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the Health Consequences of Smoking 690000 Supplement to the 670000 Public Health Service Review
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- 03763512/03766002/S H Re 1979 Surgeon General S Report.
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- Named Organization
- Bureau of Dental Health Education
- Ca Dept of Public Health
- Chicago Health Research Foundation
- Chicago Peoples Gas Light + Coke
- Coombe Lying in Hospital
- Emery Univ
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- Harvard School of Public Health
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- Inst of Environmental Health
- Johns Hopkins Hospital
- Marquette School of Medicine
- Mcgill Univ
- Natl Clearing House for Smoking + H
- Natl Heart Inst
- NCI, Natl Cancer Inst
- Niehs, Natl Inst of Environmental Health Sciences
- NIH, Natl Inst of Health
- Ny Univ Medical Center
- Orchard Park Laboratories
- Philadelphia General Hospital
- Presbyterian St Lukes Hospital
- Public Health Services
- Saint Vincents Hospital
- Ski, Sloan-Kettering Inst
- Stockholm Inst of Dentistry
- Swiss Inst for Experimental Cancer
- Univ of Ca Davis School of Veterina
- Univ of Ca San Diego
- Univ of Ca School of Dentistry
- Univ of Co Medical Center
- Univ of Fl
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- Univ of Mi
- Univ of Mn
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- Univ of SC Medical School
- Univ of Wi
- Usaf Hospital Andrews
- Usda, U.S. Dept of Agriculture
- Veterans Administration Hospitol
- Wayne State Univ
- Webb Waring Inst for Medical Resear
- Advisory Comm on Smoking + Health
- American Dental Assn
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- Ca Dept of Public Health
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- Anderson
- Anderson, W.H.
- Anthonisen
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- Astrup
- Auerbach, O.
- Aviado, D.M.
- Avtandilov
- Ayres, S.M.
- Ballenger
- Barach
- Bartlett
- Bates, D.V.
- Becker
- Bellet, S.
- Bennett
- Bennington
- Bing, R.J.
- Blair
- Blomquist, E.T.
- Boatman
- Bock, F.G.
- Boren, H.
- Boutwell, R.K.
- Boyland
- Brandtzaeg
- Brett
- Bross
- Burrows
- Cahan
- Cederlof
- Chapman
- Chierici
- Cooper, T.
- Cornfield, J.
- Corwin, E.
- Curschman
- Dalhamn, T.
- Delapuente, J.
- Dinman
- Dintenfass
- Duffus
- Eastman, N.J.
- Eisinger, R.
- Eliot
- Eliot, R.S.
- Endicott, K.M.
- Epstein, F.H.
- Falk, H.L.
- Ferris, B.G., J.R.
- Forsey
- Fox, S.M. III
- Frandsen
- Frasca
- Fraumeni
- Frazier, T.M.
- Freeman
- Freund
- Fullmer
- Fulop
- Gelfand
- Goldsmith
- Green, D.E.
- Green, G.M.
- Hammond, E.C.
- Hass, G.M.
- Heise
- Herulf
- Higgins, Itt
- Hoffmann, D.
- Holma
- Horn, D.
- Hutchings, R.S.
- Ishii
- Izard
- Jackson
- James
- Jenkins, C.D.
- Jennings, J.M.
- Keller, A.Z.
- Kerr
- Kershbaum, A.
- Kilburn
- Kizer
- Kjeldsen
- Kolbye, A.C., J.R.
- Kotin, P.
- Kreyberg, L.
- Krumholz, R.A.
- Lacuska
- Lellouch
- Leuchtenberger, C.
- Leuchtenberger, R.
- Lewis
- Liebow, A.A.
- Lilienfeld, A.
- Lombard
- Ludwick
- Lyon, H.W.
- Macmahan, B.
- Mcglaughlin
- Mclean, R.
- Mitchell, R.S.
- Moriyama
- Mulcahy
- Murphy, E.A.
- Nemser, L.
- Orlovskiy
- Paffenbarger, R.S., J.R.
- Peters
- Peterson, W.F.
- Petty, T.L.
- Pilgeram
- Pindborg
- Ricketts
- Ritchie, M.H.
- Rochmis, P.G.
- Roque
- Ross, W.L.
- Russell
- Sackett
- Saffiotti, U.
- Salzer
- Saunders
- Scarpelli
- Schachter, J.
- Schimmler
- Schlegel
- Schuman, L.M.
- Sharpe, D.V.
- Shimkin, M.B.
- Shopland, D.R.
- Silverman, S., J.R.
- Smith, L.C.
- Smitt
- Solomon
- Stables
- Stamler, J.
- Stedman, R.L.
- Strong
- Summers
- Sunderman
- Terris
- Thoma
- Thorne, M.C.
- Tieke, R.W.
- Tobin, C.E.
- Tokuhata
- Tyler, W.S.
- Underwood, P.
- Valaitis
- Vanduuren, B.L.
- Viel
- Waerhaug
- Wahi
- Weinblatt
- Weir, J.M.
- Welch
- White, R.W.
- Wynder, E.L.
- Younoszai
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- Hew, Dept of Health Education and Welfare
- Public Health Services
- US Government Printing Office
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03764973
PART I
Current Information on the
Health Canseqaences of'
Smoicing.
l'!
AL
03164975
Summaryof tha Report
This ~ reportt is a review of the pertinent medical li terature on the
health, eonsequences of smoking which has appeared since the publiea-
tionof the 11968 Supplement to the 1967 Public Health Service Review:
The 1964 Report of the Advisory Committee on Smoking and Health,
the 1967 Public Health Service Review; and the 1968' Supplement
have presented the broad base of converging epidemiiological,, physio-
logical,,pathological,, and clinical evidence on which knowledge of the
health hazards of smoking is based. ][nclhzded in this evidence are
data which show the magnitude of the excess mortality and morbidity
among smokers..
The following conclusions regarding the heallth, consequences of
smoking were summarized in the 1968 SuppllemenL
General Mortality Infornaation
Previous findings reported in 1967 indicate that cigarette smok-
ingisa.ssociated with an increase i~n overall mortality and mor-bidityandi leads to a substantial
excess of deaths in those peoplenho smoke. In addition,, evidence herein presented shows thatt
life expectancy among young men is reduced by an average of'~
8 years in "heavy"' cignrette smokers,, thosew1iosmoke over two
packs a day, and an averageofl 4years in "'light" cigarettesmokers,e those who smoke less:than
one-half pack per day.
Smaking and Cardiovascular Diseases
Current physiological evidence; in combination with adtlitionall
epidemiological evidence, confirms previousftindings and suggests,
additional biomechanisms whereby cigarette smoking can, con-
tribute to coronary heart disease. Cigarette smoking adversely
affects tihe interaction between the demand of the heart f'or oxygen
andi other nutrients ~andi their supply. S'omeof'the:harmfuT cardi-
ovascular effeets appear to be reversible after cessation of'cigarette
smoking.,
Because of'' the increasing convergence of epidemiological and
physiological findings relating, cigarette smoking to coronary
heart disease, it is conchided that cigarette smoking can con-
tribute totliedevel'opment of cardiovascular disease and partiic-
ularl3~~ to de:ath, from, coronary heart disease.
,S'r,zokzng and Clironic Obstructi,ve Bronch,opulmonarry Diseases.
Additional physiologicail and epid'emiological evidence confirms
the previous findings that cigarette smoking: is the most important
cause of chronic non-neoplastic bronchopulmonary disease : in the
United States:
3.
Cigarette smoking can adversely affect pulmonary function and
disturb cardiopulmonary physiology. It is suggested that this can
lead to cardiopulmonary disease, notably pulmonary hypertension~
and cor pulimonale in those individuals who have severe chronicc
obstructive bronchitis.
Smoking and Cancer
Additional evidence substantiates the previous findings that
eigarette smoking is the main, cause of' liung cancer in men. Ciga-
rette smoking is causally related t'o lung cancer in women but ac-
counts for a smaller proportion of cases#han in men. Smoking is a
significant factor in the causation of cancer of' the larynx and
in, the development of cancer of the oral cavity. Further epidemi-
ological data strengthenthe association of cigarette smoking withh
cancer of t.he bladder and cancer of the pancreas.
The most recent Ptiblic Health Service review of the effects of
smoking on pregnancy was presented in the 1967 Report. The con-
clusions of thatreview were as follows:
Clearly, more research is needed to elucidate the significance of
the relationship of'smoking i'npregnancyand low birth .veight.Additional Iong=range morbidit'y
studies are neededy as well as
studies on~ t'he effect of smoking on uterine activities and! placental
bloodd flow.
Smoking,does have an~effect on the outcome of pregnancy. How-
ever, it is not known whether this effect is deleterious or not.
Until such evidence is presented' so as to clearly define the role
of smokingiln pregnancy, itismore, prudent atthlstiinetoadvisepregnant women to stop or decrease
their cigarette-smoking
practices.
No substantial negat~ive evidence has appeared whicli refutes these
judgments. On the cont.rary,,stud'ies~made available since the publica-
tion~ of the 1968~ Supplement andi reviewed by panels of experts in the
relevant medical areas confirm previous findings and add new evidence
that smoking, is a health hazard'. Highlights of the 1969 Supplement
are as follows:
I. Smoking and'Card'iovaxcular Disease8
Further data from prospective studies confirm the judgment that
cigarette smoking is a significant risk factor that contributes to the de-
velopment of coronary heart disease, apparently by promoting myo-
cardial' infarct and cardiac arrhythmias. Analyses by severaI investii-
gators of other associated fact'ors (high serum cholesterol, high bloodd
pressure and body weight) show clearly that the effect of cigarette
smoki'ng persists and is appreciiable, even when these other factors are
careflullyevalua.ted., Autopsy stu~dies, suggest that cigarette smoking
is associated with a significant increase in atherosclerosis of the aorta
and, the coronary arteries. Experi'rnentall studies in animals have pro-
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vided new information on the pathologicall effects of cigarette smoking
on the arteries., This further supports the view that cigarette smoking
promotes atherosclerosis.
II. Smak'iny and CAron.ic Obstructive BronchopuZmonm-y Diseases
Recent studies have demonstrated that cigarette smokers may have
significant disease of the small airways in the absence of bronchopul~
monary symptoms. This~disease is demonstrated by the finding of ab-
normalities in the ventilation/perfusion relationships in the lungs of
cigarette smokers., Animal e.r-periments have demonstrated the path-
ological effects caused in the lung by exposure to cigarette smoke : or
t!ospecified concentrations of'products, found~ in cigarette smoke. Con-
ditions si¢nilar to pulmonary emphysema in man have been producedl
in: some of these experiInents, Other studies have investigated the path-
ological effects of'smoking on pulmonary clearance mechanisms and
d'emonstrated' t'hat pulmonary clearance may be signi$'cantly impaired
by the; effects of' cigarette, smoking. Epidemiological and laboratory
evidlence supports the view that, cigarettesmoki'ng can contribute to
the development of'pulmonary emphysema in man.
III. Smok'inyg and Caneer
A maj'or pathological study of histological changes in the larynx
has demonstrated a dose-relationship between smoking, and premalig-
nant changes in the larnyx. New animal models for the!experivnentaI
study of' respiratory cancer, which may be helpful in~ elucidating
the mechanisms of respiratory tract carcinogenesis, have: been de-
veloped and refined. More studies have been d'one to, identify those
substances in tobacc.o ~ smoke which take parti in carcinogenesis. Thesestudies may help, to dlefine
the exact biomechanisms involved iin the
cause and effect relationship between cigarette smoking and lung
cancer.
IV:Effect of Smoking onP'regnancy
New data are presented which confirm, the finding that maternal
smoking during pregnancy is associated with low birth weight in
infants and also indicate that maternall smoking, is associatedi with an
increased incidence of prematurity defined by weight alone:In addi'~-
tiony it appears th& maternal smoking during, pregnancy may be as-
sociated with an increased incidence of'spont'aneous abortion, stillbirth,
and nerrnatall death and that t.his relationship may be most marked in
the presence of other risk faetors.
V. Smolcing. and'. Noncancerou e ~ O raU Disease
The chapter on noncancerous oral disease is the first Public Health
Service review of this subject.The data available lead tothe conclusion
that ulceromembranous gingivitis; alveolar bone loss;, and stomatitis.
5'
nicotina are more commonly found among smokers than among nonr
smokers., The influence of smoking on periodontal disease andi gingi-
vitis probably operates in conjunction with, poor oral hya ene. In
addition, there is evidence that smoking may be associated with
edentulism and delayed socket healing:
Tobacco ~ smoke ~ contailn~s, a large,number and a wid'evarilety of com-
pounds which may result in complex and multiple pathophysiolbgicall
effects on the various tissues and organ systems. While further researcls
is need'edd to investigate the exact biomechanisms involved' in~the patho-
logical effects of smoking, the evidence clearly shows that cigarette
smoking constitutes a major health hamard in the United States.,
>~
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~
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40
non-
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avith
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PART 2
Technicat, Reports on the
Relationship of Smoking
to Specific Disease Categories
TSSV94co
CHAPTER 1
Smoking and Cardiovascular Diseases
Contents
Pa8e
SummarY---------------------------------------------- 1l1
Epidemiolbaical St'udi+es---------------------------------- 1!2
Atherosclerosis------------------------------------------ 25'
Thrombus Formationi and Blood I+Flbw--------------------- 27
Carbon Monoxid'e--------------------------------------- 2'8'
Cited References---------------------------------------- 29
Cardibvascular S'uppl'smental Bibliogaraphy ----------------- 31
,
9
