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Smoking & Health - Part 1 of 9
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Related Documents:- 03685621-5775 Smoking & Health - Part 2 of 9
- 03685776-5930 Smoking & Health - Part 3 of 9
- 03685931-6085 Smoking & Health - Part 4 of 9
- 03686086-6240 Smoking & Health - Part 5 of 9
- 03686241-6395 Smoking & Health - Part 6 of 9
- 03686396-6550 Smoking & Health - Part 7 of 9
- 03686551-6705 Smoking & Health - Part 8 of 9
- 03686706-6854 Smoking & Health - Part 9 of 9
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I
cant relation between childt-ens" respiratory illhess and parental
smoking, (Chapter 11). Childrens' cigarette smoking habits are strongly
influenced by the smoking, habit's of family members and peers
(Chapters 17 and 18).
Minorities
The health consequences of cigarette smoking in minorities may be
particularly severe, yet little is knowni about these health consequences
at present. Survey data: indicate that the prevalence of cigarette
smoking among blacks exceeds that of whites (Appendix). Lung cancer
death rates among blacks exceed those of whites (Chapter 5). The
effects of maternal smoking on fetall development and infant healthi
may be especially significant among minority mothers with other risk
factors for complication of pregnancy (Chapter 8). Nonwhite workers
in industrial settings may be particularly susceptible to the combined
effects of cigarette smoking and occupational exposure to toxic agents
(Chapters 5 and'7).
Smoking and Occupational Exposure
In every race, sex, and age group;, blue-collar workers are especially
susceptible to the combined effect&of cigarette smoking and exposure
to toxic industrial agents (Chapter 7). Fumes from fluorocarbon
polymers are decomposed by the heat of burning cigarettes (Chapter
7); These and: other chemicals contaminate cigarettes, which are then
smoked (Chapter 7). Cigarette smoke contains many of the same
chemicals found to be workplace toxins, such as hydrogen cyanide and
carbon monoxide (Chapter 7). Exposure to coal dust, cotton dust,,
chlorine, and~ radiation combine additively with cigarette smoke to
produce lung damage (Chapters 6 and 7). Cigarette smoking acts
synergistically with exposure to asbestos to produce lung, cancer
(Chapters 5 and 7). Other documented examples of synergistic action
include rubber fumes; dust, and radiation from uranium mining
(Chapter 7). Studies have shown that cigarette smoking contributes t'oo
accidents in the workplace (Chapter 7).
Cigarette Smoking Behavior
The design of policy depends not only on our ability to identify high-
risk groups but also on our understanding of differences in the
cigarette-smoking behavior of these individuals. As numerous refer-
ences in Chapters 15-21 and the Appendix emphasize, there are serious
gaps in our understanding of the initiation of the smoking habit, the
nature of cigarette dependence and withdrawal, and the cessation of
smoking. Yet to designi and implement effective policies, we must
know how various target groups differ in each of these dimensions.
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numerous, as yet unid'ent'ified, dangerous substances remaining
(Chapter 14).
In addition to "tar" and nicotine, cigarette smoke contains a gaseous
phase with numerous components such as hydrogen cyanide, volatile
aromatic hydrocarbons, and carbon monoxide. Carbon monoxide, in
lparticular, has been identified throughout this report as a possible
crit~ical factor in coronary heart disease, atherosclerosis and sudden
death, occupationally related illness, chronic respiratory disease, fetal
gmowth retardationy and the noxious effect's of passive smoking
('Chapters 4, 6, 7, S; and 11). At present, we do not have standard,
reproducible measurements of the delivery of carbon monoxide in~ all
U.S. cigarettes. Yet, some published studies suggest that some
allegedly less harmfut cigarettes may have higher concentrations of
carbon monoxide. In Great Britain, the carbon monoxide delivery of
certain filter cigarettes exceeded that of other nonfilter cigarettes
(Chapter 14)'.
There is substantial experimental evidence, and some supporting
data from retrospective studies, that cigarettes with, reduced "tar" and
nicotine delivery should in principle have reduced risks of health
hazard (Chapters 2, 4 and 5). H'owever, there is only one single
controlled prospective study, quoted numerous times throughout this
report, of the effect of "tar" and nicotine content on mortality rates.
Such a study has not been repeated. The risks of overall mortality and
specific mortality from lung cancer and coronary heart disease were
lower in those smoking lower "tar" and nicotine cigarettes than in
those smoking higher "tar" and nicotine cigarettes. But the risks for
low "tar" and nicotine cigarette smokers were still significantly higher
than in nonsmokers. This study did not evaluate the risk of mortality
from other causes,,such as chronic obstructive lung disease. It does not
establish that low "tar" and nicotine cigarettes diminish the effect of
smoking on the unborn fetus or the developing child. Moreover, the
period of observation in this study was 1960 to 1972. Cigarettes
regarded as low in "tar" and nicotine during this time do not represent
current products. This study does not establish that currently available
low "tar" and nicotine cigarettes are necessarily less hazard'ous.
The "tar" and nicotine content of cigarettes is measured by
machines which smoke cigarettes according to a predetermined puff
rate, butt length, duration of puff, and volume of puff. An individual
smoker does not necessarily consume cigarettes in this standardized
manner. It is possible for a lbw "tar" and nicotine smoker to inhale in
one day much more of these constituents than ai smoker of cigarettes
with higher "tar" andl nicotine content. Some studies suggest that
individuals who smoke low "tar" and nicotine cigarettes may inhale
more deeply or smoke the cigarette further down to the butt to
compensate: fort'helowerconcentration of nicotine (Appendix). In
other experiments, individuals giiven low "tar" and nicotine cigarettes
xiu
Lung, and' Blood Institute, National Institutes of Health, Bethesda
Maryland.
Chapter 7.-Inte-raetion Between Smoking, and Occupational' Expo-
sures.
National Institute for Occupational Safety and' Health.
Jean G. Frenchy Dr. P.H., Health Scientist, National Institute for
Ocaupationall Safety and Health, Rockville, Maryland; Harvey P.
Stein, PhLD., Senior Chemist, National Institute for Occupational
Safety and Health, Rockville, Maryland; William J. McKay, M.D.,
Medical Officer, National Institute for Occupational Safety and
Health, Morgantowns West Virginia; Bruce E. Albright, M.D.,
Med'acali Officer, National Institute for Occupational Safety and
Health, Cincinnati, Ohio; George E. Casey, M.D., Medical Officer,
Nationall Institute for Occupational Safety and Health, R.ockville,.
Maryland; and C: Ilana Howarth, M.S., National Institute for
Occupational Safety and Health, Rockville, Maryland:
Chapter 8:-Pregnancyand Infant Health..
National Institute of Child Health and Human~Development.
Eileen G. Hasselmeyer, Ph.D., R.N., Chief, Pregnancy and Infancy
Branch, Center for Research for Mothers and Children, National
Institute of Child Health and Human Development, National
Institutes of Health, Bethesda, Maryland; Mary B. Meyer, M. Se.,
Associate Professor of Epidemiology, Johns Hopkins University
School~ of Hygiene and Public Health, Baltimore, Maryland;
Charlotte Catz, M.D., Pediatric Medical Officer, Pregnancy and
Infancy Branch, Center for Research for Mothers and Childten,
National Institute of Child Health and Human Development',.
National Institutes of H'ealthy Bethesda, Maryland; and Lawrence
D. Longo, M.D., Professor of Physiology and Obstetrics and
CivnFa~.tllnm~
increase the number of cigarettes they smoke. In this respect, there is
little epidemiological information concerning the: trade+off between
smoking a few higher "tar" cigarettes and smoking many lower "tar"
cigarettes, A few long-term follow-up studies suggest that many
smokers who voluntarily switch to low "tar" cigarettes may not
increase their frequency of cigarette consumption. The interpretation
the hazards associated with smoking is to quit.
no cigarettes at all, an6 that the single most effective way to reduce
hazards very much higher than would be encountered if they smoked
be cautioned that even the lowest yield of cigarettes presents health
more cigarettes or inhaling more deeply. And most of all, they should
monoxide. They should be warned'. that, in~ shift'ing to a less hazardous
cigarette, they may in fact increase their hazard if they begin smoking
available) levels of'other tobacco:smoke constituents, including carbon
levels of "tar" and nicotine but also (when the information becomes
caveats are in order: Consumers should! be advised to consider not only
however, that in presenting this information to the public three
Unti1 these scientific and behavioral issues are resolved, there can~be
no final assessment of the public healthi benefits of our present search
for less hazardous cigarettes. The preponderance of scientific evidence
continues, as ini 1966, to suggest that cigarettes with lower "tar" and
nicotine are less hazardous. It has become clear ini the years since,
undisclosed additives are themselves harmless.
proprietary matter. 1Wevertheless we do not know whether these
Finally, the successful marketing of these lbw "tar" and nicotine
cigarettes has require& the additioni of numerous flavor additives. The
nature and~ composition of these additives is to some extent a
habituated to cigarettes (Appendix).
has made it easier for our youth to experiment with and later become
the lowering of "tar" an& nicotine in cigarettes over the past 20 years
there is no conclusive evidence on this point, we need to know whether
cigarette consumption of potential new smokers (Appendix). Although
only to changes in the habits of current smokers, but also to the
The effect of a decrease in "tar" and nicotine content applies not
to a lower'"tar" cigarette.
of the motives and circumstances of an individual's decision to switch
of these studies is complicated, however, by our lack of understanding
Public Policy
The decision to smoke is a personal decision, but once this is said, it
remains unquestionably the responsibility of health officials to insure
that smokers and potential smokers are adequately informed of the
hazards. This is especially true in a society where hundreds of millions
of dollars are spent each year promoting cigarettes and where these
xiv
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sen
I
ACKNOWLEDGEMENTS
This report was prepared by agencies of the U.S. Department of
H'ealth, Education, and Welfare under the general editorship of the.
Office on Smoking and Health John M. Pinney, Director. These
agencies have asked that individual authors be listed, and this is
accomplished below.
Chapter 1.-i'ntradu,cti,on and Suman~aa-y:.
Office on Srnoking,and HealthL
Leonard M. Schuman, M.D., Professor and Director, Division~ of
Epidemiology, University of Minnesota, Minneapolis, Minnesota.
Chapter 2.-Mortality:
Center for Disease Control.
Elvin E. Adams, M.D.,, M.P.H., Practicing Internal Medicine, Fort
W orth, Texas.
Chapter 3.-Morbidit,y.
National Center forHealth~ Statistics.
Ronald W. Wilson, M.A., Chief, Health Status and Demographic
Analysis Branch, Division of Analysis, Nationall Center for Health
Statistics, Hyattsville, Maryland.
Chapter 4.-Cardiovascular Diseases.
N'ationall Heart, Lung, and Blood Institute.
G.C. McMillan, M.D., Ph.D:, Associate Director for Etiology of
Arteriosclerosis and Hypertension, Division of Vascular Diseases,
National Heart, Lung, and~ Blood Institute, National Institutes of
Health, BethesdaMaryland.
Chapter 5.-Cancer.
National Cancer Institute.
Chapter 6.-Non-Neoplastic Bronchapulmonary Diseases.
National HeartLung,,and Blood Institute.
Richard A. Bordow, M.D., Associate Research Physiologist, Universi-
ty of California at San Diego, San Diego, California; Claude J.M.
Lenfant, M.D., Director, Division of Lung Disease, National Heart,
Lung, and Blood Institute, National Institutes of Healthj Bethesda,
Maryland;, Sylvia Frank, Ph.D:, Consultant to Division of Lung
Disease, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Maryland; Malvina Schweizer, Ph.D.,
Assistant to the Director, Division of LungDisease National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda,
Maryland; and Suzanne S: Hurd, Ph.D., Associate Director for
Planning and~ Evaluation, Divisiomof Lung Disease, Nationali Heart,.
Leonard S. Baker,, Expert, Office on Smoking and~ Health, RockvilUe,
Marylandi
Sandra: J. Brenman, Secretary, Office on Smoking and Health,
Rockville, Marylandl
Betty L. Budd, Secretary, Office on Smoking and Health, Rockville,
Maryland.
Harold E. Dahlgren, Editor, Informatics Incorporated, Rockville,
Maryland.
Lawrence Deyton, Public Health Anallyst, Office of the Assistant
Secretary for Health, Roekville, Maryland.
Ervin S. Duggan, Special Assistant to the Secretary, Office of the
Secretary, U.S. Department of Health, Education, and Welfare,
Washington, D:C:
Steve Fairbairn, Applications Manager, IPSD, Informatics Incorpo-
rated, Riverdale, Maryland.
Patricia B. Healy, Clerk, Office on Smoking, and Health, Rockville,
Maryland.
Jerry M. Hershovitz, Public Healthi Advisor, Environmental Health
Services Division, Bureau of State Services, Center for Disease
Control, Atlanta, Georgia.
Keith L. Hewitt, Editor, Informatics Incorporated, Rockville;
Maryland.
James W. Hicks, Chief, Technical Assistance Branch, Bureau of
Smallpox Eradication, Center for Disease Controi, Atlanta, Georgia.
Molly H'oary Data Entry Manager, IPSD, Informatics Incorporated,
Riverdale, Maryland.
Robert S. Hutchings, Associate Director for Health Information,
Office on Smoking and Health, Rockville, Maryland.
Bee B. Kafka, Administrative Officer, Office on Smoking and
Health, Rockville, Maryland.
Robert J. Kingon, Chief, Epidemiology and Program Studies
Section, Venereal' Disease Control Division, Bureau of State
Services, Center for Disease Control, At'lanta, Georgia.
Myra E. Kleinman, Clerk-Typist, Office on Smoking and Health,
Rockville, Maryland.
Elizabeth L. Lillie; Librarian, Iinformatics Incorporated's Rockville,
Maryland.
Ingrid B. Meyer, Manager, Biomedical Information, Informatics
Incorporated, Rockville, Maryland.
Franklin R. Miller, Public Health Advisor, Venereal Disease Control
Division, Bureau of State Services, Center for Disease Control,
AtlantaGeorgia..
Laura A. Miller, Special Assistant to the Secretary, Office of the.
Secretary, U.S. Department of Health, Education and Welfare,
Washington, D.C.
xxvil
1. INTRODUCTION AND SUMMARY.
Office on Srrnoking and Health
Ruth Behrens, Director, Center for Health Promotion, American
Hospital Association, Chicago, Illinois.
Richard A. Bordow, M.D., Associate Research Physiologist, Universi-
ty of California San Diego Medical Schools San Diego, California.
Lester Breslow, MLD., M.P.H., Dean, School of Public Health,
University of California at Los Angeles, Los Angeles, CaliforniaL
David M. Burns, M.D., Pulmonary Division,, University of California
at San Diego, San Diego, California.
Dee Burton, Ph.D., Director of Intervention, American H'ealth
Foundations New York, New York.
Thomas C. Chalmers, M.D., President and Dean, Mount Sinai
Medlcal'Center, New York, New York.
Paul Cleary, M.A., Research Associate, Department of Sociology,
University of Wisconsin, Madison, Wisconsin.
Sheldon Gl Cohen, M.D., Director, Immunology, Allergic and
Immunologic Diseases Program, National Institute of Allergy and
Infectious Disease, National Institutes of H'ealth4 Bethesd'a Mary-
land.
Theodore Cooper, M.D., Dean, Cornell University Medical College,
New York, New York.
Lester Curtiny Ph.D., Statistician National', Center for Health
Statistics, Hyattsville, Maryland.
Roy L. Davis, Director, Community Program Development Division,
Bureau of Health Education, Center For Disease Control~ Atlanta,
Georgia.
Robert M. Donaldson, Jr., M.D., Professor and Vice-Chairman,
Department of Internal Medicine, Yale University, New Haven;
Connecticut.
Joseph T. Doyle; M.D., Department of Medicine, The Albany Medicall
College of Union Universiity, Albany, New York.
Jeani G. French, Dr. P.H., Health Scientist, National Institute for
Occupational Safety and Health, Rockville, Maryland.
Gerald Ji. Gleich, M.D., Research Laboratory for Allergic Diseases,
Mayo Clinic, Rochester, Minnesota.
Robert S. Gordon, Jr., M.D., Special Assistant to the Director,
National Iinstitutes of Health, Bethesda, Maryland.
Vincent Garnell, PhLD., H'ealith Education Consultant Department
of Education, State of South Carolina, Columbia South, Carolina.
Dorothy E. Greeny Ph.D., Consulting Research Psychologist, Arling-
ton, Virginia.
Morton L. Grossman, M.D. Ph.D., Director, Center for Ulcer
Researchi and Education, Veterans Administration Wadsworth
Hospital Center, University° of California Los Angeles School of
Medicine, Los Angeles, California.
~
1S,. Psychosocial Influences on Cigarette Smoking.
National Iinst'itute on Drug Abuse
1!9. Modification of Smoking Behavior.
Nationall Institute on Drug, Abuse
PART I I I
EDUCATION AND PREVENTION
''4~ Youth Education.\ ational Institute of Education
21. Adult Education~
Office of Education
22. The Role of Health Care Provid'ers.
Center for Disease Control
M The Role of Educators.
Office of Education
Appendix: Cigarette Smoking in the United States, 1950-
1978.
Office on Smoking and Health
Index
