ ~l~l~'~ ~" £~,~, "~l~ic~
w~l~ lettrrrl~l LIL the n~Lle q)l" 1~,5 per ~(,ll li)~ e:~Ph u~ the I'il'~ t 4 w~.l~
t~oll<)~iil~ c/!~'~tnti(~n. II(~r LII(• ~llnl~ 4.~.'~e~ ~eri~)~, ~Tl~ts II1~+1]~ ii
weell~ (~l'~lb~l ia+ence. ~t+bjecl~ who ~n+Nk L~I dur]n~ Lhe Iler iods hm~ tllo
~efeit~d in L)IJ~ w~ly wele divied~d iit;io~lg Ih~;e reln:liJ~in~ ~l~Li+
l~el~L. AL IJle end of L]I[S ~-rllorl[h periIltl, ~bsLhl~nCe level~ ~llorl~
imrli~'ip~lnls ;~ppz~l~irnnt~'d 76 p~r(-en~, wLlidllted by urinary n~¢olin~
~nz~]y~('s. L~+~l,r~)l mllljecl.s who (1~(I no~ Imeti~iL)~te ]~ Lhe reirh~J~ce-
JJiii)~ll'~nt ii~ (~.lllOlll~l follC~Wltl~,
irlL(~ Ihe rt~al ~orl(I J~ Lhlou~h pro~eqlnl~ ~zl Lhe workploce+ ]~osen +lll~
|,]chtell~,l¢]nl (4~) r~porte(t .q re]n~ol~e~0ienL program usir~,~ tl mlS~l~
Ii<)riLe~ i~1" $~ ~lch illllrl(h p]u~ ~ (~hri~ttll~l~ bOrll3~ for ~Jllllll))'~P£-~ who
I~ 1)~lrLiCil~rll~ who h~d e~l~l~+~e~l prior |~ the Dr'o~r~iil I'evozfled Lhe
~y~etl t~ 9 ci~t~rette~ per ~lay I~er. Fo~lr of ~hee~ hldividL~iil~
A iltllllhPr iiJ" tllt(~,:l]l~L~i ~[,t)~r L~ nf ~;lllllll~ll~ ce~.~tlon pl~d i,~irl ~oJ'c~.
~r pe~)l)le who nulirlLa]n Lhelr ~l~il~Pt~ce unLil ~ t+l~eL dnIP,
41.~lln~L Ill~ '*lll)tl~'+ (i ~.+ Ihe ~OlllilmlyJ on one'~ Cll~lrlC~ OI~ ~U~C~'
~e~lll tD h~ve C~I~L(~rL'~ ol1 ~q ehit~r ex~:¢uLive'~ er~l.]~l~i~i¢ efl~)u~ L+)
+lull ~ll~l, ~oneur~enL)y, to en~nutql~e ~)Lher empIoy~.~ Lo iIo ~o (l~
Wheiher Lhi~ ~orL of ellLhu~i.q~r~ ~aJrl bo rel~lJc~ll~J ~t~ pl~tnne+]
i~r~r:Jlns i~ iiot cl~ar.
'Ph~ ~'~lLi~lml Int~r~lgeney C.otmc(I m~ ~moking ~rld ]]e+lllh re~+~.L-
~y ~urwy('d ~('ver~l hllndre~l rn~jor Alll~rlc~lr[ cnl~p~lllieS re.~,ql'l]in~
Lheir inlele~L~ ~:nd ctlrl'eIil, ocLJviLilm it, ~m<lkin~ cu~s~ Lion i~n o~ nt~l~
l.++l~r'Zll+l~ i, Ill+, W+plkpil:l++' IIH' +IVl++lXllUh' IY+ +I C++llI~'l+'+l+t' ie'l~<ilt
l~ul)li~:hed It'/ lh(~ (+~uI1(~il (~15~ zu~d ir~ p+~p~,l++ by li+1.~lh~.r (l~I)~u~d
i'~ul<)lht,r ~llPl+l<~+sch le+ l'einl~'i,+11~'rl( i++ .s<+ll~Ir"+v~tld +l'hi': w~t,< F+~ttnd
~ ~y~ ~t~t, ~t~ t~x~<T~l( ~It(t~~ ~t~ ~L~ ~tlt (,l,~+'ghll ~Pl:lll ;lllld~l~(
lhilnt' w]iil wt, le l111++ItI!~'+':~l'~1~ itl ~l(It'rtll~l,'. Itl +luil ~.~iIPIit~p~ itl+h+l.'rl
~h'+li n~¸ ~ll~ ~I ~ini~nliL~i1111 111 i~l~ll ~I 7),
,gq!l ~ ~ J1 ill~ I~ <.nl t'il I
,~l~L~l~l:t~+lllt,Ili+ 11~tt'kIiiW:~ ti+:~ in~hlde l+lq~(!q++hlli,n f~pn¸ II'1++,~;dt+~rl
I+I (ell)i. wil~T ttt~i.~ ~+r" lhe i'+t1<di<~il~ liII+'ly I~ ]~I1)v(ll~I. ct;Ivitlp~,
llll(~Pll:q':+ ~)I¸ I~,lllr)~t! nl~i] [ii+~ili~t, t:l~11~A~illli!liCl,~ Jill' lll;~il)l+,ll~lll(~~,
;ill<t
~'~( ~llllll tl~ <~<IPlt ~iI*L iii (~(~qlll t(,~ Ill '~, ~lit'll Cl~l,~g I~'~" ~)llt l~ill~ ~II~
~i'+ lli~ ~
l>r Lllenilnl~t('il l,ltildo (~'I l~>leti+~ "I(; p~rq'<~iT~ i~h'dir+q+tlI:t~ i¸lltt'~+ +11 I~
llldln L h++ ~h PI i,l" (i,~,[11 i<Hl WITrIII 11 i'~ iii~ I 11 ( !~ I I!lIP+1%'t~ l)I <;~P :~III
W~iS, ~I~1411,II ~P~
~+l~ll)+)r;lloly ++lll~IIill~," l'Lili<~ll lll<~It+ ~rlli~W'ql 3~ l+~+II'q'rll :ll+~:finVl+('<,
~(~VI'IZtl ++hirli+!~ h~v~' +~'p++ll(+t~ thI! ]rl11):s~I ~IJ¸ c'nnlpre'h+~n~;ivI~ ~.II\
lll~ll]ii~+~ml~nL (!II ~i|tl~lli(m~ll t!+~llll<)l f~l~>~l!I]tll'l'9 +,viCh(IIl~ IlVi.l~iv++
.,:iiill~Ilt,11(~ ~l'Ix(~i'¢ rpt~ttll~ +Ill i~,~poI~ tLl~ ~llel~l<lJdrllill+'l~ ~IIl pe,ii'I,lll
~]I'~ Lil1~lIcl~ ~IL (~ ItHl11~ h~ f)r ll1+ir~ id¸ ~illowtl]~ ~ir~t'i <~t.p~m<~llilm+ 'l'ht+~(, +ii
I,
milr~ ~'ili~+l.~. l~x~a+~s't~+', be~'~ll~m4~ cs~" ~l~i¸ "/i~l~dlt~i<~tl tl%' ~i,pi1tt!; +~I"
lltli+e~+ <~ r(+~Ip l~)ell11~r¸m (f~)p m11iwl I h i<l<~y~Ii+~L~ e (~II, +)I¸ llrin;IIy llie.+~l
irii.
.& i]iIT'i+3'~nt l~o~+~m~l~ i)l" fllt. illlllnlr hltl[!(! 4)J+ ~oII'.ll~irl~l~!(.llli,lll w~i'+
~ll<)~+Itll'~ il1(:Jt,llnb' in+lltir~+g I'<mlutt<~]++ lilt¸ Iil~+~lili,rl+Ltlrt! w~]It I~'~'+'+
l]<ir~ ax+l~11(~d Ill ++m+l]lilll~ ii11(I ~ht! d<'~+itl~ f~ir" (!iI!ill~'~h!++. ;l+i~l Lh+~Ip~hl
~I Olll~ill[! 'l'h ~'1 l~l~I lll",J( ~+tlu ~ ~ (,t/~ i~ d('.r~I~llt'd ] o il~t~'l rllll~ V~,l~l,I
Jllvl, iii¸
L~ I~'.JI+I~L~]~ th~ll~hA~. ~ ~L t+t t,t~II++ li~I¸ Cr~()illK "+viI~ II l'l~t+~ 'rh~'~r l)r+~;~£11rl
".~ll~+ it:,(~+] wilh lun~i] withe+ilL +'l~+i:tl~;nt~l ~Irl~JlIhT/~." itl whi<'h I)~i11i~'i-
~l:lll~+m I~l~t~I ~ %'+zll~, f ~i'+t+~ '~I~i~,~ ~<I~ ~'~ tp+ LLII! ttv~'u~iv(" <llltt I ~ y +~I¸
~Itiillcbl~, ~unc] cll~sin ~riiIlkoll l~ir ilbrJtlt ]13 nllrlt~l~'~ liar ~'11<.II I~I
I:]~ll'Pll~.tl t+n Illq! ~iVt'iiij~l! iTl ~t(h 4)~ lhPs+~ I/~ llllnllh, +:(,~.,,~rlil~+ 'l+h(.it
ii!~tl]~..+ ++~inxv~,iI ]io ilnpri~v(~llii'nl irt lll[liT~IPllll~ICC" %'¢~II~ ll)l~ ~l~l~)~)i~+ll
<If
(!onipl~,]l~'+l~iV(! l)lO~llllll ~t~]l~I'vr,IJ nh~l, i11(,liC(~ l'~ll~++ of .~(l lln~l~+t,lll :14
qhe t~- I~I ~ lllolllh l!(~hIL+ I[ i~ it~lllIlil~nL (¢+ nt~Lq!~ hIlwI!Vt'l¸, lh~11 Lh~"
~+ml~nl I)f lh<+ ~ell'clm[rIll ll+nl PI~II~('~; ti~'II by l,Ilr)do .~II(I hy ]I:I~ III'l~
~tIltl I l(+~tlt tTil~'~I1, l)~LliI1h~'r I I~ ~ll.~+) F+liled Ir~ fill(I ~llly Isl]v~lillilf!~"
+>r¸
i.cludh1~ m,l~¢imLrl)] ~r~+inlr+fl +~i4h r;qlid mr.~inl! o~¸ with It r~o~+i:II
Tlll'l ;llli+,l ( .hi,let
Allolliul ~ll~plll~ch I[) rli;lilll4+ll~llll:i! hLIB beell inel'ell~cfl (}11 varied
m,)d,:a ol¸ Lhul~lpiP.L conl~lcL ~chuuJhl (!1 ~l {~+1) ~m)]<l thLIL SUI/iL+('I~
t+lih:d I~iwet:].ly I~ it It'~l~;IJch as:,ist~lnL Io check on [)rt)~ru:~
Irdl,)winl~ ct!:;nali,)ll were IiJi)l~ likely h) lellq~e Ihall W~lU LJlo~
(a~i(:,i I),nly n.)),thly. Bhnihlrly, I{clhl~r and hi~ colle;igue~ 611)
I~JlllLtl IIJ~lL iJl~:le~J~etl Iht:l~q)eultlc CL)JH~Wt I~)lll)willg ct:.'~s~tli,)n dill lll*L
liUl)Jt+ve inlh!l)ntt:s A +nilnil~u' lilnlillg w~*s rt:l)(lrt(:ll I)y J,an(lo (2~1),
t.+q)h)ling b~+th exle[iL i)l theralli:~l t:,)niltct ai]tl inllgnituth~ i)f ireal
ineill, L~` twl) :~lill{tJ tlelttlnL~nI. eOZLibhl(~d "l+Jhorllll)l~ !;nl(~kilib~'' itlltl
Iht~ t;<)ll)lll.(:llen~ivl~ illi~hllelUitl+~e i)loeedlllt:~ it}l)l)l It]{] hy [,lllulo (27}¸
~l~lJJt:a I~ ill Zl I hl~!++ :~ti4~{t! Lre411 lile~lL t'e(!uived this ettml)iJUlLitm i~ll~y+ ~1
l)le ct::~i~t itlll i )hil:~e ill cl Ii(lilll~ lillll~, IJ.lllll)hle|~, J.tnd di~cll~ion (}[" [h4J
t i~,k:io] ~;lllOkill~ Ill 1411 iiLlell~iVe <+onlilt:L i)ro~r~ml, sLIl~jeel~ ~ll(~ll(led
13 i)1 15 he~dlllent in4JeLin,~ llClli~lidhil~ Oil whether |hey were ill Lhc
iwo <)1 Ililt!t~L~ll~e tlellLi}lelli.. M]rliril~ll coil|tie[ +;illJjel:l~ lit(elided
Ollty I hl'ue ()1. ~i)ll i- ~t~il)ll~, zlg[liJ~ del)t:iltli IltJ (ill wh~( h,Jr |lily were i~l
tile two+ or Ihlce si~lge (le~lLill(:nL A ~igrli~tl]L illl~zetctioll w;l~
I~,uJ~tl; sl~l~jt~c(~ re('uiving th++ two ~tal~ treahncJit dld I)eLtut¸ in t.he
i,tl<'Jl~iVL: ttmil~cl iirn~rmn, hltL Lhu ~;ul+jeci~ ill Lhu thl'eU.~La~t+
I i ~ill n lelit did hel ler Wi[ It le~ itlt(Prl~ivt~ ¢(~ll|lieL,
I :uldo 12~;) all i ilniit~<l hi~ l] n(iinl~ ol rehlLively poor ouLeotnes il~ tht~
Ii~,quulhi Lheilqlist cl)ni~lt:l, Ihrt:{J ~lal~,~ ~:iOLIII Lo I)t~sihle "inl~)rnla
lioil <)vt:~ I()~iLI+' or tl) o:<¢e~[ve J~<)Jn[)]exiLy of t i'n~l~+iltenl • ]llVeSl [l~alOl ~
I,~ tll~':~t) ~Ue~lP+ lyl)i~£11y i)i't:Sl:llL (mly ++k~tchy hl[~)imation (hi ihe.
iih~ldlll( r ilh Wl~il h (~lil'li4'kll~l ~lr(~ i)jt,~elllull ~ll~t It~(!tlIG}l Jt~[)OilN, It)J¸
Ili:,l~lll(l~, ql(~V<)h" lil{h! liltll! I(l (~e~,t~tillili~ how lill~eliliW] W(:l.+J itlJl,
~,h~ll lill.,lilt ivt,l~ or wl~i~ lii)~ hl~+t!d Ii) ~ll[Jl)Ol t illl~l'V~!lllil)Ji~;, whl:l ht~l"
h:*Lth~l~i iJ:;t-d ~1 llidtlt~lie ()1¸ :J '~++t~[i~l{[~Ld)Vt~l~V'' ill)~lr4)~lch t4) ill~;h'4n
lili~{
I~;~)lhil~ml~,<~h Athliti<m~lliy, Ill(~:~t:hu, hlling()t IIIcuting+~(,)l:~][n(:]dt~
wi~h IIJ4: 41~liqll~il lil+lgl(~i~i<)ll {)i 4~Xl)l~lii'lbrt'N [)lilll+ Itl tllh~] tl~/(.r
L't~:~:~,i i, ul i:+ I ar,~ly dh.~ u:-..~ud (4}
T;lihuhiK *l'a~ailneni+. t+) hlcli'~idtt;ll CILarltet4~ri++ties
hL,Iha('llt ei'i~!(~l:+ nl;ly I)L~ t+xl)l~)il!d be:;L an inlL:l~l('Lio+)+; mtmnl~
I i i~ilhlll,lit [y]lt~, l lit~¢i~ ~yi)~) ;illd Cil 4:tlill:~t ~llil'4!5.
II,.hl q/) ('XldL)ICll i)llel'+l(ti(>il~ Iletw(:t!ll It(:~llt]lelll:+ and clieait
ilil}liviilil)ll l*llcl :~i~hl~ {)11 I{<)it(!i'.~ II~) dill~(!ll~iOll <)l¸ i~ln(~d;lllt y Itn¸
il~i~:lli~LI V(:i:~ii:; l~:I(~lllill IOl!tl~ t)l¸ (.Otlht)l, Thl! inh:lli~tl v(!i~;ll~;
i,~it,i hill { I i,:] t liil)t ~ll,~ii)ll W;I:I (~): pier ( i.d I i~ ii)l d!rilt:l W h ] h ib "h
l!~ihl~t .lil
h)~lI~,," (~ilhL!l ~;ihILIH)z3 Ihl~)tll{h <[t~llhlill[{ III)tllllll ~nlol{iil~{ ~il~t! i)i
;iJl~ly/iiig i~k h,I il~ll I:Lil'~i I~ir ~lllt)h ili[~ ,~;~LI i~l[ i(Jll Wll~ e){IJt,d (!tl lib we)+
k:
I,clh i i~n¸ illl~j ilill:~ ~in(:t~ il I)il~vi(]l~il ~t ilit~ill~, i)l ii~illl~h)~ di,~it (~:, i~))¸
i il~;ilt Ilt.~+ ~lltdy~ili)~ t~l~VJ~4)lilil(~Jll;ll t ~il,:i I~ll. ~lllt)l[iill~, ~)11 {ht! q~lln~l
I)~tlll, ~lql'~ ~.Xl,~.l It.~l h) I)t~ h4~l (tq' I~1¸ t~xl<~l li;ll=i ~,hl( t~ II~t~y ~,i)qlld i<lld
it, ]+t: j:~,~, + it,+,l h J :~urh ~ ue~.. 1 ~)e i I'} wu i+d)k~ ~'/~ls al~i,) ,'M)*,ci~,,I I~)
G t'P.TOg9
L ,,
inlu~acL with wiluLhel or JlU/. ~uldect.~ wm (} l(dd tlJ "pillli~h" relap~e~ "
by mn(~ki,,~ doubl~ Lheil Imlnl~d lat~ Ior 21 hom~ F~dl.wing a,~y
i(:hlnst~ hlleu-nal~ were expt~cLl:tl to helle~lt inrJlt~ ~l'r)l)l pllllishlIH~llL
~Jllce the Illi¢lisllmen~ was ~elf-illallaffed and izlv~lved tile ~;iLi~iLioll
j ~l'OCedll I'l~ d ~ I'e~l~d {llWll I'd IIl'[{eS Io ~tllolI@,
T]I(~ I@Ve] @1" jllol.~.4~lt~(lII ~/zl:~ In@~lS{]] @d by Se'/eHI] ~O~IIL~S, IIl[:lHlliIl{{
a ~emarllie differential evllhlat i(nl of ~lllOl~itlif alid ~tll!jec{~' e~JiJnill e~
Ill Ih¢'ir InOliwlliOit Lu qlliL, de~i~e lo mnolIe, {lll[I plohall]l]ly II~
~uc~e~. 8~vural Ilypolhe~e~ weje Imsed: (I) fllai, m~tivatiorl w~mhl
i.leui¢/willi l]l~ tinting uf ~m mtitude change [naml)~latioo l.laled
I¢1 tile IlegaLive it~l)eel~ oJ" ~lnol{in~: {2} thaL atLeullll~ Li) I)r~)voke
~1(1 j[tld@ dl~lnl{o wOIl~d bIJ [ll(}le elj'eelive al{l!r Iluilljllg Ih~lll huihle
(hel))l e q uiLLilLI~, they ;lliI] h L 8hnply b~ Jnvl by elJesl L )'c~i~tallCe); alld
,(:}) thaL it Was expected this woultl he Inore l)l'i))l(u)llct!d ~llllmq~
~l[)jects Jow ill moLiviltion, ~ill(:e tllel'¢ wotll(J l)t)gle~ll¢~z dil[~'lL, ii(:e
betwu~ll Iheir llL{itud~ prior LI~ q.LiHhlg and Ihe allii[llh:~ en.'~ml
aged in the ellam~ procedure. All ~ubJ~da ~eceived ilnlividualiz~.l
~lVl!r~i9@ ~Oll(litioDiD~, LJSilI~ Illlii(] ~rl/nltiIlg alld (!tal(:cllhllled ,~il~;i-
(]iclod dh'ecLio/In I)uLween the I]catmt~ltL Iocu~ ;slid Lilt [ 1~ vtleJ~ll)l~:
~111{~ I)~1 wet~ll tile thnlnl~ t)]l lie ~]Ltil udt! t:hiulgt~ ¢llallil)U hi[ iolt mid Ilvl)
,';lilnated I)rOb~bility I)l" ml(~*~:,:; No siKslilical]t inh,i~ti(,n l'¢~in
I~)Ul,d I~eLweerl the' J E [sn!anlirt! a~ld ~(~[[~liUUHi',t',l [,Inli~tltiClll
In~)liv~tlit)ll alld Lira I I': ~,~zlle, ~,ll!j~'*'l~; w,.e i'~)tll'(I ;l:~ hil:hly ()r li(,I
llil~hly IIl()liv~l[l:(] ~l/Id i1~ iil(t~l~l:d Ill (x~l'lll[ll I)(,pl.llillil~ oil nlltll
!;l~[lllS ~tll[t (h@ h'(!~tjlLlellt I~ i:~'iV('~L [jli~Y k~I'IL' ti]t!ll tndcd ~:~ IlL;Ill ht!L[
Atnrml~ Illl~e Iblillt!hed Jhi e;~clt, 50 [)elt OllL IVt:l ~: i~I~SiilL[Nli (~ IIh,)lllils
ni}di~l~ll I~ ItlOIllll~ I~lll!l, 19hile ~,ll ]fi~li [~lll ol I ho:~, IIl~lh II{~d IMI oJIt!
:mtl nlinnuitched o)~ thu olhcl vm izdlle went, IiIJn{mtqlt, A/laly~,e't (d
ih¢" Ilel~'eillag{J o[ I)lt:-ht~*ililunl levI!In Mill nitmked ~1 (;111~111111
lidh,wtlp ~]l(Jwud o ~iJmllicanl dillk,;em'e litdWc~'li Ihe IIIlitcJlt'i]
I,l~[li:}lt'li (304 lit!l'Cerlt) ~lnll ll:i!~nl~ilcltt,iI illi:~ltl~ih Ill,d I/!)2 Ilel('t nil
{~('V(;l:ll l)l{ll~]('lilS li/nil IIL/~ Mltdl'+ f"i/~,l, ii t'I)ilh,d ( I,tIIlll h)¢l lJult did
llbl lilnllilllll~lle {]le IWIJ~ellLlIc~ WIIh Whil:h ~ul!jecl~ ~eie lilhl{ li{:ll or
)lliSi)inlclled in olher eonditilms w;l++ ImL ~igllili[!itllllV ]t:ss :,ut t:t':;~,l~l[
Ih~m the bull oi tl.: olheJ ~owliihm:L 5ccm~d. in ~adel Io dellmll-
~ll'~lle ILu eiiuical ufili¢~ *X {~,ih~t i,qf by inelivRhla~ dillelenc¢.~, one
l~mild havl) ttl ~hl)iv thai ~It<'i~ l:dh)rinK w~+ dilOl't: !+tl(i'l~ndtll [hJlll
i~imlllb' li~i~Jit'.liJ IIt~ all I )ia'l il iliitlll:+ I,) (hi' Ik'~,t avaitahle I I e~,t Ill I'll I
!%!{
i~elill~s Ill i~ II~I i'lll i¢lll, IiII ~i~'Ly, (ll¸ ~ilt llli,~ [reqtleli[ly ill ce¢.tle
t.i,lol~s(,
(,121
lildii~'~t ~+ii'~I11 lli~+J~llI! int!lili]+'[l, l+PiltIJll'ily~ t)Lllt'r i)(+olll<~ t;r+l~>l~i.,I=,
i)leH,llc'd 6 I+t'r~t'nt of uelaps,,s, l~ttL 19 i)ercotlL weft+ i~rc'('t,~)ed t~y
Lichlt~risi~ill el ill. I ~tOP, ~u hj+~r t..4 ~'l~o hod llUiL rm Lheir t~wn ~+rltl tl,t.n
u t.l+~l)~,s ~t ttdil,d by M+lt II,¢t I~n([ I~+)l dt,t~. The sl~llj~'<:~ iu~lervi~,wetl by
~lll<l (~IlltlI)tl~ bul ~h+! ~(!tl~rlll lll~Ittyl'n Fott)t~l)~ ~rrli)~lr. Olle lll(,~l I~
(i,altl)l+u(iOl+~+* clnl~,d ~1~ Llxe Ill~lj~]r ltnL¢~ed~rlL of rell~pse for J~
I,ich [~,t~slc'iJ~ el al. (3(~) also t~k('rl s~Jl)jecI~ ~tllou t ~he circu nlsL+]~lee~
.~lll'l++itllldillp.t lhoiT I'~I~II)SC~. ~lJ~f+ If)Ok Id~l~e ~iLh~r/I~ llI)/tl~ lJl" ill ~l
IJlir, i~lvet tl, (It" resE+ltll'atlt. Only 7 p~'rc<'ll t i+ook Illtiee '.vllile WOl]lJtlg,
w('n'(' offet~d hy others, I~n~d o~ry 2"; i+(.r'c~,n[ wele I>+~tq:ht, 'l'hiu ly,s/×
~,tce~lt t,f ~llL~jecLs said tlle~ were dtillking ~lcollol ~nL Lhe lime or
/Xl~ i ml+on'dtlnt p+tt Lt, rn eJ~lel+,~itlg fl~+tu+ Ih++ nUl rvc, y of I,ichhm~t Pill I+f+
tll, which de~cn i]~es the iltll~+)('l. {if s~:i~d f~nl:ilittititm ~+[ t'~'l+tllsL' :ln~l tile
'+7,~
lllltl I11 3"++llTtlJflltlJ+r nh$;Ilrll!tft. /~ll~w(pl~ Vtlr.i(,d wi<It+ly+ hill lhi! irl<ip:l
fi~[uoi,I iv41P+ ~i~il[ Slt l~licpll, lli(.il I ~t!ll+.~I Ipy 2.~ l~el~l.lt I
~llil~ilillll (.~6) ~l~it~t'i~ vt.l+il~L' t'ri~e~ i~t.5..er~llt.¢l i~y ctillt.rq l+~ n
.~iili~l<inlf ci'.~::lili+~ll h<)iline, l{i.Plil)~e cri~i!~ xvt.i+. ~ifilli¢iilii~ fl~tt+ill+bn-
Jill~ c¢in f in u¢,~l n hsLillellt:t!. ¢l+,I/li(,t] IJy i~ii! sti1!/+.c#~' <Ic.¢.imi¢lils wh+,l h<'r
llr llol. f¢i t~ill i~ic hf~llillt.. ~ixly Otl~ llel'C¢!ilL elf lilt" (.~iIIt>r~ liild n+i1
rel;tl~,~I t+klllt'r+¢ Iraqi ill [~li~<. lle~ix [ll~litlei~L ~i¸ ~iI l~.tl~t 2 d;~y~ +I'll<.
nic~li:irl illllliIlt.r i~f d+tys lilJsl hleill wns 9.7. lllll dlil +ilii~ll +if ol+sl int.lir't.
l'~lll/~'d IIIi to ~ yelil~.
• ~,)~iifl~nn's resltlL~ wt-re sin~ilnr 1~ thnse <if |,ichlenslt,lt~ +,t+ ~l} (:tl))
.rl n II M~lrl~l[[ II11¢1 (]ordoll (3:!jr ~1¢ h~)u~]l f~6 ilel~:f,n I oililY" {!t is¢~ I¢1¢n1<
Ih(! ~lml I)ll+ 4If ] ,i~]ll~lt~t~]tl {,t ~ll, ot]l~l~ W(!re [)t'e~,ll [ dtllill~ lll(1Rl ¢)f
Ilru mitu:ltioll++. Thus, socit, I fiil'ililil~il~n lind iil(~lelitil~ tilt. #ll!+lill
/lllldit:ltll!ll in rel~ll~s(.~.
iil~t cl!lll ). iiIcohol (]!] ll~'l~'l'll [ ~ ()r Un ffe/~ (I/4 pl're(+n I l+ 'l*h<'xl. li;ll/i
IliilV
hi! ~lnll<.*is/(iod ~11 I~orljnllcliliii ~villl (Ire ivilhdliiwld ~T+lillltlnriu~+ Ill~i4
+tc~t)ll) [)li liiet] f).~l ])el~erlf o[ Ill(! ¢!risl!~. It IIIlly he. li)ll~ [()gpul, ilit'lpll<l],
t~l
O~lffee ~er'#e as conlt~L~ltt.d It(in%tlli f~l. ti¢~!c~ (l~ ~ltt~ll!~ ~ll~(('ll~q%ll ~
~ll/~tinenL fewer th~tl 10 dll}.s ill Ille Iirlle (It IJteil (rlmt.s+ i)<.lll~ll~
AffecL lln(I stress were ill~a r~ouilml liy Slilffm~o Io ll(. iliiljnl
tlnlecPdenl~ Of rcl~lis¢' eri~P~. ~evenl~ on~ p~i'¢.~int ~v+'/'iT i~t pc(.cll.[I I,y
neRilL~ve e[ft'ct, 4~ porc~,llt lit rill C~ll)er~ Jrldlc~lled tlllJ]r i:rls+,~ wl.l~'
pr+Pc~t[f!tl I)y tlll:<.~e[y~ ~ pelcell~ [~y ntll~t+l' or /Itt~lllllidln+ llltll ~
rld~J IIRI!).
rl'~l)orlsl)ll~ for [hcnl. Fi ft.y Iwi) p~l ct.llt Wel'e c(Hred il~ ll~+iLiv~ Ii fl+t.~(
~0 f01LI1, 'l'ol~et]ier, Lho~a tWO cltt~s~nries £1c~'~LIlnl~d f~+r ~4 ll~t¢.rll~ i>f"
(h~ cri~es~ ll~ lll4/X~ Ill1~ t/'h r ~ll~ line Ill) ppre~nl of Ilie i ~l~tl]~e~ tltll il+lltl++l
Io inlerl~l+lsllll~l coliFlict, iI1.~11i%'~ el)lt)lil)lltl~ 14L~ll4.~l. illld I+f)<iill
I.'/2L
The lilcLors r~OVernitlfT wh(.Iher Ol+ not cri~ Jell [o ~llil~]lilll~ W~.lt!
I~xl/Inr~'tl ill tlllllly~lf.~ r~f OVl!l ;It) v:iritlllS¢'~+ I.)llly n ~ew w{.i(' sl/~llifi
Cilni+ 'rhe {)rl+~eliC~ O~ ~ll¢l~ll(!r ~lillOl{l~l.. ~hc. Ctlll~lUii)]tl jl)n (1~ ll~(i)ITitl.
alld lhI! ]tic;Ill,iT I][ tht+ oi!cul Jeln,(! ,~,f-r~ ~tl] ill~;l rutlil!HJlIL lJ ~111O[ll(~r
---
(iA~.
1~3!t~ (II ~lhllli1 all~ ~U ~lll~ll;llll III I)aplOI *(l*),'*!l!l,(Jd ~141oJ
"ill 111 III;ll I,II] ~II 114 IU'p Olllll;llllll all,l, "lUelllO,ld U~/!Sap ~ ~lI lial!lU!l
x! I,IlJll[[ H Illlllllll~rI JU ~1011111! "lllLI, "~II!]IllUli J~l ~O~ll/ll~l IUIIO!llllll~
J(J ~ill~lI,Jlll ,141 L*I IlOIIIl,~ ~lJOIll 04 llllloAt *~llLl!~od~ Ill~!llllllli/~ Ill
LI41 jlll!lil~/~ll(IJI ~(llanj u I)] I),lll¢laJ ~[,3~Ola OJ(llll i~l~% S,)jiip~i,)(lill
I II~/LIlll I 111~11 Ill)! II~II!l~J Jll ,~Ii1 ill li],l(liJ~l~[ "l'~Olil.lIj[Joa ~l~/~l U ~l!') i?]
,)~lll l ~
,~ Hli)lq i~lU ;lUOln id ~1 Ila~ll ~iall b!ll I1~,~ I l(I,l~llO~l J I~ ill 611111!;IJ 1~13a~llll~
iII t~ I ] IliLIIlll~ [illiOIl~ ~tl ?l~ I17~18 ~al~ Ill Ii~ III ! ~111 'li~ I ~ 1 IIIJU ~l!llglI
~111 ! llll~lJII
~III!~UlI ' i ~l;i ~l&l i )} I ' &'L ?ll .lOd ll,)lllllll~ ~i)Ili).l IIII!L)JU J,Illtll II LI IliIll
~lL!l~i)llll~
~1) b;itl,ir~ Ill (~lljIIl[l~ ~lI II~lll!~l ~11 '1!111111 IlaUl~al I.~,~ IIIf I/,l~l4 ~I!LI
lU!I!LI! llllll I~,~1;111~ 1~1~1 'Ill la IIl/~ll.l.lllill~ JU lllll~l ~ll,l, "liIliII)lll
,I~!Ill;IL)ll (Il d~lllld~ll I? ~U ~ll!)[I)llJ~ IIIIII I!qU4 II ~11 ~'iII!~OLI]~ U~)i)~,lq
"*q,l.l!~l*ll
Ir
63013489
ll~ll! ~nllt s! al'.l I[IS!a!l~i~J a4,1, "(l~a!l~allsaJ ~lllil~.l¢ll ~," I1~ I)u~l 'it'll'
Lgi~ '1499 *~(la~'!~oalluaJ 'a,lam s.Ja~lotus (gl~p/~lloa~!~ I)l~ ~ ) #~al:n4
.loj lta)u.i ~3UOtl!'t~qe [Ja~lllll~a ,411~h!1n~J°illl°3 'tuaullua~rt jil illlo IV
,aaO(l~ pal!a ~,~sd gla I u! ~uo!lo~
c~^!l~aLI JO a[o.l oql lio s:lu!puy o41 slloddns osl~ S!LLL "s.la~l°lLm
t~ajjll aA!IU~aU ~oll aJa.~~, o11~ *ls~:ll[t JO lLlO~lJ,~tl ()~ II1!~ n/is!all41Uoa
Ul ~alllI .ll~it~ I 'ill~u!l~ll~l ,~,1o~ 'Itl~.~+.latl 9Z £1u° 't~l'~4~l ~Ll°ttlV
~lll~ 1eLI1 p~oqila~l!I ~ll? JO ~;ltl~o u! sl~a,ul a^U lU!l ~q ll~lllu~ alo~
~)1 '~u!"l"l!I~ll a% ao!,ld 9a:lolus ~luaa" jo .laqUlllU ,ia~;ij ';lu!)I.L.S
jo atea ~uauii~a~l-oad ~o~1 U ~ul[~ punoJ (~L') "li~ ~a lll¢~ll~nu(~l
,~llno~lIl0 J(P l~Jill;i!lIJ*ld
illllUlllll ~u~Jatl~ Oauutl~u!lliu Ilia4-JJ~lS o41 ]IT41 "lUll~ll~i ~Jl)4111u
~llLI, S U~!llllU~ i),'liliillO)llll] Ui "Ialilh hL9 lle!~8 Sill JO Jo41!a ~11 11;4 Inll!llI~
~lI Iolllltla I~lJOJOl,'~41 '~311!J e~llal~!l~(tlI Iu,l~11~uoI I[~l!l[ Xlll~pi~ll~olll~
aLl,i, "ssa~ns a~ll~iii}+lu~[~ xl! ~a~laaaJl!p a~pu~'t o~ liut~ ~l~l[~J~J~lil
aJallj" ,aau~i41s(ll~ ll~lo i palJOd,~l Sl~afl]nu all1 JI) ? ua~.la~l I;9 Idn~(411U
41¢a~11 lV "luell!l~'q~ oJO~ lualIJIn~l ~U!l*)[dtulla SlnnOIrl~ 1(3 °41 JO
alll pa21!a3~J ~l~a~qn~ IIV .llno.n~ i~)l)LIo~ ~,)lrlUO,l-uli ll llul~ '~l,)qu4all[
~lll!j,14j JlLlU ~)tlilnu4~ Ilk!lira u! tlnll~i 'lll~.1411'f lla,~ p tl :%x<lddtt~
ii~!~l~ ~kl!lul~d!uul~l ~uo!1!pLl<),l ~l;lul~ll~)lll(l?lu GaJt[} LII(,~ tulu~ll.id
luallllq!~Jl I[~l,')#,*.,t e, rt!~ua~! llLI };;)LI!¢ILUO~ ((;I,') litJU~)LIL~l [lllll (la,~l('ll
---
~2
2. I{uill~)Ic.~incnL llc~(]s to b(. IpLl[It iil(o [he llll[IIrli] ~ilvirollln~tLt
Lil iillprov~ nlaild~nil11[~ of iiori~ntok}lll~ ol'ler int~n:~ive [legit.
l.en[ pro~r~uns h~lY~ ~tli]~]. SinoI[iil~ e~qIl I ion prol,rrfl I I~S ill [he
worIIlphlce tnay o[l~r an (lll]lorlunity ~r Lh]~+
~J. (~Olnl~l~hi~n~;ivI! ~If lllnn~t, lnellt packal~es which havi! ]lei!n
~howll Ii) IH)o'~t nl.~inI~i1~l~ce rIi~e~, ii1~IuiIe i~ wide ¥11rieLy lJf
(i!c]lJt iIllnc~.
4 'l'real.llle.nl. ollt~oln(~ c~rl ht~ inllgrov~d by f'l~u$inff Oll I,h~
lln~e.~eI[eltl~ oF re]aide rrhe~e ieiclul]e ~¢[inK9 of ~'usL¢[l(ion.
l~nxi~Ly, al~er. ~ilcl del~re~slon n:; We][ a~ social i11~de]s ~]11~[
sIl~i~Id~ig-t~!h]led cues and ~eLtii1~.% B~hav]ola] and co~n~Live
.~l~ilI~ fi)i" de~Jillg wiLll such nn[ec~elenl~; ~houhl be deveh~l~d
5..~ilcbll mnlq~Oi.L i.terventions are [n~ini~ilt~, Relillb[e Yillding~
liiiI[ ~icial cuL'~. ~;nlokin~ fli(~iid~, llntl slno]ling ~;Imllsi!~ I,~
leI.~i~e, whi!reil~ lJle pl~ell~e of [{roup 8Llpl)oil,~ noIl~Ilnokinl~
~;I ~oII:~es. lind i)t Ilfe~sionn I ~onl neL ([e~zi ea$~; ~-~[dlyisl]t.
I'g@ ' TOg9
,I
[]0[cr~flC~
IIANIIIFIIj~, ~ "[lle.~l.if;y~q,.nl in vq,q;i,la~ql aT, Iq.rlilinD;~lil ,l~oll,~ll I~lnJp,,I
III:IINNrl EIN. I)~, hti.Al,l~ll;II. A '11., t,i¢~lili~;d~.) of <~).~lLi~p~ In*all ~,~1
IIL~;'I ,l~ 'Ii~ilnlnintl: ~ll)~]~.~llp! wilhdl:~Wa] p,~,hl),~ I,, N*I ~uldill :.nd
4:lIh I }t, 1975
L~I IIIIH'NI",II. [~I. (;O(AFIlEIII;. J. MRII[IAI~M, M ('~:.itiv,. ~llhlmln,,p
¢¢~ rll~l i lv N, I~ A , l,r1:11,1 I.:N'~H!I N. I: 14[,,1~ ,! ~ ¢ ',,l!t~ilir,, 13~lr.ui,,~.l
fl~.l.l,,.
q71 IIIII)~NI~I.I.. I( II, IIII'I(I,:I[hTAN. (!1.. WI:'~I'I.AI(I.: l~.I I[A~I~ ~;I'
~(.w y.rh, ~te ~ ;ulw I lill, I !)r;!), plI 37:1 :ltrl
( "IilIH .I INII/nl~l~t~9, 47r:11 fil I I;1~, ]!!;9
q;;19 ( ~; 9NI HI rr'l I¢ ]~1 M . I,l~:f ITI.;N~ ~ I~1 ~. 9r: ~1,.1~ ~ I/ie;,..~ :,,h * 1,1~ <,. i,
~,,,J6,p!
OI} I'(X)NI]Y. NI,, I([)1'1~1,. ~;A I',.rl,~,lI,~! II, hri~ A :~i.I I~.,..U! ,l/~
])/~NAFII':II, II(I I~:npirl ~..,kir)l! ~.d ~'l(o,nnh.I hn IPn,. ~.r,dili*.:,rio. *,[
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il~V~ll~l~ll~l't~l plin~il~ I~1¸ ~1~1 ll~l~lh~e!~lll ~ll~v~Tili~)rl prrJl~l;unl.
[1~111 ~l~.~,lZ~, i)~lr~.rt{% ~tnl[ 911~,Eri~ lllt(] Lrl (l~'lli~ i~lh, Illl~r~(,[,; i(l~i*,(~ll~
~lll!L~m~.ttr~ l~lrll~l ~]IIIIIITII~ ill qlllll'l" ~r~ ~lt(,ll~lll,rl Ihl,ltl~l,[l~.!~
ly ir~rer(!~ell in ll(,v~l~j~ill~ ~lpE,i:tl jm)(h~lilll~ [i[11~ thM wr~uhl la(iviEl~.
~ ~111~1111~ ~ltll~ e~ily ~tl~l~}~l~llllt, illen~illlll ~llr ~1.~ }~vr,l~lhln
I~/~ ~'t ~1~i~1~ AI~I1, I~1~, ~.ll~,la~ I~Pi~rl)at~ln hi ~h~ 1}l~lq,I
[)l~,~l,rlhl(hm ~.llllltVyell I~y I~;v:ltn~ h;l~ hl,l,n u~e(I ~nl (~rh~.~ ~;I,~irnl
e:ll c()rlllilnlli(~n wa~ I]le li~e Ill ~rllivll ~;lln]lle ~(llh,liilm (~l~l¸ itirl~linl,
I~t~l~ly~i~,l ,~t IIII1~1~11"1~ ~1~" "~a~illily ;~[ st~ll¸ r~l~lyl~ :ll~mll ~m~l~t~i~
~lll~il~t! w~lell ~i!~,1"~11~ w~,l~, itlet'~,/~t,II I~ ~l~i~l ~'~,~lit~ ~1¸
Jm~l[y~i,~ lhl~ll wh{,n i1(}~,
M~A~i~e~ t~l~l ~ ~,l~ I~, 2!}, :l~ ,']7~ ~f .~m[~l 11~ I ~ ~ ~1 ~
~ll~lel~ ~ ~'~' live, ~( her L[~II I~l~ (ilt~, I~ld ~:~111~i~ ~l ~11 ;i ~(';~11~ I~l li~,
h~ ~even ~t lll[('lll~ from ~l Ile~te hy Ilii~Fi ~e h q)l~] recl ~lih.] mid h ~li~n~'~l hi
Inlpl ~ ~l(,Live i1~ Iv<:l[, enq~ll)ylrlg i ~le~ I')l~ly J i1~.1)1¸ rr~i~[llllcl~ {!,r holiqul,~
f r~-:llltll!nt ~chlll)[ (2 pel¢~ll~ } I~l;tll irl [lte i.~iiI r.lll ~lhr~l~l lit !~ I.,r ~:(,Inl I
.~prill~, I(),;I lu~r~'en~ ill fh(~ (!llrlh{l[ c()rl(lili~rl nnll ,r,~l I,.id'rnt in the,
II(,l~enL~ i'e~pcclivel~*~ ~i([ th~!y ha([ ~l~(ll~(,~l ill 1he pl('vil~lt~ wl.~,~
h~!yr~r=(I Lhl! enl[ rlf I h~ plo~r anl,
M~'Ali~ll,r el, ill. I~l, rr.pl~rl nn r,x{en~[~n (1[' Ih(' ~rl~l~l¢inll~ l~rr!w,u,
([~n Inellrlel to pr(~venL l~li:rlll~ll ~rll] irmrljl~:lnrl t,I)ll~l, n~ w(.l[ Thl.l(,
ltiis ii 4.7 [l[,r ('(~11| ir~¢l.p~lHe lllll~ ~l [}[ Ii(~l~(!nL i~(~(~ll*:l~:r, il~ i(,~11J;11¸ r]l¸
e);ll(!ri in{'lll~l[ ~lllll[I illl~ hy {!l~ll lit yl,;ir II IY~orll~ ~¢i~1 h mid ~,vl~ll I h Iu
:L~(~
~ttl(l(!ll~ in (ITe live cond.lO] ~'hr~l>[~ ~]llll ~ive- (,xl;.eritllerll~[ .,;I.~H~I~,
t(~lle¢livl!ly, I"in;l[ly, I~elry q~t ~1, (371 i~llw lel~r~ril!(I ~ ~tn~lr,~hd
i'(.plieatill]l ~f {lie 7th gitllh! (]lni311inff pl~lgr~lnl ~)l¸ ]Illh [~:~(]~,
re[)~r t ~] ~1 pro'coil L (iv[,r~l] I le~[llCLirlLi ill L[IO rllllllher ill" ~(~Fl~l i,illll Iq i)[¸
~lnokil}~ in {h~ ],'l~t week, CiIiiil~ll e(I w[[[i Lift. ~lll~,[ [ i1~ nllllll;~l
~hlhll~(~r] ~lrld Ltnolll~or ~11 till, I hl[*~el~i[y or Mi~l~nl,~lll~t flr!vt.hJ[.~d Jt
~inT~l:u" ~lr{ih~i~ ~n¸ ~Tul)llhl~ in(,v{,rT(~(In ill nlll)[(~!l~l~l~ (/, /,~ !!~1
---
(!llll~t'iltll!liLly. I lllldlllll n~sil[llnll.llL lit" ll~rliCilllllll~ w~l~ no[ lll~'~JJIf',
rlii~hll~ Illll'~lioll~ ~lh~uL wh~lL i~nc' ¢:lil inli:i¸ [iorll uny lllll! ~llldy (HL
.~lri~tl~s ~lll'lllliJl~. Iho llllit lit ~nllly~i~ in Ih~c. ~Ludi~'~ lllil~hl lrl I~
~;l~hli~ll, ~l i~lllt>Li~lil hlll~l~ibilil~ b~l.llil~o ~[ linlile~l d~l'~.c.~ i~"
[ll~l.lllllll ].'l:ly ~1 111. I1~1) ~vc-ro lilll~ Io li~lll nl~lJlillle ~chlll~l~ hi th~
W;lll.ll~lil ll3iillli i~l. (',n~illzil ~lr'~':l. ollrh ~villl n .~ill~l~ ¢]ll~.~i~Olll I~l¸
t~l'illll.. EIi.vi.ii ~e llll{ll:~ %vl~r~ rllnl]llmt'~ il~i~ll~.ll lo ~illl~r [llll~;lltl I~F
~:~lnllol ~lldilillil~ 'i'hl~ ~lrl~ill~#h ~l[ Ihi~ nll!lhollololT~ i~ Ili~ll il
I~iilllL~ llllldlltll li~i~nllll!llL Ill ~l~l~ll~lili~ nnd. npl~rllllrilll~.ly, Ih~
ll~t! I~l¸ Ihl! i~lil~llllllll ll~ Ill~ uni~. ill¸ iiilill~i~. The W~IE.I [llo ]lr~lql nl
~lL ~ll~nf~lill lind M~llilc.~ll;i. ~nllll~inl~-ii!]lll~ll in[orlnnLion i~ ~!llc:il~rl
h~lin ~llllll~ills iiiI]l~!l• ~.hlnl Lllll~ lo III1!111~ Ih~l'~ is II ~l~u~ on ~ii~i~il
illlhll~ll~l!~ ih!~!i~illll lllilllill~ ~1[i11~ iill, lllll~llL~ lind n llllhlic ~onllili~-
nil.ill i~ ~hfilitll!~l. I1~ ~ovl.nlll l!riidl!, llill~'F~ll~:l~ ill ~x[li!l'iln~ll~l]
~lll~ll~ilil~ w~.li, hl.l~illllin~ I~} i!ln~ll~l, bl.l~>~.n ll~.ll{rn~llL ~llll ~ollLro]
will h.lill i~ i~q>i illll!lll ~il ~lllllliJi I filr Ihl! I'~n~i~L~ll~ plllt~rn o1" ~lldillt~
IjhllilIl~ their ~lllldciiL~ IIr~!vi!ltl jIIII ]ll~lj~illln~ WiLh ~bl I~aill idc'lllili~llllI!
I:lllllPllflorlls I:~i?l b~* Sll~'Cl,~Sj/ll ill Pi'(!V~nllrlff l,h~ oll~cL of ~lliol(ifl.~ hI
Hdill[,:~I,l,I I(?c.,
sumnlnry
I .~l~Illllillil,~ll:~ :~lnokinl~ cl~:~,zll h~ll llrlillrlb, i'~l~U]lir U~l~ (~lpllro~i.
~ll Ill,I¸ Ill ~ I ~!i ~l~lll. ~hlrln~ nllr>ll!'~l'l!ll~'e,
I~il~ll:lltililV ill¸ IlliiLthl~ w~l~ I~l!>~il~r ~o~ 111~.~ ~jch~le~nt smllk-
~'l~ lii ~1, illll!r vi~l,II hi I!174 whl~ hlid ~iI. I~il~ ~l~rL~d ~o ill Lon,I
~'llllc,l~l! Ily 1!}7!) Ihiill I'~lr Ihil~/> ~lil~Jlcl!r~ tvhll did noL llll~d
3, ]ll~lb;Ibilily Ill¸ lllliLI hI~ I h!l:r I!ll~l!~; linelil ly ~viLh llllrlllllln ~1" Lh~'
Ill" ~lnllkin~ LII ] 4:] ll~l.c~nl, il~ 7 y ~lil'~.
4. I ~llill ill~ "clll~l ~111 ~c¢~y" lll/ll~lii .'~ IIJ llI~ II Inllf I! ~.r[~.¢ I i./~ cl!~ I
loll
~1 lllh.~y I h~lll trill illl~ dllwll wilhrltlL I rylrlf~ Lo ~; Lllll ~lll,i ~ly,
.~ ~llcll~4 ~il Illlltlill/~ in~i ~il~l!l~ WiLE Lhc~ ntiillbe~r of ~.l~'~Jr iS Illilrll!!
~lllllirl, +j~,~ Pl!rl!l!li[ of .'~llIJit!~lx!llls wli~ k~:llt llyin~ ~w~nlll~llly
,,,ll¢~ct!l,ll~!l[~ w jIb ;ll~lll~. h~llr (If [hI~ ~11~-~.~o.~ ~-cui.l'illl~ ~iNl!l. ~ht.
(i,~lltllllilll~ pfl'vl~lllitlll IIIlll~llllll!i fill' fil,~hllliil, lllli,llllllil,l,~> Ill
I!l,~.~ll(iilll llllll~rlllll~ llillll,d Ill yIJIl(li ~ll~l,l.~i~(lll ill~ll~i:Slll~ Illltl.
ht>l.li llll~l,tl (,11 tl~ i:11 i~ycJl,~J,~lfil.~ll Jill,ill # ~llld i i,~l,ill dl, :llld ;11 i,
lcli~lo] ll:l~d [lt,~lill~ Ililt~l, ~.hlllvii ii +r)l) lll,lt(,lll 411 iiit111,
I I'dlll I iOli ill ~illlllllilil~ Dil ~1'1
7,'rhl, illil~l Illl,l!{,~ftll iiIlll~lllfll~ i'¢l~lt~ lhliF;i, {,lil[lliit!;171111~ Iht,
nl~ilil llllll illlnlt~:lilllo ('llll~ll,,lllt~lll'{,~i fil ~>lilOl{ililf ililhl*r Ihlill
IOlll~-IOlln }ll,;lllh i~Oll~(!fllll~ll(~l,~, 'l'lit:~l~ llilll~l;llll'4 Ii;l~,l, llliil,l,ll
~lil,f i~tl i~illl iIii1~ii~ llll I i,lll h illl( ~lcill~ hi i I.l~ol(fli~illl~ ~illlt i q,r41:~l
ilil(
,~(ic'illl ill ~iil i i,~ tll f4 illlllt ~,
.lJ)JlNS()N, (~ A Ull{e,~kcll z11t*l ~Jl[llll'tlU~ It~IJll]ll[iilli~ lliliJ¢llyillg Pllli,~lllok
IL,dth in )'m~lh N~ YoJ k, Ae~.ic~nic l'r ~, ill l~re~
(211 JOIIN~SI)N, CA, {]IIAIIAM, .IG, IIANSI,~N, W]I. Inh,~aelfi~ ,~Jflbct i,tt
,tl~dtqde Iii~k T~kir,~ ll~I.~v~or, f!qz~;r, tte ,~;.mkO~g, AI, olml IL~e ~lld
A~s~'i~flio~i ,~nnu~l bleefil~g, Nc~wmhcr l~t~1
~:~I Ji)I]i'qSON~ (]A. MIIIIIIAY, J], JACOIkS, D[I., PI,',CIIA(:Eli, TF', II[IIII),
I'.Ih, I,IJI~PI{I~R, IIV. I~j]i~tn o/ AZliturh'~, Nr,r.mtir~, b.~l~,~l.lio~J~ ~tl~d
J~7td
J )ivlz~it iii of Ilc~rc.]l. W,l~}lil~;:~.., ] ) I !, 1979
('~1~ ,II)llN~'l(l~]i LI}., IIACIIMA?4, ,l(;, O'I~IAI,LI~y, I>M Ih.ug~ ,.,d the ('la~s
111ld ~II llru~ ~ lll]~, Divisi~, t,f ] ~t'~:it l'c h, Wil~ hilllll flit, I)(~ 4Alibi I~!I ~T~'.
;15fi l,p, 1979
12~I 3 O/'/I ~";, I! I~, l{ A NOLI,~I~, DI,]. K ~I .I,E "(. I I11, N ISlll,~r I', It I,:., VAI,INS,
~I,
i.,t,~ I III:J,I~EII, llV, MIIItlIAY, ~$M. ,JI)IIN!JLIN, CA, I'I'.I:IIAI'I:I~, T ]~llll
I~ l,lli~l~l{l,:il, [{V., I'EUAIA(!EI{, TI,' MIII{I{Ay, II M, AI~IIN~IIN CA,
l:I21l J~J21, l)~:i't, llll,er l~i~l
I:!#I MeAl.IS I l;Ii, A, l'l,:It IIY, (! IilI,I,EN, ,I, 5r INI~ ALTO. I, A, M ACI'I)IIV. N
t!li; I
i.i,,l i~] l!Itl~ I, II J. (:III.~19 I,~LI., ~'¢ iI , S['l i N i,~, lJ Jl, ] IIIH, J~IAN. W
NI,:Ig~I~N
l:I:II I~IIIOIAy, I)~L, ,I(IlIN,SIiN, CA, I IIl:l,lil:Ii il V, l'i,]l!ll,~('l,:l{ ,rl,,
.i01
IILq~nrtn~.llt r~f II~.lk~l~k l~h~c'nli~11, nJl~l W~lhl~,, ['.hlh~ []q.llltlD ~,~vhl.
~!~ I'l:~ IIAl!l~l, 'J'F r~f~l~r]ralhb~I r~ ~.~b~kl! I~.h~lvl.r. It1: I~TE~,~U,,~,r* II A
ariel w~,rl:~r~. ['uhli~ II~T[II ~.r~ir(~ /~h~ljh~l, I)rl:l! A[~I~;I. nr~ll "~Tl,lllal
I~ll;I I'l!lll( ~. [ ~ L, ll JI,L?:r~. J, ~l.l~ll Ailil. I, ~.. r.l~ALl~['J!ll. A l,. I~,.r (en~
hh~!
Ill~rl~/J ~[~]r~,~.~ iri /~r~l ~l~l J)~l~ I~r~l~l~l~ Vl~lLl~e 3 New ~tk.
,l~*hp~ Wih.*; and ~lll~. J!~T~;, pp I 1'7
II/Ip ~l:~/l:[l!~(l~1 II., ,rl/Wl~rlI, ,I, IIll;I ~,N. A, N/~ITI~I~ p., IIAVllY, J,
I IIl SP[HAI[:III:Ii[I, I! I), ,IA[!OI~ (~ Ii. (I[IANI~. II~, RL[~LI,. ~ ¥ (h~ tile
(10 II ~ [*lJ~l I(! Ill/Al~l'l[ ~l~lIVJl'l¢ Afl~l( I;~,, ~ ~,~,~r~l ~@70. U~ l~l~l~
I,'OG[' TOG9
• i,.~. ,.,~ w~:t~ i ~ll.v,.,i r~rl,~, r .,7 ¢, r~,.
U m ~=~& -, -, T ~- = ,. ,.,.
t~
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