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The Health Consequences of Smoking A Public Health Service Review] 670000
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03'764;'J'3 .
Ne,
The-Health
-
Con.seq ; uences
of SMOKING
A PUBLIC HEALTH SERVICE REVIEW : 1967
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U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service
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Foreword
The Federal Cigarette Labeling and Advertising Act of 1965 (Pub-
lic Law 89-92) requires that the Secretary of Health, Education, and
Welfare submit regular reports to the Congress on the health conse-
quences of smoking, together with any legislative recommendations
he may wish to make.
This 1967 Surgeon General's Report was prepared to provide the
Secretary and the public with a review of the research findings which
have taken place in smoking and health in the approximately 3% years
which have elapsed since the Surgeon General's Advisory Committee
issued its monumental 1964 report. Part I of this document was in-
cluded as part of the Secretary's 1967 Report which he sent to Congress
in July 1967. Part II, which provides detailed discussions of the re-
lationship of smoking to specific diseases, is issued here for the first
time.
The 1967 report represents a review of more than 2,000 research
studies published since the 1964 report. These additional studies con-
firm and strengthen the conclusion of the Surgeon General's Advisory
Committee that: "Cigarette smoking is a health hazard of sufficient
importance in the United States to warrant appropriate remedial
action." '
In a separate section of this report, acknowledgments have been
made for the help of numerous scientists both within and outside the
Public Health Service, who participated in the preparation of this
report. These include the 10 distinguished scientists who made up the
Surgeon General's 1964 Advisory Committee, all of whom were kind
enough to review part I of the 1967 report before its publication. A
special word of thanks is due Leonard M. Schuman, M.D., one of the
1964 committee members, who advised the staff in the final editing of
the entire document.
4.Gl.fl~ebs.~/ /'AWihl.J
SURGEON GENERAL.
yr ,
0:.
;y:
Table of Contents
Page
Part I. Current Information on the Health Consequences of
Smoking-----------------=---------------------
1
Introduction--------------------------------- 3
Smoking and Overall Mortality---------------- 7
Some General Considerations-------------- 11
Smoking and Overall Morbidity---------------- 19
Smoking and Cardiovascular Diseases----------- 25
Smoking and Chronic Bronchopulmonary Dis-
eases (Non-neoplastic)----------------------
29
Smoking and Cancer-------------------------- 33
Other Conditions and Areas of Research-------- 39
Cited References----------------------------- 41
If. Technical Reports on the Relationship of Smoking to
Specific Disease Categories----------------------
43
Chapter 1. Smoking and Cardiovascular Diseases- 45
2. Smoking and Chronic Bronchopul-
monary Diseases (Non-neoplastic)-
87
3. Smoking and Cancer--------------- 125
4. Other Conditions and Areas of Re-
- search--------------------------
179
,:
0
r
PART 1
Current Information on the
Health Consequences of
Smoking
x
ZE
TABLE 2.-Changes in the lung cancer death rate in male British phy-
sicians (age 36-84) compared roitkh cAanges in the rates for the male
populatian of England and Wales for 3 time intervals between 1954
and 1964 (7)
ta,g ~ aean..a. Pr I,ooo
Tlma pslud pff~
Nenin B
and W Btltllh
PhyeldW
1954 to 1957----------------°--°___°________ 1.49 1.09
1958 to 1961________________________ 1.71 .83
1962 to 1964----------------------------------- 1.86 .76
Percentage change:
1st to 2nd period---------------------------
}15
-24
2nd to 3rd period--------------------------- +9 -8
lstto 3rd period---------------------------- t 25 -30
. . . . .. . , . .. , .~-~ .. .:hai
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Acknowledgments l
,~ . .:
Responsible for the preparation of this report was the National
Clearinghouse for Smoking and Health, Daniel Horn, Ph. D., director.
Staff director for this report was Albert C. Kolbye, Jr., M.D., M.P.H.,
LL.B. . .
The professional staff has had the assistance and advice of a number
of experts in the scientific and technical fields in and outside govern-
ment. The staff gratefully acknowledges their contributions, often
made at considerable sacrifice of time from their own professional
duties. Although space does not permit a listing of all those who have
participated in this project, the staff wishes to express appreciation
for their cooperation and help. Special thanks are due the following:
Aanrsarr, P~ms B., D.V.M., PH. D.-Ch1ef, Virology and Bickettatology
Branch, Extramural Program, National Institute of Allergy and Infectioue
Dtaasasm, National Institutes of Health, Bethesda, Md. .
Auge, Bauce N., )1i.D.-Laboratory of Molecular Biology, National Institutes
of Health. Bethesda, Md. . . . . . . .
AasaD, WaarsM P., M.D.-Medical conaultant, Stroke Section, Heart Disease
Control Progiam, National Center for Chronic Disease Control, U.S.P.H.S.,
Arlington, Va.
Aorsasoa, Oacsa, M.D.-Senlor medical inrestigator, Veterans Administration
Hospital, East Orange, N.J. , , . .
A'^=^^, Dsvm, M.D.-Medlcal consultant, Laboratory of Biology of Viruses,
National Institutes of Health, Bethesda, Md. .
A:ars, S~Haa M., M.D.-Director, Cardiopulmonary Laboratory, Saint V_in-
cent'e Hospital and Medical Center of New York, New York, N.Y. .. .
A~, Wa.r.rex B., M-D.-Medical officer, Heart Disease Control Program, :Qa-
tional Center for Chronic Disease Control, U.S.P.H.S., Arlington, Va. Bstuttoca, Joax J., M.D.-Head,
Department of Otolaryngology, Evanston Hos-
pital, Evanston, ID. .
BLSSnore, Henaz, W., M.D.-Chief, National Inatitute of Neurological Diseases
and Blindness, Perinatal Research Branch, National Institutes of Health,
Bethesda, Md.
B®u, Goaoos W.-$tatietician, Operational Studies Section, Cancer Control Pro-
gram, National Center for Chronic Disease Control, U.S.P.H.B., Arlington, Va.
Bast.rasa, Boacax, M.D.-Director, Office of Director of Research, National Heart
Institute, National Institutea of Health, Bethesda, Md. . ,
Blao, BlcaeeD J., M.D.-Profeseo; and chairman, Department of Medicine,
Wayne State University, Detroit, Micb. . . _..
Busa, Sruena B., M.D.-Medlcal consultant, Heart Disease Control Program,
National Center for Chronic Disease Control, U.S.P.H.S., Arlington, Va. .
.. ..;J.: -4 .... . . :....... -I: '~'.tL>fi . .
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03764805
