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Smoking and Health Report of the Advisory Committee to the Surgeon General of the Public Health Service - Part 1 of 3
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SMOKING and HEALTH
KEPOR'I' OF'I'HF. AI)VISORY COMMITTEE
TO 'I'Ifh~ SLiRGI:()N GEtiH;HAL
OH TItE PUBLIC iII:AL'I'It SENVICE
1'ubiic 11caiLh 5ervicc
SMOKING ^n' HEALTH
REPORT OF THE ADVISORY COMMITTEE
TO THE SURGEON GENERAL
OF THE PUBLIC HEALTH SERVICE
U.S DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public IIealth Service
I
Public Health Service Publication No. 1103
For sde by the Superintendent of Doeuments, U.S. Government Printing Office
Wbebington, D.C., 20402 - Price $1.25
;i
H
THE SURGEON GENERAL'S ADVISORY
COMMITTEE ON SMOKING
AND HEALTH
Stanhope Bayne-Jones; M.D., LL.D.
Walter J. Burdette, M.D., Ph. D.
William G. Cochran, M.A.
Emmanuel Farber, M.D., Ph. D.
Louis F. Fieser, Ph. D.
Jacob Furth, M.D.
John B. Hickam, M.D.
Charles LeMaistre, M.D.
Leonard M. Schuman, M.D.
Maurice H. Seevers, M.D., Ph. D.
COMMITTEE STAFF
ProfessionaI Staff
Eugene H. Guthrie, M.D., M.P.H.
Sta f;' Director
Alexander Stavrides, M.D.
Special Assistant to the Director
Mort Gilbert~
Editorial Consultant
Peter V. V. HamillM.D., M.P.H.
Medical Coordinator
Jack Walden
Information Offter
Jane Stafford
Editorial Consultant
Helen A. Johnson
Administrative Officer
Benjamin E. Carroll
Biostatistica.l Consultant
SecretariaI and Technical Staff
Helen Bednarek Alphonzo Jackson Adele Rosen~
Mildred Bull Jennie Jennings Margaret Shanley
Grace Cassid'y Martha King Don R. Shopland
Rose Comer Sue Myers Elizabeth Welty
Jacqueline Copp Irene Orkin Edith Waupoosee
iv
Foreword
Since the turn~ of the century, scientists have become increasingly inter-
ested' in the effects of tobacco on health. Only within the past few decades,
however, has a broad experimental an& clinical approach to the subject been
manifest; within this period the most extensive and definitive studies have
been, undertaken since 1950.
Few medical questions have stirred such public interest or created more
scientific debate than the tobacco-healt'h; controversy. The interrelationships
of smoking and health undoubtedly are complex. The subject d'oes not lend
itself to easy answers. Nevertheless, it has been increasingly apparent thaU
answers must be found.
As the principal Federal agency concerned broadly with the healthi of the
American people, the Public Healthi Service has been conscious of its deep
responsibility for seeking these answers. As steps in that direction it has
seemed necessary to determine, as precisely as possible, the directionf
of
scientific evidence and to act in accordance with that evidence for the benefit:
of the people of the United States. In 1959, the Public Health Service
assessed the then available evidence linking smoking with health and made
its findings known to the professions and the public. The Service's review
of't'he evidence and its statement at that time was largely focussed on the
relationship of cigarette smoking to lung cancer. Since 1959 much addi-
tional data has accumulated on the whole subject.
Accordingly, I appointed a committee, drawn fromi all the pertinent,
scientific disciplines, to review and evaluate both this new and older data
and, if possible, to reach some definitive conclusions on the relationship be-
tween smoking and' health in general. The results of' the Committee's study
and evaluation, are contained in this Report.
I pledge that the Public Health Service will undertake a prompt and
thorough review of the Report to determine what action may be appropriate
and necessary. I am confident that other Federal! agencies and nonofficial
agencies will do the same.
The Committee's assignment has been most, difficult. The subject is com-
plicated and the pressures of time on eminent men busy with many other
duties has been great. I am aware of the difficulty in writing an involved
technical report requiring evaluations and judgments f'rom, many different
professional and technical points of view. The completion of the Com,
mittee's task has required the exercise of great professional skill and dedica,
tioni of the.highest order. I acknowledge a profound debt of gratitude to the
Committee, the many consultants who have giveni their assistance, and the
members of the staff. In doing so, I extend thanks not only for the Service
but for the Nation as a whole.
SURGEON GENERAL
V
k
ar-
-9
Table of Contents
Page
FOREWORD ..................
ACKNOWLEDGMENTS . . . . . . . . . . . . . v
ix
PART I INTRODUCTION, SUMMARIES AND
CONCLUSIONS
Chapter 1 Introduction ............ 3
Chapter 2 Conduct of the Study . . . . . . . . 11
Chapter 3 Criteria for Judgment . . . . . . . . 17
Chapter 4 Summaries and Conclusions ..... 23
PART II EVIDENCE' OF THE' RELATIONSHIP
OFS1bIOKING TO HEALTH
Chapter 5 Consumption of Tobacco Products in the
United States . . . . . . . . . . . .
3
Chapter 6 Chemical and Physical Characteristics
of Tobacco and Tobacco Smoke ....
47
Chapter 7 Pharmacology and Toxicology of Nico-
tine . . . . . . . . . . . . . . . .
67
Chapter 8 Mortality . . . . . . . . . . . . . . 77
Chapter 9 Cancer . . . . . . . . . . . . . . . 121
Chapter 10 Non-Neoplastic Respiratory Diseases,
Particularly Chronic Bronchitis and Pul-
monary Emphysema . . . . . . . . .
259
Chapter 11 Cardiovascular Diseases . . . . . . . 315
Chapter 12 Other Conditions . . . . . . . . . . 335
Chapter 13 Characterization of the Tobacco Habitt
and Beneficial Effects of Tobacco ...
347
Chapter 14 Psycho-Social Aspects of Smoking ... 359
Chapter 15 Morphological Constitution of Smokers. 381
vil
.
U3765567
9
I.
ACKNOWLEDGMENTS
During this study the Advisory Committee on Smoking and Health has
had the constant support of individuals, groups and' institutions throughout
a broad range of professional and technical occupations. In many cases
the contributions of these individuals involved considerable personal, pro-
fessional or financial sacrifice. In every case the contributions lessened the
burden of the Committee and! increased the authorityy and completeness of the
Report. In this space it is impossible tb ~ assigp priorities or special emphasis
to individual contributions or contributors: The Committee, however, doess
acknowledge with~ gratitude and deep appreciation-and with~ sincere
apologies to any individual inadvertently omitted'-the substantial coopera-
tion and assistance ofl the following:
ACKERMAN, LAUREN, M.D.-Professor of Pathology, Washington, University
School of Medicine, St. Louis, Mo.
ALBERT, RoY E., M.D.-Associate Professor, Department of Industrial Medi-
cine, New York Uhiversity b'Iedical Center, New York, N'.Y.
ALLEN, GEORGE V.-President and Executive Director, The Tobacco Insti-
tute, Inc., Washington, D.C.
ALLING, D. W., M.D.-Statistician, National Institute of Allergy and Infeca
tious Diseases, U.S. Public Health Service, Bethesda, MdL
AMERICAN CANCER SOCIETY, New York, N'Y
AMERICAN Tosacco Co., New York, N.Y.
ANDERSON, AuGUSTUS E.,, Jr., M.D.-Senior Attending Internist!, Research
Laboratory, Baptist Memorial Hospital, Jacksonville, Fla.
ANDERVONT, HOWARD B., Sc. D.-Chief'y Laboratory of Biology, National
Cancer Institute, U.S. Public Health Service, Bethesda, Mdi
ARTHUR D. LITTLE, INC., Cambridge, Mass.
ASCARI, WIt.LIAM, Mi.D.-Pathologist; Presbyteriani Hospitial, New York, N.Y.
ASIaFORD, THOMAS P., M.D.-Instructor in Surgery, College of Medicine,
University of Utah, Salt Lake City, UtahL
ASTIN, ALEXANDER W.,, Ph. D.-Researchi Associate,, National! Merit Scholar-
ship Corporation, Evanstony I111
AUERBACH, OSCAR, M.D.-Senior Medical Investigator, Veterans Adminis-
tration Hospital, East Orange, N.J.
BAILAR, JOHN C. III, M.D.-Head, Demography Section, Biometry Branch,.
National Cancer Inst'itute; U~S. Public Health Service, Bethesda, Md.
B.aTTIST.a', S: P.-Pharmacologist, Arthur D. Little, Inc., Cambridge, Mass.
BEARMAN, JACOB, F., Ph. D.-Professor of Biostatistics. University of Min-
nesota School of! Public Health, Minneapolis, Minn.
BEEBE, GILBERT W'.,,Ph. D.-Statistician, National Acad'emy of Sciences, N'a-
tional Research Council, Washington, D.C.
ix
BELL, FRANK A., Jr.,-Program Director for the Engineer Career Develop-
ment Committee, Offlce of the Chief Engineer, U.S. Public Health Service,
Washington, D.C.
BERKSON, JOSEPH, 1Vl.D.-Head,,Division of Biometry and Medical Statistics,
Mayo Clinic, Rochester, Minn.
BEST,, E. W. R., M.D., D.P.H.-Chief, Epidemiology Division, Department of
National Health and Welfare, Ottawa, Canada.
BLUMBERG, J., Brig. Gen.-Director, Armed' Forces Institute of Pathology,
Washington; D.C.
BOCKER, DOROTHY, M.D.-Bibliographer, Reference Section, National Li-
brary of Medicine, U.S. Public Health Service, Bethesda, Md.
BRAUNWALD, EUGENE,, M.D.-Chief, Cardiology Branch, National Heart
InstituteU.S: Public Health Service, Bethesda, Md.
BRESLOW, LESTER, M.D.-Chief, Division of Preventive Medicali Services,
California Department of Public Health, Berkeley, Calif.
BROWN AND WILLIAMSON TOBACCO CORP., Louisville, Ky.
BROWN, BYRON WM.,, Jr., Ph. D.-Associate Professor, Biostatistics Division,
School of Public Health, University of Minnesota, Minneapolis, Minn.
BUTLER, WILLIAM T., M.D.-Clinical Investigator, Laboratory of Clinical
Investrgations, National Institute of Allergy and Infectious Diseases, U.S.
Public Health Service, Bethesda, Md.
CANADIAN DEPARTMENT OF NATIONAL HEALTH AND WELFARE, Ottawa,
Canada.
CANADIAN DEPARTMENT OF VETERANS AFFAIRS, Ottawa, Canada.
CARON, Herbert S., Ph. D.-Cleveland Veterans Administration Hospital~
Cleveland, Ohio
CARNES, W. H., M.D.-Professor and Head of Department of; Pathology,
College ofl Medicine, University of Utahs Salt Lake Cit'y, Utah.
CARRESE, Louis M.-Program Planning, Officer, National Cancer Institute,
U.S. Publfic Health Service, Bethesda, Md.
CASTLEMAN, BENJAMIN, M.D.-Department of Pathology, Massachusetts
General Hospital, Bostony Mass.
CHADWICK, DONALD R., M.D.-Chief, Division of Radiolbgical Health, U.S.
Public Healtli Service, Washington, D.C.
CLARK, KENNET~H, Ph. D.-Consultant, Office of Science and Technology,
Executive Office of the President, Washington, D.C.
COBB, SIDNEY, M.D.-Program Director, Survey Research, Center, University
of Michigan, Ann Arbor, Mich.
COMROE, JULIUS HL, M.D.-Professor of Physiology and Director of the
Cardiovascular Research Institute, University of California, San Francisco,
Calif.
CooN CARLETON S., PhL D.-Curator of Ethnology, University of Pennsyl-
vania Museum, Philadelphia, Pa,
COOPER, W. CLARK, M.D.-Professor, Occupational Medicine, School of
Public Health, Berkeley, Calif.
CORNFIELD, JEROME-Acting Chief, Biometrics Research Branch, National
Heart Institute, U.S. Public Health Service, Bethesda, Md.
DAMON, ALBERT, M.D.-Associate Professor, Department of Epidemiology,
Harvard University Schooll of Public Health, Cambridge,, Mass.
x
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