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03764963

The Health Consequences af SMaKING 1969 SUPPLEMENT TO THE 1967 IPbbllic Health Service Review: IIT.S! DEPARTMENT OF~ HEALTH, EDUCATION, ANDI WELFARE Public Health Service

1''969 ' Supplement to Nblic ~~ Health~ Service Fahii'catiOn No. 1696-B' Library of Congress Catalog No. 68-60025 For sale by the Superlntendentof'Doeumenta, iT 8., (lovernment Printing Offiee Weshington, D.C. 2M02- Brice 50 cents

I Foreword This is the third report required by Section 5(d) (1), of'the Federal Cigarette Labeling and Advertising Act, whi& directs: the Secretary ofI-feaTt~H, Education,, and Wellfaret'osubmit annual reports~to, the Cmngress on the health consequences of' smoking. The preced'ing two reports were The Health Consequences of b'7naking, A Publ'ie Health Service Review: 1967 and The Health C'ov-sequenceso f S7noking,1968 Supplement to the 1967 Publi.c Health Service Review. The present Supplement was submitted ta the Congress on July 29;. 1969. iii

Acknowledgments The National Clearinghouse for Smoking and Health, Daniel Horn,, f'h. D:, Director, was responsible for the preparation of this report; Albert C. Kolbye, Jn., M.D., M.P'.H., LL.B'., was consulting editor. Stafiff director for the report was Daniel P. Asnes, M.D: The professional staff has had the assistance and advice of a number of experts in the scientific and technical fields, both in: and outside of' the Gouernment. Their contributions are gratefully acknowl'edgedSpecial thanks are due the 1ollowing : ANDERSON, WILLIAM H.,, M.D.-Associate professor of medicine, University of Louisville, School of'Med'icine, Louisville, Ky. AUEasaeH,, OSCAR, M.D: Seni,or medical investigator, Veterans Admini'strationi Hospital, Eastl Orange,, N.J. AviAno, Do:arrrco M., MLD:-Professor of pharmacology, Department of Pharma- cology, School of' Medicine,,University of Pennsylvania, Phiiadelphia, Pa. ArnEs, STEPHEN M., M.D: Director, Cardiopulmonary Laboratory, Saint Vin- cent's Hospital and Medical Center of' New York, New York, N.Y. BATES, DAVID V:, MLD:-Chairman, Department of'Physiology, McGill University, Montreal„Quebec, Canada. BErsEr, SAMUEL, M.D.-Director,, Division of Cardiology, Philadelphia General Hospital„Philadelphia, Pa. BiNG, RICHARD J., M.D:-Professor and chairman, Department of Medicine,, Wayne State University, Detroit, Mich. BLOnsqursT, EowARn T., MID.-Chief, Chronic Respiratory Disease Control Pro- gram,, Health Services and Mental Health Administration, US1P.H.S,, Arling- t'on, Va. BocK, FaEn G., Ph. D;.-Director, Orchard' Park Laboratories, Roswell Park Memorial Institnte, Orchard Park, N,Y. BoaErrs Hor,Lis, M.D:-Chief of pulmonary disease, Professor of medicine, Mar- quette School of'Medicine, Wood VA Center, Milwaukee, Wis. BOUTWELL, RoswEr.L K., 113 D.-Professor of oncology, McArdle Laboratory for Cancer Research, University of Wisconsin„Madison, Wis. CooPEa, THEODORE, M.D.-Director, National Heart Instithrte; Nationall Institutes of Health~ Bethesda, Md. CORNFIELD, JaxomF_-Biostatistics Project, Bethesda, Md. DE LA PUENTE, JosErH-Chief,,Program Studies Section, Kidney'Disease Control Program,, Health Services and, Mental Health Adminilstration, U.SJP.H.S.,, Arlington, VaL EASTMAN, NiCHOrsox J'.,,113'.D. Professor emeritus of obstetrics, Johns Hopkins Hospit'al, Ba1t'imore,,Md. ELIOT, ROBERT S., M.D.-Associate professor of medicine, Diwisioni of'Cgrdiology, College of Mediicine, University of Florida, Gaanesville,, Fla. i~l

EiwnrcoTT,, KENNETH M., M.D.-Director, Nationall Cancer Institute, National In- stitutes of Health; Bethesda,,Md. EPSTErN, FREDERICH H., M.D. Professor of epidemiology, Department of' Eppi- demiology, University of Michigan, Schooli of Public Health„Ann Arbor, Mich. FArK,, HA:vs L., Ph. D:-Associate director f'or laboratory Tesearch; Nat'ional. I'nstitute of Environmental Healt& Sciences, Research Triangle Park, N.C. FERRZS, BENJAMrN G., Jr.,, .1f.D.-Professor, Department of Physiology. Harvard Schoollof Public Heaith+ Harvard University, Bost'on, Mass. Fox, SaaiLEr: M:, HI,, ltl'.Ds-Chief,, Heart Disease and Stroke Control Program„ Health Services andi MentaI Health Administration, U.S.P:H.S!., Arlington,,Va. FRAZiER, ToDD M.-Assistant director, Hlarvard Center for Community Health and Medical Care, Harvard School ofPiiblicHPalth, Bocton; Mass. H'ASS, GEORCE M., 3i.D:.-Chairman, Di',vision of' Pathology, Presbyterian-St. Luke's Hospital. Chicago, 111. , HIGaINS, IAN T. T., MLD;, M.R:C.P.-Professor,, Department of' Epidemiology, University of Michigan, School of Public Health, Ann Arbor, Mich. HoFTbtANN, DrETRrCH, Phi D.-Associate member, Environmental Carcinogenesis, S'lban-Kettering Institut'efor Cancer Research, New York, N.Y. KELLER, ANDREW Z., D:3i.D., M:P'.H.-Chief', Research in Geographic Epidemi- ology Research Service,, Veterans :i,dtninistration Central Office, Department of:Medicine and Surgery. Washington, D.C. •KEBSasnuac, Ar.r-R.ED, M.D.-Assistant Chief, Division of' Cardiology, Philadel- phia Gcneral', Hospital,, Philadelphia, Pa. (Dr. Kershbaum, who contributedl to this,and previous reports,,died suddenly ini:llarch 1369:) KoTrN,, P'AUL. MID;-Director, National Institute of Environmental Health Sciences, Research Triangle Park, N:C1. KRUatHOLZ, RtcrrARD A., M.D. Director, Institute of' Respiratory Diseases, Kettering, Medical Center,, Kettering,, Ohio. LEUCHTENBEROER, CECrLE, Ph. D.-Head. Department of Cytochemistry,, Ssciss', Institute for Experimental Cancer Research; Lausanne, Switzerlandi LEUGHTErBERGER,. RLOOLS;, Ef.D.-Professor,, SwiSsInstitutefor Experimental Cancer Research,, Lausanne, S~vitzerland. LIEBOw,, AvERrDL A,, M.D.-Professor andl chairman, Department of Pathology, L'nii-ersitiy of Califbrnia, San, Diego; La Jolla, Calif. LrniENFELD,ABRAHAM; M:D: Professor and chairman, Department of Chronic Diseases; Johns Hbpkins School,ofl Hygiene and, Public Health, Baltimore,, Md. LYoN„ HARVEY W., D.D;S:,, Ph. D: Secretary, Council on Dental Research, American Dental Association; Chicago, Ill. MAC114AHON, BkzAN4 M:D.-Professor of epidemiology, Harvard University School of' Public Health, Boston, Mass. MCLEAN, Ross, M:D.-Professor of medicine (pulmonary disease), Emory Uni- versity, School of Medicine, Atlanta, Ga. MITCHELL, RoGERS., M.D:-Director, W:ebb-Wa:ring, Institute for Medicali Re-search; University of' Colorado Medical Center, Denver, Colo.. MuRPHY, EDMOND A.,, MiD:, Se. D.-Associate professor of' medicine,, The Johns Hopkins Hospi:tals Baltimore, Md. PaiFffENBARGEa, RALPH, S.,,Jr.,.M.D: Chief, Bureau of:Adult.Health.. and.Chronic Diseases, Department of' Public Health, Berkeley, Cai'if. PETERSCN; WrLLrAar. F...,. M.D:-Chief,. Obstetricsand. Gynecology Service, USAFHospital, Andrews, MSHCB„ Andrews Air Force Base,, Washington, D.C. •Decea®ed. Wt 0

PErrg; THOarAs L., M.D.-Assistant professor of medicine, Unlversity of' Colb- rado Medical Center, Denver, Colo. Rocassss, PAUL G., riT.D.-Heart Disease andl Stroke Control Program, Health Services and Mental Health Administration, U.S!P'.Ii:S:, Arlington,, Va. Ross„ WILLIAM L., M.D.-Chief, Cancer Control Program, Health Services and. Mental Health Administration, U.S.P.H.S., Arlington, Va. SAFFIQ'rrI,. U1VfsEETa,. ril:Ds-Associatee scientific director for~ carcinogenesis,, etiology,, National Cancer Institute,, N'ational Institutes of Health, Bethesda4. nrd. ScHACaTax, JosEPa-Statistician, Adult Heartl Activities; Heart Disease and Stroke Control Program, Health Services and Mental Health Administration, U.S.P'.HIS., Arlingt'on~ Va: SCauMAr, LEONARD M., :iI':D'.-Professor of' epidemiology, University of' nTin- nesota.,, School of Public Health, Minneapolis, Minn. SHiMxiN, MICHAEL B., 3LD. Director; Regional b3edicali Programs, University of California at San Diego,, La: Jollay Ca1iY'. Sn:vESMAN, SoLS, Jr., D.D.S'-Professor af oral biology, School of Dentistry, University of California, San Francisco, Calif. SMrrn. LOWELL C., D.D.S.-Chief,, Preventive Services Section, Community Pro- grams Branch, Division of Dental Health, U.S.P.H.S., Betnesda„ Md. STAMLER, JEREMIAH, INLD.-Eaecutive direct'or; Chicago Health Research Foun- dation, Chicago, Ill.STEOMArr4 RussEr,a. L., D. Sc.-Head, Smoke Investigations, Tobacco Laboratory, U.S. Department of A'gricuiture;, Philadelphia, Pa. TfECxB, RicFiASU W.,, D.D:S:-Director, Research Institute, American Dental Association, Chicago, Ill. ToatN, CHARLES E., Ph. D.-Professor of human biology, University of' Colorado Sohool of D'entistry,, Denver, Colo. TYLER, WALTER S., D.V.1Wf., Ph. D.-Professor and chairman, Department of Anat- omy, Schooli of Veterinary n1'edicine,, Universi'tp of California, Davis, Calif. UNDERWOOD, PAUL, M.D-Assistant professor ofs obstetrics and gynecology, De- partment of Obstetrics and Gynecology, University of South Carolina Medical' School,, Charleston, S.C. VAN DUUnErr, BENJAmi w L., riti:D~-Associate professor,, New York University Medical Center,, Institute of Environmental Health~ New York, N.Y. WEIR, JOHN M.-Director, Bureau of' Dental Health Education, American Dental Association, Chicago; Ill. WYY®Ea;, ERNEST L., M'.D:-Associate member, Sl+oan-Kettering I'nsbitute for Cancer Researchi , New York,, N:Y'. The foTl'owing, professional sta-ff' of the National! Clearinghouse for Smoking, and' Health contributed ta the preparation of' this report : Louis Nemser, 1VT.D:, David V. ,Sharpe;M.D:,,DorothyE. G~reeny,Rh. D., Richard Eisinger, Robert S' hIutchings, Erni1 Corwin,, and Richard W. White. Special thanks are due Jennie IVZ. Jennings, Mildred H. Ritich iie; and Donald R. Shopland.. vii

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Table of Contents Page Foreword----------------------------------------------- ha Acknowledgments--------------------------------------- v Rart 1. Current Information on the Health Consequences of Smaoking: Summary of the R'eport--------------- 11 Part 2. Technical Reports on the Relationship of Smokin.g, to Specific D7seasei Categories---------------------- 7 Chapter 1. Sffioking, and Cardiovascular Dis- eases~--------------------------- 9 Chapter 2. Smoking and Chronic Obstructive Bronchopulmonary Disease------- 35 Chapter 3. Smoking and Cancer--------------- 53 Chapter 4. Effects of'~ Smoking on Pregnancy---- 75 Chapter 5. Smking, and! Noneancerous Oral Dis- ease--------------------------- 83 , ix W. C3 ® .,, I r: rt S ~~",r