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i'.
r
THE
HEALTH CUNSEQUENCESaF S1iOICING
1975
U. S'. DEPARTTtENT' QF HEALTH, EDUCATION, ANDi WELFARE'
Public Healtth Service
: ,
T'q
"~i~~~s 5,. .. . . . . ..
J
41
PREFt#C E
t
Each year the Public Health Service reviews the scientific data
related to the health consequences of smoking and submits its review
to the Congress. This report, the ninth in the series,, summarizes
: recent research in four major areas: cardiovascullar disease, cancer,
respiratory disease, and the effects of smoking on the nonsmoker who . ;i
shares the environment of those who smoke. t.
11s has been the case with each of the previous reports in the
series, the research summarizedi herein further confirms the relation-
.ships between, cigarette smoking and disease and premature death andl
a
,
~, refines our understanding of the mechanisms underlying these relationships.
. . . . .. ' .. M . ~ .. . . .
Cigarette smoking remains the largest single unnecessary and
~ preventable cause of illness and early death. In the eleven years
since the report of the Advisory Committee to the Surgeon General
in 1964, there has been progress toward reducing this toll. Fillions ~~
of Americans have stopped smoking cigarettes, and millions more have'
°= not taken up smoking. Even for those who continue to smoke, there . t
has been a striking,red'uction in the "'tar" and' nicotine content of'
" cigarettes used by the vast maj,ority. At the same time however
' counter-balancing these gains,, there has been an increase in cigarette
G
1y
To~ eliminate the needles& deaCh, andd disabilityattributa~bleto . ;~'. cigarette smoking, the
Public Health Service remains committed today,
as in the past, to increasing,the knowledge about the health conse- .
quences of smoking and to ed'ucating,the American people as to the
nature and extent of the hazards of smoking. This is a task, not for rti
government alone, but for the great institutions of soci'ety as a wtiole-- ~
the family, the schools, thie healith, care system. Through concerted
effort, 'a climate of respect for our own heal!th, and that of othiers can
be created. Such a climate must certainly be conducive to reducing and art ,4
eventually eliminating, the needless tiurden of disease and premature
death imposed' by cigarette smo~king,.,
a
Theodore Cooper PT.bi. Assistant Secretary for Heal th
June 1975' ~'
Q.J
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iii
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~'f y smoking by' womeni and' young people, especially teen-age g'irls.: . ,
vrj: .- ~.5. ~. . `
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TABLE OF CONTENTS
Page
PREFACEI . . . . . . . . . . . I . . . . . . . .1 . . . . . . iii
TABLE' OE''' CONTE;JTS . . . . . . .i . . . . . . . . . . . . . . v'
PREPARATION OF THE REP©RT AMACKNOWLEDGPiENTS' .....,, vii
INTRODUCTION: Overview--The Hea1th Consequences
of Smoking, . . . . . . . . . . . . . . « . . 3
CHAPTER 1. Cardiovascular Diseases . ., . . . . ., . . 13
CHAPTER 2. Cancer . . . . . . . . . . . . . . . . . . . 45'
CHAPTER 3. Nbn-Neoplastic Bronchopulmonary.
Diseases . . . . . . .. . . .~ . . . . . . . 63'
CHAPTER,4. Involuntary Smoking . . . . . . . . ., . . . 93'.
INDEX . . . . . . . . . . . . . . ... . . . . . . . . . . . . 117
v
PREPARATION~OF THE' REPORT
AND' ACHINOT,Ti,EDGMEP3TS
Previous Reports
Revi'ews~of the scientifi'c evidence linking smoking, to health
effects began in 1964 with, "'Smoking, and' Health. Report of the Advisory
Coanaittee to the Surgeon General of the: Public Health Service,'' or as
subsequently referredito, "'the Surgeon General's Report." After this
report,, Public Law 89-92 was passed requiring supplemental reports to
Congress on this subject. In compSiance,, three reports were submitted:
1. "The: Health, Consequences of Smoking,, A Public Health Service
R'eview : 19'6 7'. "
2. "1'he Health Consequences of Smoking,, 1968 Supplement to the.
196 7PHS I R'ev'iew. "
I. "'The~ Health~~ Consequences~~ of~ Smok~i'ng~~,, 19'69~, Supplement to~ the~
1967'PHS Review."
In April 19'70, Public Law! 91-222' amended'the previous law and
called' for an upd'ated& report on the health effects of smoking no later
than January 1, 19'71, with annuaL report& thereafter. "The Health
Consequences of Smoking,, A Report of the: Surgeon General: 1971" a
comprehensive review, of all the scientific literature available to the
Clea~ringhouseforSmok3n~g and Health, and with emphasis on the most recent.
additions to the literature was that updated report. Since then, the
following annual reports on the health consequences of'smoking have
been submitted:
1., "The Health Consequences of Smoking,, A Report* of the Surgeon
General, 1972. '111
2'. "'The Health Consequences of Smoki'ng,, 19'73'."
3'.. The Health Consequences of Smoking, 1974."
Each: report since -the original "Surgeon General"s Report" as
reviewed'the scientific literature relevant to the assoc3ation between smoking,
and cardiovascular diseases, non-neoplastic bxonchopulmonary diseases, and
cancer. Smoking as related to~the following, diseases and conditions has
been reviewed periodically in the reports: Q
Pregnancyr (1967, ,11969, 1!9'71, 1972, 1973)
Peptic IJlcer Disease (1967, 1971,
Noncancerous Oral Disease (1969) 19'72, 19'73)
vii
Tobacco Amblyopia (1971).
Allergy (1972)
Public Exposure to Air Pollution From Tobacco Smoke (1972)
Harmful Const3:tuent&of' Ci'garetteSmoke (1972)
Pipe and Cigar Smoking (1973)'
Exercise Tolerance (1:9731
The 1975 Report
The present document, "'fihe Health Con"sequences of Smoking, 1975',"
begins with an overview of the health consequences of smoking and'contains
the current data on relationships between smoking and cardiovascular
diseases,, non-neoplastic bronchopulmonary diseases, and, cancer. A
fourth chapter, "Involuntary Smoki'ng,,," reviews, the effects to nonsmokers of
exposure.to smoke-filled environments. Although emphasis is on the latest
additions to the literature, where necessary to, provide the background
or framework, research from earlier years is included.
This report was prepared'by the staff of the National Clearinghouse
for Smoking and Health in thef'ollowingway:
1!. The Technical Information Center of the Clearinghouse continually
monitors and collects the scientific literature on the health
consequences of smoking through several establishedd mechanisms:
a., An information science corporation is~on contract to: extract
articles on smoking and health from the scientific literature
of the world.
b. The National Library of Medicine,, through the MEDLARS':system,
provi!d'esa: month~lylistiing ofarticlesl on smoking and health.,
Articles not provided by the information science corporation
are ordered.
c. Staff members review current medical literature and identify
perti'nent articles.
03%4d3g
2. The literature was reviewed by the Medical Staff Director who
wrote, f irst draf ts for this report. These draf ts were sent to:
reviewers for criticism andi comment regarding the format,, the
appropriateness of the articles selected'for discussion, and the
Vi:ii
conclusions. The final drafts of the total report were reviewed
by the Director of' the National Clearinghouse for Smoking and
Health, the Director of the National Cancer Institute, the
Director of the National Institute of Environmental Health Services,,
the Director of the National Heart and Lung Institute, and by
additional experts both inside and outside the Public H'ealth Service
ACKNOWLEDGr1ENTS'.
The National Clearinghouse for Sznoking and Health, Daniel Horn,, Phl.D'.,,
Director, and Charles A. Al'thafer,, Acting, Director, is responsible for the
preparation of this report. Medical Staff Director for the report was
David' M. Burns, MI.D. Consulting editors were Elvin E., Adams,, M.D.,
Daniel P. Asnes, M.D., John H. Holbrook, M'.D. Paull Schneiderman, M.D'..,
and H. Stephen Williams,, M.D. Technical Editor was Priscilla B:. Holman,
and Technical Information Officer responsible for the literature collection
was Donald!R. Shopland.
The professional staff has had the assistance and advice of the
followi'ng experts in the scientific and technical fields whose contributions
are gratefully acknowl!edged.
Reviewers
ANDERSON, William H,., M'.D.,--Chief, Section of Respiratory and Environmental
Medicine, University of Louisville Louisville, Ky.
AL1ER'BACH,Qscar,M.D.--Senior~ MedicalInvestigator,, VeteransAdtninistration
Hospital, East Orange,,N.J.
BOCK,, Fred G., Ph.Dl.--Director, Orchard'P'ark Laboratories, Roswell Park
Memorial Institute,, Orchard Park N.Y.
BOREN, Hollis G., M.,D'.--Assistant Director of the Medical Center and
Associate Dean of the College of Medicine, University of South
Florida, Tampa, Fla.
FALK, Hans L., Ph.Dl., Associate Director for Programl National'Institute
o Environmental Health Sciences, Research Triangle Park, N.C.
FERRIS, Benjamin G., Jr.,, M.D.--Prof essor of' Environmental Health and
Safety School of Public Health, Harvardl Umiversity, Boston, Mass.
GOLDSMITH,: John R., M.Dl.--Medical Epid'emiologist,, Epidemiological a
Studies Laboratory, California State Department of Health, GJ
Berkeley, Calif.,
~
HIGGINS, I'an T. T., M'.D.--Professor of Epidemiology, School of Public 11
'Health, University of' Michigan, Ann Arbor, Mich. ~
ix
r
HOFFM'ANNi, Di'etrich, Ph. D'.--Member,, and' Chief, Division of Environmental
Carcinogenesis, Naylor Dana Institute for Dfisease Preventioni, American
HealthFoundation, Valhalla!,;. N.Y'.
KELLER, Andrew Z., D.M.D.--Chief, Research in Geographic Epidemiology
Medical Research Service, Veterans Administration Central 0!ffice,,
Washington, D.C.
CP
Diseases, Kettering Medical Center, Kettering, Ohio.
OLZ, Richard A. ,, M.D.--Medical Director, Institute of Respiratory
LENFANT,~ Claude Ji., M~-,, M!.D~~., --Associate Director for~ Lun& Programs,
National Heart and' Lung~, Institu~~te,, National Insti~tutes~~ of~Health~,
Bethesda, Md.
MacMAHON Brian, M.D.--Professor, Department of Epidemiology,, School
of Public Health,, Harvard University, Boston,,, Mass..
McMILLAN, Gardner,, C., M!.D.--Associate Director, Associate Director for
Etiology of Artheriosclerosis and Hypertension, National Heart and
Lung Institute National Institutes of Health,, Bethesda, Md.
NETTESHETM, Paul, M.D.--Gtoup Leader, Respiratory Carcinogenesis Group,.
Biology Division, Oak Ridge National Laboratory, Oak Ridge!, Tenn.
PAFFENBARGER, Ralph S'.,, Jr., Mi.D.--Epid'emi'ologist,, Resource for Cancer
Epidemiology, California State Department of Health, Berkeley, Calif.
PETTY, Thomas L.,, M.D.-Professor of Medicine,, and Head, Division of'
Pulmonary Diseases,, University of Colorado Medical Center, Denver, Colo.
RALL, David P., M.D.--Di'rector,, NationaT Institute of Environmental Health
Sciences,, National Institutes of Health, Research Triangle Park, N.C.
RAUSCHER, Frank Ji., M.D.--Director, National Cancer Institute, National
Institutes of Health, B'ethesda, Md,.
RENZETTI, Attili'o D. Jr., M.D.--Professor of Medicine, and Head,
Pulmonary Disease Division, University of Utah Medical Center,
Salt Lake City, Utah
RINGLER, Robert L., Ph.D'. Acting Director, National Heart and Lung
Institute, National Institutes of Hlealt'h Bethesda, Md.
SAFFIpTTI Umberto,,rL.D.--Associate Director for Carcinogenesis,, National ~
Cancer Institute, Nationall Institutes of health,, Bethesda,, Md. ~
SCHMELT7. In-7in Ph.I?.--Associate Member and Head', Section of Bio- `~
~
organic Chemistry,, Division of Environmental Carcinogenesis, Naylor &J
Dana, Institute for Disease Prevention, American Health Foundati'on,
u'alhalla,, N.Y, Q''
x
SCflUK#.N, Leonard M'.,, M.D.--Professor andi Director, Division of Epidemiology
School of Public Health, University of Minnesota, Minneapolis, Minn.
SN']hfKZN, Michael B'. M.D.--Professor of' Community Medicine and Oncology,
School of Medicine, University of Cali'fornia, La J'olla, Ca1if..
NYNDER', Ernst L., MI.D'..--President and Medical Director,, Americani Health.
Foundation,, New York,, N.Y'.
Special assistance for the Card'iovascul!ar Chapter was provided by
JENNZNGS, Michael, M'.D., Medical Epidemiologi'st, OMio Department of Health,
Columlius, 0'hhio:, and
MAN'NING, Kathleen, Mi.,, R.N., Department of Staff Development,, Boston City!
Hospital, Bostoni,, Mass.
The ffollowizLg staff inembers of the Center for Disease Control a1so,
contributed to the preparation of this report: Bureau of Training,-
Jmlia M. Fuller, Winthrop N'. Davey, M.D. ,, and Seth N., Leibler Ed.D. ;National Clearinghouse
for Smoking and Health - Nancy M'. Johnston and
Sanda Lager.
®
xi
