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RJ Reynolds

Comprehensive Smoking Prevention Education Act. Hearings Before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce House of Representatives Ninety-Seventh Congress Second Session on H.R. 5653 and H.R. 4957. Dangers of Smoking Benefits of Quitting & Relative Risks of Reduced Exposure. (Split Record).

Date: 1982
Length: 40 pages
503328728-503328767
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the Dangers of Smoking, the Benefits of Quitting, by Acs, 720000. Comprehensive Smoking Prevention Education Act. H.R. 5653. H.R. 4957. List of Footnotes. List of Articles. Smoking and Health, by Advisory Comm to the Surgeon General, 640000. 1979 (790000)
Garfinkel L, Seidman H, Lew Ea, Origins of Human Cancer. Book A: Incidence of Cancer in Humans, 770000. Origins of Human Cancer. Book A: Incidence of Cancer in Humans, by Hiatt Hh, Watson Jd, Winsten Ja, 770000. Changes I
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tW HEAVY SMOKING AMONG Chart 18 HOUSEWIVES VERSUS WORKING WOR,tE+l 5mokOA P.0Or Mon 0/ Cip+irNl.. A Day % Ibwwri.q K WoolLingWomm- 53 , - Chart 19 R C OUAGEO YOU TO ou trr WNO wNC BENEFiTS & Rt'sLA'['IVls RISKS x ` ! UF ItEl~UClit) ~XI'USUttts No onerda on own so NusbandlOoylrMwfd 2• R.IatIr. (p.nnt, sbta. a1c.) 13 Ooaa 3 Fri.nds 2 Cnua.n Duw 2 2 • ChArt 20 POTENTIAL FOR OUITTING 42% T..n-aQeOM. Youiq woawn y1f (/Mo/mAr.rMym10• IM. !N W/rM 4. 31 ut:vtsta~ ta»•rt(uv . .. Au up-tcl-data xunuuury artho key sricuti(ic urrd mcdical xbaliex, phux umw hJoniraticui on PCUIN/luiit:G, t1..ydhubigy, tiluirnuu-ok>gry RIKi other uct~~~c~txuf lulK~cti.rrxu~ukinl;suul hculth. . R . ~ sJ y .!4 --5033 z --e728 DANGERS' OF SMOKiNG Aawk-ao (:wraw Sudcly. luc. 777 T1Ird Avrnuc, New 1'ork. New York 1(f017.
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t 166 '1':41114• VI t'il:Altl•:1"f1•:1NI! )A INt::1M( )Nt: l't 1UNt: PI•a )PL1•: Ac:l•:: 1•2• 1•1: • I"ru Ixrys• /1xr tH•rer:otr.tir rd rrylul:rr arabkcrs went (ruen 2.9% in 1f1Gti to 4.2% in 1974 to 3.2i in 1979 •!' ur girls, tiK: IN-n•c•rrtagc rd regul:rr srrxrkm weMrt fnxn 0.62 in 196ff tu 4.9% in 1974 to 4.3% in 1979 '1'u sum up: a sharp drup arnung Ixiys since 1974. bu1 mdy :r sligld clrup auuxil; girl.. 60 r 167 '1'a I'Ir 50332 8760 t:ICAItM:I"I'M: tiMOKINt: AMONl: l'uUNI: PM:OPLM: At:M: 15 AN1) 111; • Far (xiys, tlwr pcrrcrrtaKr of rr•grrlar snwrkcrs wart frarr 17.0% in 1968 ta IN.liin 1974 to 13.554% 1979 • For g41s„ the percenlagc of regular smolcars went from 9.83 in 1908 to 20.2% ir 1974 to 11.8:[ irr 1779 •'Po sum up: a sh•rrp Jnli anKUrg Ixwh Ixrys and giris. 87
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172 173 , 50332 8763 i 1950 4000 -- 3000 -i 2000 -r 1000 -1 FiKuro S ANNUALC(?NSUMPTION OF CICARI•."l'1'ES PER PERSON ACED 18 YEARS AND OVER. ANNUAL CONSUMPTION OF FILTERTIP CIGAREITES PER PERSON ACED 18 YEARS AND OVER, 1950-78. 1'al~k• 1\ SALES WEICIITED AVERACE "'1'AR` PEIt CICARE7TE, 1flSt-10?T 1955 40 -.-~ 55 80 85 70 75 Total • •••••••••O •• Hiltedip • • • r- 4000 ~-- :1000 2000 - lfl(10 { 09 35 -1 90 • 60 0s • Z0 -- ls • 70 73 - ~ IA5S 80 . (1.5 70 75 -35 30 IS Year I 1950 55 60 05 70 75 YEAR Source: Alillcr, R.11. (S1 •32), U.S. Departrnawt of Agriculture(47, SI). 0 preUminuy estimate Source: Consuurr.rs UrJun (8), llnrwnuwul, E. C. (20). Ha:wcll, J. C. C. (2T- S0), Own, T. B. (38), Plrilip Alurris, /wc. (39u) U.S. Fcdcrd Trudc Cour wdsrkm (li7)Wakelwm, 11. (7?), Wrlwr. 2.1/. (7(1) Wywder. F. /.. (78). 73 •• 72
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• 114 81 miUiun i>,•rWm-rl:ry.lusl frulu wurk. ... 145 ulilliun Ix•rsllrrrlays spr•ut ill iu bwd. ISC 1979, pp. 1-131 I~ur uu•u br•twr•r•n a};rs •15anrl 01. IINNY• than 251x•rcr•ut of the nuudn:r of days of dix:rbilily w/•rc a.s.arciateyl with cigarette smoking. Another study anrorrg womcn, housewives arxd those with paid jobs, shnwal that those wlw smnkerl cigarettes spent 17 per- cent more days ill in bed than waruht who have never snw)kcr1. [Smoking and llhxss, National Clearinghouse for Smoking and licalth, Public llealth Service, May 10071 Chronic Illness Taking the rate of chronic ilhxss of people who had never smoked cigarettes as the baseline, &rt 1987 the National Clearing- house for Smoking and I lealth estimated that: "Thcre are 11 million more chronic cases of illness yearly in this country than tIN•rr• worrkl lrc' ( if INr rNre sa><rkcrl ). T1W. sanrr• vstinr:Ne rrtwrrlrvl tlm1: "Tlrcrc are 2811,t10U nurrc lxxsrrrrs who report a leart condi- tion' and estiuratryl urkr roilluwr uarrc casr•s of chronic bronchitis and/or emphysclna; 1.8 rnillion nNUc casr's of sinrrsitis; one million more cases of peptic ulccr than there would be if no one ever smoked cigarettes. [Ibidj Quitting Reduces Risk There is amplc evidence that giving up cigarettes reduces the excess risk of mortality. The hene6t is cumulative, over a period of years. After tcn to 15 years of smoking cessation, the ex-snuikers' risk of dying prematurely is reduced cl(xsa to that of persons who have never smoked, as in the following chart (Figure 1): i 115 1 /n~nr• 1 S.0 4.0 ~ .5 00 a 0.4 50332 8734 :\NN11,\1.1'Itt)ItAltll.l'1'Y 1F Ul IN(: I ult P:\•ti\/t)1:1:ItS ~~ IIt1/_)1111' ItI.I l Yh:AIiS. t7t/1i1tISN'1' /:It:;Utl•:1-1•1•: ti\Itria•:ItS Anl) Nt)Vti\Nrl:• 1''.It1, A(:1~.5 55'1't) (it. U.S. YI:1•1•:ItANS 1!).:1 (:()11t)It"1'. I(i-1 h:Alt 1•-1)1. 1.(W-tIl'. Never Snxli;/Y1 r r ~ lr:x-ci{;arM1eK11N~r'/!i Sl/qllx~l 10-11 )'/:rl\ Alaxunurn :ulauull soM~klti 131 •aJ / ry;an•Ib~ IH•r Ilar • (:urr/•nl ril;:urlle sm/ul./•Ix Smul:iu);'>1-a!)4•i);:uritr••: In•1 rlay 0.2 14 MOItTALITY, l)ISAUILITY AND C1111ONIC ILLNESS 0.1 L1 t t 1 1 1J 1~_L_l l1 1 2 3-1 5 0 7 8 9 10 11 12 13 14 15 1(i Yc:uxo(Piolluw-tIp tiO/ Nt('Jt: Nu):rf. K.. tinukiirg nnd Alurlulil.v i1 rnnn); f 1. ti. V'/r'rnirx lnr. C//rnnir /li:utirxrx a7.'tti!1-314'tl/47-/). I I~,
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160 161 50332 8757 - lrnvcrsiuu aud low ill ncurulir i.u~. i\1a1e ynitlors arc: nN»r siNaahlr aud muir 4•Aruvr•rlocl ill 11N•ir IwIraviur. Nu rc•laliunxlup has Ix•1•n fululcl (x tcvc cu c•cluc:rliun (c-vc•1 awI snNoknlg Cl•S.ti11IUn. SIIPtY•mfn) riuillcr.arr uwrr likely lit lie uurlrs Ilurn fc•oxdcs. /St: 1l17f/, pp. 18-17-191 Porceo/ Itabit 71xxc• is uxxrutinl; cviclchrc•c that llrcr nrnrrlx:r of cilt,areltea suokcd lu•r clay is dirrylly, :uxl uflrn m:rrkirlly, rrkrlrvl to iuahiiity to ynit xurokin};. (11'c-%l, 1). W., l:rah:un, S., Swanuxr, KI., Wilkin- sou, (:. Five yc•:rr firlluw-rrp rr( a snxokinl; wilhrlrawal c•linic• Ixqrnl:r- f licxr. Anerican Jrxrrnal of l'nblic 11c:rhFh ti7(fi): S3t) 5-t 1, Jnnc 19771 t lorv to Ouit It has Ixv•n mtINGIIrYI IhAI 1ir) I1PrQPnt of 11Ne mnrc th:rn :31) million suxrkers wlxr Ir:rvice rpril sirxr 19(il luivc cknm sa cNr tlx:ir own. AlNrul cNlr. 11riu1 nr fc•wc•r ill snN)kc•rs wlNr are uNrliva/c•r1 lo ynil :ur iulrr4•,10•41 iu 14Nrua) lxu/,r:rrro.• a IxA.•nlial :rudirrxr uf iN•/- haps 15 uulliixn Aun•ric•arrc. I luwr•vc•r, rxrly a small uliraxily uf 1Mnc• who axprrxs :nc iutcrra in cluitliuyq aclu:clly crl/runl srneb Ittograu.c• pcrhaps Ix•causc• they are not uuivc•rsally :rvarilabk:. 'Ilio Ainc:rican C:auccr Srx:ic•ty has cxpariclyd its activities in this area sincre it is kuuwn that :rlxxU atl ix•rcymt uf smokers w/ai p.•rrticilxitc ill such prul;r:uns:ere• still INN tinx/kn1gINNe ye•ar later. '1'hr•re licrva Ix•r•u great advancrs in inJorar:rlirHi alfout sinok- ing ccssaliuu nw1lNxls ill rrY•i•ut years, utainly (xtsiYl un I:ul;c-scalr curnn:rry prc•vrnlitbu Iri:rls aml rvsr•:uc•b elinic r•xpericlKvr. Tlre nusl crilica1 anccru is tlx• validity of thc u•If-rc•Ixort clala: "11iis has been cluc•stimx•cl in np lo 2111x•rcchrl of clinic Irartic•ipanls. C:arlxHr muuoxicle ill the blaxl aplwars to Ixr cc iucuc reliable nnvasurre of suxrkiug Iwhaviur tlr.ui sclf-rc•ixortiug. F.rluc•ntiurr rrutl i'rr•rvrrtion Vast nuinhr•rs of :uolisuxokiul; lrrrr};r:uns exist for lxdh yuung Ixoplc an4l arlnlls. Nc•w•rI1wlchs, it is slill nul knuwn what forms of cduralion arr muxt r•Ift•c•livc• in kef•piul; l'onotr}; Ixvrplr• (rrxu.ioNwinl; from cxhcrimcnlatiou wilh cipprctlch to ixruiniul; habilu:cl snwk- crs. And it is still nM knowu liuw Ix•st lo Ix!lp aclults give up t6a smoking habit. Toc•n:r}Lr•rs (fifi Ix•rucul od I;irls ancl(i7 Ix•rf-f•nl rff 1Nl3'ti ) Ix'1- crivr lrac•hrrs as likely Ir) INr siuukc•is. YO cuo Anx•riv:m (:ant•4•r !VN•ioly xurvr•y frNUxl 1ha/ rNr1y :)1l Ix•r4•0•n1 uf f4•1n:1b• Irar•Ix•is :nNl IR Ix•rc c•nl of nudr~ 1~ ar IN rr:u br:rlly somike. /Sl: 1979. lr. 17-L'i1 Ic1cMt stab•s snplxrrl wtucatiom as :1 INNr•ulially inqNNl:uul nN :uss of prcvr•niiul; snNikiorl; Mal inOrN•rN•iu}; cr•SS:r1kNi nl .mNrk «r};, adthcHrl;h results br clatc• fnNn snch Inogranrs are fcrr frrxu.alis- fac•trrry. In 35 st:rtr•s, sc•hoxrl Imlicics rNr snNrking ccluc•:rlirxr are h1WY1/N1 sta/rllaws whN•h /•xllrr•ssly Ixulrilrit nrilNrrs floxn snNrkiul; rwr sr•1xNr11N/1lNYly. 1'Jd 1L4• Inrl$1/•1 /5IN•lir•vrll boIN• u4y!lir.il1l.• 'I'I IF: SAI(11:I N(: 11AIIfl': 'I'I IE SAIOt:INC I IADI•I•: 1'SYCI1(N_.(N:Y ANI)1'IIAI{h1A1:c1I.()(:1• 01 60 PSY(:110C.(K:Y AN/)1'11AItAtACO1.(X:Y
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1 112 hlcmol;r;qih 11). I!Nro, pp. 12i 21)1. Kahn, 11. A. Thc 1)urn sludy of sonokisil; and murtality ainuul; U.S. vcti-ran.c: retxrrt un R71 ycars of ubscrvation. In l lacimicl, 1V. op. cit., pp. 1-1261 Suwkiul;-Nclatrr~/ I )~ atGs "It has Irceu calculated tlwt in c•uuotrias w1wn: suwkinK has lrrwu a wirlrslrrc:r.l habit, it is rrstuarsilrlc for !Xl lx:rcrnt of luug cAucr:r rlealli.s, (ur 751u•rcrut of hnnu•hitis tk•atlrs, :onl lm 25 pcr- ccnt of isclle-mic leart dix, :acc deaths 1ualcr ti5 years of al;c ia lui•n. In worricn the proportions may be srNruewlrat less." [WIIU 1971), p.101 Life Expectancy A 25-year-old, two-pack-a-day smoker of cigarettes tf the typo prevalent until the 1980's has a life expectancy 8.3 years shorter thari his nonsrnoking counterpart. For grarps of uen snxnk- ing fewer than 10 cit;arettes per day, tlrc loss of years of life expectancy is 4.6 ycars; smoking 10 to 19 cigarcttes a day shortens the life expectancy by 5.5 years; and snx>lung 20 to 39 cigarettes a day, by 6.2 years. (Hamnwud, E. C:. Life Expectancy of American Men in Relation to Their Smoking Habits, j.N.C.I., 43: 951-962, 191irJ.] (SeeTable 1 p. 13). Pipe and CiE;ar Snookin/; Pipe and cigar saarkcrs have rruntality rates similar to those of cigarette smokers for cancers of the oral cavity, pharynx, larynx, and esophagus; but they have much lower death rates than ciga- rette smokers (but higher rates than nonsmokers) for cancer of thce luul;, isclu:ioic lwart di.-Was.r, alKl cbruuic obstructivo lung dis- case. The diffcrcnccs arc thought to br. related to diffeccnces in inhalation of smuke. Pipe and cigar soxikc is chemically similar to cig.•Irattc smuke, except that lhe fornx:r is alkaline. Sirice alkaline snwke is irritatiutt to tlre respiratory tract, it deters many pipe and cigar smukers from iuhaliu};. Wlu-n cil;ari•I/c snuikcrs switch to pipi-s or cil;ars, lowcvvr, thw tt•ndclu•y for suute. is to coutinue inhaling. Disahilit y As in mortality, there is a normal or expected rate of dis- ahilily. A Natiunal I1valth Sunvey by tbc U.S. 1'uldic llcallh Service calculated tlr.tt in a single year cigarette srrxrkiniG eaused an additioua) or excess of: 12 MU1(TAl.t•t7, I)ISAB1t.1TY ANU CIIIiONIC II.LNF.SS 113 50332 8733 SUIt%'1V( )ItS111P OF Atl•:N A(:I:1) :L'# IN ItI•:I.A'fl(1N '1Y ) ( :I Iltltl•:N'I' N11A/ItlClt OF tiMOt:Fl) I'/•:R IM)'- ItA11•:Ir ON ItA'1'I--.ti A1))Iltill•:I) 1't1'f111: 1/1 5J•tt1 U.S. LIFM: •1'Altl.l•: F/rlt A1.1. MAI.M:S _ - . --•------.. .._. . Nrvrr w~u~1 rd SnMitt•ix: Nu. ul rry;arl/r. dail~ A/;e AHuu•u IrI;lil-uh• 1•!) 10•1A '!0.19 Itl (yr.) (x) M M M M ('F) 25 100.0 1tKt0 100.0 Itxl.O Itwl.n It>t/.u t10 99.1 S)0.4 99.1 99.1 99. 1 lLR.x •'{.5 04.2 JH.7 l/A.1 i/N.1 !/R t/ 47.'1 •1/1 4Ni.it 97.8 96.6 !Ni.5 !Ni.ri I 1 i 1 •15 t/4.f1 4N).4 &/.2 41/.0 93.8 f)1.n 50 91.1 94.4 fM).0 4)n.// 11l1.:1 85.6 S.5 8.5.0 W.0 85.1) 11:3.14 82.5 77.7 00 7N.1 Ii.S.5 77.11 75.3 7:15 /i7.1 ti.5 (i7.R 77.7 m.a 1ia.•t 61.1 51.0 70 55.2 66.7 52.4 47.7 •/5.l1 •1t/.() 75 41.2 513 3(1.2 :1:).a :111.t1 25.7 8/) 20.7 :3.5.0 211.0 1R./i IH.I 1•1.:1 ItS 13.0 19.2 7.3 ».5 7..^. r:.5 !N! •1.1) 7.11 2.^ 2.^. ^ • .' 1 95 1./) 1. i 0.5 0.5 //.5 11 1 l.ifa ex)x:ctancy 70.2 73.0 09.0 68.1 (i7.•1 /t5.:1 (age) 1iG+ expC4•tanoy 45.2 4A.(1 •1-1.0 43.1 1^.4 -1Q:t ( yr• ) 1)i/1Mamr. Gum N.S.1t. 3.4 0 4.0 5.5 ti.2 ts.a (yr.) SOURC.E: Ilauirnond, E.C., RoRat, E. (S(:1979, p. ?•12J Ia
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50332 8764 175 174 '1'adtlr X I!1 IIl .lt H:IiAI'l l l• 1'olIrlic•alicwo+ ro/r114Yl 1ts rrlw•:clrcll)• in /hIC 141144.1 aw i4L•a Ii/GYl hy a sin~lrlc•cYwlr, ax G~llu~~•.: AIAIiKP:I• SIIAINE ()F (:I(:Altb:l"1'MS 1Y1'1'll '"1'AI(" 15 MC. ()Ii I.FS.S, ti1 ~:I/aI Ill•:III11: III•IMHI /1/ IIa• AdvIUw)' (A111//111I /••(: tioud iaI~ 12)G7•ly7tl (lU7tl 1'lIOJECI'kU) Icr /u 1114. Scu)(cynl (a•urcal oil Ilu• I'ul4• I/V:r11h tirn•irr. ll.ti. 11r- 11:Ir1//aN11 Uf 11t•alth, MalSxralkau 31141 Wc•Ifarc•.1'ublic• Ilc•al/b tic•r~•n•c 1'nhlic :INni Ncr.11U3.1!1R1 /S(: 1S)ff7j 71a• Ilc:dth (.In1slNl/a•IMY`S oil Snaakiag. A 1'cddu• /Ic:c11b Sc•r.•icY• lich•a•w: liWI U.S. /H•Ir:crlurnYr1 ir/ Ilc•allic. 1•:oluva 30 ~ licac aud 11'c•It:crc•.1'colhlic• Ilc x111i tieY% nY• I'nldit •:,tif wi Not. lip.Mi. 1!M.K /S(: 1')f:til'1•la• I(rsclih (:na•a•tlutcurs oil Snn4aoog. 1!N.. tiult. .pla•aa•nt (u Ilu• 14)67 1'rulJ it • Ilt,alih ti4 rvicc• Ito •vif •a•. I I.S. I h•1r:a1 nnYrt ci( tivorvicY• 1'ablic :clnwl Not. 1tM. 1!M& /S(: 1!XQj'17a• Ilc•aIlh (mn/XPOlla•UtY:s Of Silatkiqg. II•ti. 111•- 1xcrln,cYd uf Ilc:cllh, 1•:cluc•alinu arnl %Vrlfacr. It1(4') Supld4•aa•n1 140 1'ulda• I lc allh Sc•rvar 1'rclhliralunc Not. IIMM)'! 1J71) (1(: (4)711'11a• (lr•al(lc (:cncwY/ac•caY•s cft tiuakin};- A lic•Innl af /lu• Sorl,cYwc t:oYa•r:& 1!r1 P.S. 1)rl1:climrcrt cd IlraUh. F4lu.•:1 litwe acal 11'rlfare. l'cddiv 11e:dih ti~Y~ur. O111•:\V 1'1d,l4•aliful t`:41 (IISAI)71-7.;13 /S(: 19791 SAIOI:IN(: ANI ) III-AI:171: a rc'1xN1 oil Uir Snr- );/Ywl (:c•tu•ral, U.S. 1)rparlmrnt uf 11vallh, (?cluc•aliaNa alal \I'rl- fare, h1/1)lic Il/•allll S/•rvllY: Office Iif tla• A.CsiXla/lt S1YY'elar)• fiw' llc:cllh, OIlicr cnc Saa+kiu/; arul llcallh, /)III:W 1'ccl)lic•alicnc Noc. (1'IIS) 71)4-i1M1(iti, U.S. (:ovc•rnouh d 1'ricdinl; (Nta•c, Washiut;lua, 1).C:. `.SM/P?. NcHe: "Ilu.c dtanrnuvut is Im);iico1vYI Iay dh:ydrrx. falbrr lU Iban cv ti~ li • 1Q nIsc c u % (1)irh) ('1'c~IuuY u a~a 1 Y our 11vaII b Iby 11:u-uhl S. 1)ivhl. A I..~., K1.1)., Sc•.I).• Slx•c•GII (.lNlSllllaul fur lic•sc•arc•h aral Mrdira) AIL•cirs, Amcric•3r11 (.aiaY•r Scx-ic•ty, luc., Ak•Craw-/ lill licxrk ('.canpany, New Ycwk, It>n), 211) I,p. ica•locdinl; iudc•n phcs xi ha};c•x cif lnlrcwlurliuu. / liuyal) Saaa:iu f; uncl l lralth Now-A New lielxw•t :ual Snuc- ur:u•y nu "Sna4iaf; alal Itx r.lfc•c•Is cnc Ilc•alllc" fruur tlcr 1iu)•al (:c4- Mba of Physicianu of l.tnukxi-1'ilman hb•dioal ainl Sc•ic•nlific 1'ub- IisbiuK(ai.,1.Id.,l.tnakHr, F.nl;laial 1971. /1V11O 19791 (:cwircillin}; Ihr Snuikinl, I:piflc•aciv. lic•lworl nf )I)G7 68 GJ 70 71 72 73 ?•1 75 ?ti 77 7.4 tho WI!O I:xlHert (arnanilU•P cHD Suulkiug Cunlml, Trclacic•al Year liclxrct Sc•ries 630 Wcrrkl /lc•alllc Ur};anizatim, C:cucva 197fl, f!7 pp. (9Sw. fr.) Source: Afaxwelt, J.C.C. (27-•?p). Standard aud Poais Coqwrat(on (94), U.S. Federal Tradc Conunl.r.eiwi (G7-0). 75 74
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191 180 50332 8767 :11i'1'l l( )11 1N1)I':\ rlhtaua.wiscz, 1,1., 51 Adlws, \V.Y., 2!1 Alu,•rwau, t:.D., 1s AItNY/l•:wl I I/•:rrl As4M'I:ItwMl, :1•1 A1w'/h.w•h,11., 2:1, :17, 71 I laru.n I, X1' , 1 I, 1.^. IIAww/NNwl, l•:.t:., 11, 1`r, 1:1,'r2, 2a, 2.5, 21i,24l,tI1,3-1,:)0,:17,71,73,7/i,77 11ia11,1I.11., 2°. 1 fi/ucius, M.W., 42 11i11, A./t., 78, 77 lGdh'11, A.I.,:LI /hwu,I)., 11,78, Wis Ibww, ).\V., 21/ 11rwr1.v, t :. M., •IN [.>,riik'u, l )., .'>ti Iiauwrau,l..M., 50 Itrark•i s Uiarsl, 81 li.•itGwlw•rK, AL M., 55 ItiM•Iwrw.wI, J.B., S iwmoa, t:., 13, 15 IG.u•u, M.t:., 47 IlGtllarutw, K., 31 IGryal C;dkpte of 1'bysicisws ( I.rrrIuw ), 30 Kuslr, I)., 41 Rwssrq, C.S., 48 Ruwll, C.S., 48 ltussel/, k/.A.11., 48 Itusy, R.F., 55 WAkrhawr,ll., 7:{ Walk.v, C.R., 77 Wallw•e, K.M., 29 Walsua, j.D.,22 Wr•Iwer, K.11., 73 %Vrs1, !).W., 80 Wr.st,1..J., 58 wilLiwvey t... IM) wIDiArus„ R,R., 29 Wiusirw, J.A., 34 Wiw/crails, W. W., S8 11'iscr~rrsiw, Modica) Cuqr•8c uf, 49 Wyarkr, E•L,'l1, 30, 32, 73 B:w4•r, 2:1 Barkr, R.A., 2'i &•st, E. W.H., 77 Bk-%vk-y, B. 40 BIAnd, J.M., 40 Breskwr,1.., 76,77 Buell, P., 78,77 BwNrr, N.H., 46.47 t Calilarwr, J.A., Jr.. 5, 8,S C.artcr, ILW., 37 Ocrry, N., 59 Owrrg, J., 23.25 (:ourlhwk, C. W., 42 (~sw.vwotis, L., 49 Cwawrurcr's Uniurr, 0•I, 73 Gwey, L.S., 30 Cu11cw, J.W., 56 1)r•Id, 11.5., •tU, 7S LAdI, It., lR, 40, 51, 76.77 1)urn, I1.1'., 12.713.77 1 hwu, 11 /:., ./Y Uujur, J.E., 76,77 Ecklalm, F.., 8,1 tavru, P.C., 5.9 Fcy.'ralr•twl, C., 49 F ricdru.ra C.U., 48 C:ufnkcl, L., 22, 23, 28, 29, 31, 34, 38, 37, 71 Clauscr, E.M., 55 Caauxr, S.C., 55 C:ukismith, It., 32 Cwtbis, N., 0 (.r711a(n, S., 60 C:ritz, E./i., 58 Cruvc, E., 63 Gnl(iuJ, J.S., 57 Iwltraur, S., 411 Jarvik, M.E., 58 Josfc. C.il., 77 Ka1wr,11.A.,12, 78, 77 KrBer, A., 31 Ke9cr, J.B., 42 Kicrwau, K., 59 Klrmaa, D., 28 KrKSak, A., 43 Lcw, E.A., 22 Lirdaa, C., 78.77 1.uuKu, L. N., 47 l.ace, B.n., (12 MAlww•hi, I,.,:N) Mr/irrnw•y, A.K., 48 Marw, J.I., 51 MarL., It.l).,'3:/ Matsuya, T., 42 M:utarll, J.C:.C., 73.74 Mrizrw'r, ILI.., 42 Meycr, Al. B., 47 Milk•r, lt.l1., 72 AbwNr, 4:., :11 1/uslwuski, M., 10 Natimwl rire 1'ratectiuw Association (NFPA),53,54 t>,vru, T.B., 7.3 1'+uwyot4ywtukRS, S., 41) 1'apa•r.uKkw, N., 49 1'clcrs, J.AI., 43 1'ctu, It., 4/1 PLilip Mlwr4s, Itw:., 73 Ihaow•y, I.J., 29 SAka1, Y., 42 Sr bawit~rr, S.()., 82 S.ihrtta, J•J.. 47 ScrugKs,11. j., 29 Srkhwau,ll., 22, 23 SrlilurB,1.J., 2'3, 25 Sr'Nzrr, (:,C„ 48 SitMw, li., 4.9 SirKriAulr, A.B., 48 S)Ivrrl>»vlt, F.,11 Siwrs,F.A.11., 5•^. Siuwr_,~l'.R., •17 1taa~Mrd arwl I'IMU i l iwp., 7•1 t1.Nw•.1i.W., 42 S1.art, A.1'.,:11 Swaw.aur, M., (t0 Tallarida, R.J., 55 '1'Iww~.Kawl, M., 51 T~tl~ ar Siruarwta, K1 •I'rtrrwM•ia, J.A., •12, 47 U.S. Ur.parbuwnl of AKrinilturc, (t9, 72 U.S. Falcral Trada Comurissim, 84, 73, 74 U.S. Natinu.l Clewirrghouso for Suw.king arwl l lcalth, 14, 20, 50, 65.00 U.S. Nalwwlal Iu5/itute of 1'.rluratwqr, 8.5 U.S. Pnhl&. I lraltlr SrrvMx, t65, 58 Vratsry, M.1'., 51 Vi1al StatWics ( U.S. ), 18 VoKt, T.M., 50 8Q 81
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1 55 154 50332 8754 Tulll/• V FATAL l:11(FS S/'AIiTEU t1Y CIGAItK"1TL«S 'l'lw Top Tca IgoitNrrr 5e.•utirarirrs Istatcrirl Set On Fire Area Whare Startod Pereeat of Deaths Pertxwt of Fire I Uplwlstcrcd furniture Living roao 43.9 40.1 Dodd'arg licdroan 30.8 343 Utrlullstr•red funriture Rnlroaro 19 8.1 Hcddiug Living roau 2.4 2.3 Rubbish Kitdu:n 2.3 1.7 (:krthcs on a pcrsorr Ilcdr(rum 1.9 17 ( au11N•x /al w tw•r.uu I.t\'111g IYMN11 1.5 2.1 Si)ft~ g/xnls rNlK~r tiran l.cchliug or ckrllres nn a pcrsnu D.xlr/arn 1.3 1.2 t (:G/thcs on a Ixxs/nl l;i/clwen 1.0 1.4 Furhiture (type un(kNerrnineil) Living rourn 1.0 0.7 i Source: National Fire Protcction A.uociation. Based on 3,037 deatl,s in 2,131 accidcntal fires in the Unitcd States 'reported to the Association /or the years 1971-1978. The ten scerwrios in this Table accounted /or 89.0 perceut o/ these deaths and 89.6 o) tl/ese fires. 54 I V11=1'lll•: SAt( )i:IN(: 11AItI'1•: I .S1Y,I1O1.(K:1' ANI )1'11A1tA/A(:O1.(K:Y Su/ukiul, is a rynulrlr•s a/•1 iuvulviuH Ir:uru•rl (u•Iraviur, Idr•cl sun• /rr rs•r111r•Iirn1 of uni/1r•us:ur( si/u:rliuns a s/irlur/:dint; a1ul INr.- silrly Ir:rhilrratin}; atal/rrr adrla•li.•t• rlrua (nirtirlitu•), atNl a varir•ly of rrihr•r r•bt•rnicals wills an rturruuats munlu•r of pbysirrlol;w•al clft•rts. Alnst rtwarch in helping suulkcrs rluit Irus rrs<til /r arrrinK tlu.•ory, bast•tl ort behavior nxxliGcation. l.vsuning thr(uy rt'l;ards snu/kin1; as belravitir atYluircd urxlt•r srw•ial reinforccnwnt, typit•ally Iwyr Iwt•ssrrrr-sincc trxWt snxrl;r•rs br•I;in as terrmRt•rs wlmn pryr Irrc•asurr is nrrst 1xNcnt. At first inhaling trrlutcrrr suurkc is rrqul);rlant. 1?atlr prdf irrrrr•asrx plrysiral toN•r:urcr•, and huilJs tlu• h:rlril. F.vr•ulrrally, srrxlkiug luu- rlut•rx rhurtq;h reinGrrt•r•trahtt to sustairu ilsr•lf willwutt sur•i:d plrt•s- surr•s. '/'Irc nuudmr of cuxrtirrrr:rl rvr•r/1s, Ixrlll ImsitivQ alxl Ix'ga- lirr•. IIra1 r:ut iulltahx•I+.narkin/; is 1>r11/•utially Vrry yrral.'1 ir utrKlify irnnkinl; lx•hat•inr uuty rr•rprirl• :r +•:a ir•1v rd iulrrwhdir»r Irr•br:iyrn•s in a sprY•Irunr nf rilrraliuns. Alul il ic t.nnpli/•:Nwl by 1hr• faM 11urt snarkin(: Irrm'irl/h iusl:mt r1•iu(f lnv•nu•ut flrrlu 11u• pllysiulogir:dll. IM)Wr•rfrrl drrrg• nu•W i1u•. (S(:. 1974), hh. i(i• 5-71 NifYlt tr11• Nirti//ilu• frour cur inbab•11 1•i);arr•tIr rr•acht•s tlu• br:rin itr sM•PI/ \/YYqul\ (Iwitv• a.1:1.1 :rs fluur arr iulr.Wrlu4./ iryr•r•li/ar). A lau•k •a rl:ry suu/kl•r lakr•s uaxe Ih:u1711,(Mx) pnl(sa ye :rr, a frr•/pu•u1•y /1t -4u1W /II///I:III'IN9I 1/y :UIY /1(114'1 /1/11t; I:/1.111/! '111115• IIN• l1.lINI 1•. Irr•na•n11/ru.ly "uvt•rlr•arruyl:" An/l i1..o/i/Nrx ill r•ifr•r•Is, of which swukl•c.:r/r awarc, t.rue years lalcr; Iluu scvw very rrnxrle. Nicrdiuc is tbc most Iww•rful plurrnracrrhry,it:rl agent itt ei};arr•ttc sourko; otlier ingrcdit•uts /6at r•scrt clu•miral effects on tlw Irxly are cstrl>,In uaNroxirlc :uld tar (p.. , ul:rtc trutttcr, a ntix- (uro of uwr•ral thtursan/1 cIM•rnicalx.) On/• slu/ly in which tar atKl uicrrliul• were vnrirr) alxl dissrx•ialr•/1, showal Ihat Iha nutulu•r of ci);clr1•lirh suurkrtil was rr•lalrvl 14) Ilro rIKY11nH` (Y1n11yrl Ilut rn/l 11/ l6c tar. ((:Ialm•r, S. C., Clalrax, h:. At.. Ik•itlculw•ry;, M. h1., liusy, Il. F ., '1':Illcui/la, li. J. A1r./;rlHilir o/frrt in 1nan o( lhc crKSaliun uf snulkiu};. 1'harul:u•ulrrgist 11 (2): 2K'i, 1!Ki!). (Abstract)) 55
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168 1G9 50332 8761 '1':J& \'llI (:It:Alil:I"1'1'.JMl1KIN(:.~\ION(: YOUN(: 1'1•:(11'1.1:.•1t:1•: 17 AND 18: • For iwys, tM: pr:rc.:W atic uf rcKular snarkcrs werN from 30.2% in 106ti /0 31.(!3 iu NJ7•1 ~ to 19.3% in 1979 • For Kirls, t1m tw•rc•r•a1aKe nf neakrr auokcrs weut from 1K.t3xiu Ifl(i8 to 2S(9Z in 1974 to 26.2% iu 1979 •'1•u >n:u up: :r sJculI rl1uti :U/NNIg IMIYy- Ilrrt a disturliiug, awatiuuin}; ri.u uuamK girls. i M I I I;(HMI cx:rtnplre by nut smukuq;. And the majorily, r•xrrpt pllanua• cists, never suwrki•d in Iruut uf palir•nls. ISurwry of Ilr•alilr hofrs- siuiralx, 1975. 1)r•Jrarlnivu/ uf 11r•al/b, EAlur:rlirur :rorl Nalimial (:lr•ariri/;larrra• fin tirurrkin/; aufl (lrw1/6, All:rrrh, (:roa/;i:t :It1:1a'tl 11'lart They Smoke Fnan If)C01o Iflr//, /lw• nr:rrkr•t slr:rrr+ of Gltr•r-1ip c•iJ,arr•11es irw rr•awrl rapirlly frrNn 11; Ix•rc•r•n/ lit 50.9 Iw•rceut. lty 1975. M) lwv- cerrt of current rcgular suwrkc•n crHrsrnrw•rl Gltr.r c•iprn•t1i•s. lit 1!/7J. Ilw• ur:rrk(•t xlr:rrerrf lillr•r tip r•i/;:rrf •Ih•x r•srrryl~ r) !M1.:11a rr rnt. Sales of U S. cil;arr•tlr•s %.•ilh 15 nrg or Ir•ss rrf tar have in- (•ma.ud from 3lxerc•r•rrt Irr over a0 pr•n•vnt rbninf; tlw• la•rN%1 1970 to 1!17R. AknnK willr tlris iiw•rc•:rse, lln•rr• Ir:rs Iw•r•rr a rbti•liur• in x:rb•s of relatively higher "tar" arwl nirrrtirwe Ixarwle. Fnwn I>/ Irr 1la77, tlw scdc-wcightryl average "I:ar" (µhrlu•ntatc nrat/vr in snwrkr•) lw•r U S. cigart•Itc cMelirrrcl fnnu a1liNrrxirrra/ely a(1 ing lit 17 rrrk rw Irrss, for IxNh filtcr-tih arwl rHHrfiltcr c•iF;aFetlr•s. A drelitwr in tlre salr•s- wrigIrtr•d average rric•r>lirwr Jttr r•i};arrttre was also rrbsrvvrvl, :uwl i.s rwrw at 11w+ level o( I nr1;/8 If•ss irr r1l:nry Irraiwls ("1':khli• 1 X, p. 7:1• 'I :rlrle X. p. 741 1'aralkrl reYllw•/NNIs ill lar /niridnw• Ir••rr•r I:rkeu pl:~~ r iu u1b0•r dr•w'krlMYl r•tw•nt1N•s. lit (:r.•at Itiilaiu, loul, r•:r(wrr ralr•. :nr• nr)%V (Ir•c•rr•asing, arwl in tlw: Unitrd Statr•s, dc:rllrs frunr carrliovascul:rr discasc•s have lxequn to dreline. Both r•/frcts may M- aurihutahle, at least in part, to srnnking c.r.x.catuon p.-rttcnu and to swil(•Irinl; from N};lr to low lar/nicydirle c•igart•I/t•s. (aunil;ee in l.uul; Nnuurnaiilir.c SIHIwS 1)rrN)f of IIN•m• r•4uurc Girnr :r rrr6•111 hiclAsq•i,• shuly in the Unilc4l Sla1r% "•1iidh lr:ls xbInvu a riraru:klif• 4114,11 ill lung alHwrrrr:rlitiu•s in seauk4•rs wbo died (of Olicrva.rs 4rlbrr Ib:ur luul; carrcr.r) irr Ilw: Ix•INNI Il1711•1l/77, as (YNUirarv4l a•ilb IIwm• wlwr died lit I95"u-ltJf'li 1. A iuucb low(•r prolxxtiru nf ahswrrnml- itics of varir»rs sorts--cclls wilh atypu•al unclri, k•sidnns willr no cilia an(1 lursal cc•Il LyIH•rplasia-werc frnurd in the hronchial epillw•Iirrui of sumkers u•Iwr 1111Y) IN•hw•rn 1970-77 Ih:ut irr IIwKc %rhu rlir•d Irr+lwrra 1955 (4). 'fhnsr %r•b40 iliril iu 1!Ii/I 1!/'i,; rrruxl harvr srrwrkr`c) lower tar aud nir•uliiw• ci};an•Ik•s Ihan thi• r•arlir•r grorrp because all brarwls harl drY•rvo~w•d tar arw) nitydinc (•uulerrt. SAt(l1:INC 1?CONOAl l(:S ANU SI'A'1'1S'1'1( :S 00
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124 1%i);ura• :1 i 25 1 22.5 (A #4 O ~ 20 W N p, 15 13.2 O I': 2.8 2.2 i w 0.1 0.8 ` 0 1) IL:. 1 , . 0 A B A B A B A B NEVER SMOKED SMOKED </ PACK ItE(•U1.ARLY A 1)AY SMUKED SMOK1:1) 1-2 PACKS 2+ PA(:KS A DAY A 1)AY l:igurn 3: 1'urcrrrta~~['cod Sl•ttaN4s wills Ach•:•iYl l.csi~nls (Cilia Absrut uud All Ntx•Ici Atypical) AlY1N/1Ulg to SuxlkiUg IIa1Nt xl (:rlurp A(1J."H>-1lNN) Deaths) and (:ruup B (1970-1977 l)caths). Suurr•r: Aul•rlxirh. O. cfalrar t•uti Jul. i(Nl(tl):?.Ri .9Ali, 1979. Ibid. 24 125 50332 8739 Apri1 ISN-t. Sl•likull, (. J.. Ilau1nubnd, I•:. (:., (:hurl;. J. t•s Ini.urv• stnukinq;. aoll nwqrpl:i<ia. Juueicil soi Iht• Ana•air:w Alrilit•a) :\..o N•ialiuu ~~111('L): IIFI-1 N/, A 1)ril H. I!N:'i.l '1lu•rlr is :lIso au inrtram•4I ri•.l. ld Ieul); carx•4•1 l.•I14n1l•J arMqlj; IN•fHdk• wlut a•lsrk willl :uW•uil•, ..•Inlauiurn, uirkrl. lYr.r1, u:llur:d I;as aul1 l;t•allhill• _luul iu :dl 1:4a•s, tlx! tisk is rrruclr I:rr:rll•r ilrr ci);arl•llesuarkr•rs 11u1u flir rxxr.nur{a•ls iu Iln• saaa• l1lrrqrNiuus. (S(: 11171, pp. `5fi-21'i•( ( :c•srrral .1 i r /'lrll uf iuu Alauy Ixtirplr Ihac•r IxNrl1 Ilual Ihl• ria• ill luu}; t•:uw rr r•u itu•ilk's cvillr IIn•I;rra/ irx•iraSl• in imlu•:Ioi:I) aiNl lnlmn uie IN-Ih1li4ar• aull Isrvc tluywir.l•rl th:ll Illis is ihl• rr•:rl t•:ruw• uf 1un); SUulivs, sn far, du tuel lx•ar /hi.lxd. 71x- axx•klsitur, lr,ra•lI /N/ IMx'P Ilwnt 13 dillrroul t Irilb•ruio- lo};irr fuvcsliK:riiGxrx, is that in /la• :tlta•rx•.e ill r•iKarrltl• suNrknl)„ IIx• c•lHrrlriruKl t•1Gr/s of all i1/11NK111xYk• a};r•uls lkr tuN iru•rraa• /lu• cb .rih rall•s frar krul; cancrr uurrl• Ih:ur a Vc•ry fcw t•aa,•s Iw•r I(NI,/NN) ix•rslxts lwr year. JS(:1!!7!l. p. 5-f'.7.1 'I•cvu 14N1'7 x1uJn•s wVr.• nr.ldr itf IxvpA• IivinK in 1.6% Au}tl•k•s, cvhl•rr air Iwrllulam is 11N• wlNs1 in (:alifuruia, m:r1l•Linl; snwlkl•rs stud tw:u.uurkrrrs in rrlaliim lu Ilir liux llx•y ball livl-.ll Ilrcrc atxl in eklu•r (:alifurnia citids. It slur.vcd Ihal tiu• y;r-Iuer:tl risk of kuig c:uxrr was tur Krc•atcr ill I.o:c Augck•s than ill nuy ulhcr C'ailifuruia city. llocvcvc•r, it ru:ry Ix• t/xr early to aukludl• tlral air pollutiat is uut a siguificaul fal•tlx ill (uuK c.arra•r, tirx.r Ihl• disl-rsc lakl•s uwruy w•ars lu drvt•Iop :rnal crir 1«rUulbNl Ix•c•aux• a Innblrnl ill 1 are Ankek`s /N1Iy Ix•1wl•r•n 1515 anl) (9f'~II• (S(:• 1!K:`i• Ir• !1.4J Sulukirrg 1)u1;x t hic. li( thl• c•rilicism. k•c•t•h•ll al Ilu• l iB:urlll -aull IH :rllh linkal;e wtrs that 1uu); c•suur•r bad ulrl Ix•t•11 Iwlxl•uYYI ill I:It);(• ani- uulls by cil;arl•ttr aux)kr. lu 1!)io, lhix ktp.vas Glkyl Iry t6l• tl-culls of a kxtK-tl•nu zludy of lbrls whu snurkcll ci);:ul•Ilr•s Ihrnlry;h a sINY•lal lll•vilr. Niurly-s,•vru lu•a111iy Ih•a),k•x lvr•ir u>vll iu Iba• t•xlw riuu u(. 'Ibl ll~ys cvr•ro llivilll•ll into );nuy1% suuOkiu/; nuw1H•rs lif ci};arl•Ill•x lylnivall•nt (o iua• Ir. tavr tr•rl•k. a ll:lv Fhti• a I~i111/,l mms, ll•i11a stuou~~nsuaeki~i); riurlisil :\/1 suNd.iu}; lbo};• .Iwmr4l c.uxY:rrxrs nr Mlx•r La/lxdol;il•al c ban};l s ill Ilx• Iuu};s afil•r li7.i lla)•s of suxikiug. LUN(: CANCF.11 2.5
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1 176 APPENDIX '1'hc results of seven prospective studiec of large Iwpnla- tiuns, lutaliii}; I.early sevi-n million (>.-rxon-yc:us, :ue fr/viuctully t;ruutu•d in this aud other ml«tis. (:real weight la/s Iween l;ivr•n lu thi-.c stuilirs wadr iu three cuunirics, lKxause i>f their crmsistcucy. These sevcn comprise all tlK: large 1>rualxetive snalking studies known. The first started in Uclaber, 1951; the latest, in (klwbcr,lMJ. Several are continuing. In brief, the sevcn groups arc as follows: (1) British doctors, aquestii>tuwirc having been sent to all u/cmlers of tin: nxxclical profcssioan in tlle United Kingdom [l)oll and I1i11,1J51] (2) White Amcrican Incn iu nine states. Thcse mcn werc enrolled by a large number of Amcrican Cancer Society volun- tccrs, vach of whom was asked to have the questionnaire filled in by 10 white Incn bchvccn thc ages of 50 alut 69. (Ilaumwnd and l tornl (3) Iloddi•rs of U.S. (`.ovenulH•Id Life Insurance Ixllicics, available (o Iiersouis who sivn•rxl in the armed forces bqhvicen 1917 and 1') it).11)uru, coutiuuttil by Kahu) (•1) Aten ap•ll :3.5 11) IFt ill nine 1N1CIIht/liona in California who were suspcctcd of being subject to a higher than usual occu- pational risk of dcvchoping lung cancer. (Dunn, Linden and Dres- lowJ (5) California members of the American Legion and their wives. [Dunn, lDucll an.l lireslow( (6) Pd•nsiourrs of tlie Canmlian l)ep:utwent of VMcrans Alfairs, i.r., Vi ti•rans of World Wars I auod 11 and the Knreau \Var. (7) Amorican inen and wnnlen in 25 slates, enrolled by voluntver researchers of !he American (:auci•r Society, each of whum was a.ked tu cnrodl alwnrt 10 families containing at least one tN-lW m or4•r •1.i. 111.uuulnnIl( Sce Table X 1, p. 77 for dates aud nmunhers. 76 / 177 50332 8765 -o ~0) ., ~ CIA .'t'. i C/ r i O t+. ~r O ~r r 1 ~ O ~-V /° ° - ~ .+ T. ~ z 7 0 ~ " 0 ~-7 ~ 17 6i [o l > A ..~~ ,[`, ~ qpp Fi, O t/l ~ Vf Y " co ~ .r a6 0 ~ O ~ ~ (1-1 q V ~ ,,, g M H q a ~ ~ ~ ~ - ~ O W ~ o ." - +- O O iw , ~ ... 0 O ~ o >. ~ 7 q z 77
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#4 106 ueull• hy c•i' v:uvItr w:1nufar•Unrrs and ... othrrs ... Ilia/ tla• sr•i- 4•u1iG.• rc•illrnrr• was .krl<•hy; 11ur1 nw link In•hvcrti suioking arel ranc•rr a•as 'pnrvru.'...'1'tKlay Ihvrr ran Irr no clarrlbl that smokitig is 11111 y sluw-urul iuu suiricle:" 11ris Ixxrklc:t Tla: l1rngrr.r n/ Smoking. Tlrc Benefits of Quitting mul Rechacd Exposure ackls, to the material covered in the original The Dangers o/ Snulking, The Bene~ts of Qtdtting, the latest findings in the 1979 Surgrcur Cmrerals rrport, arKl other IiEW rcports Ixdhlishcd since 1972, pius those of the 1979 rcrwrt, "Controlling tlu: Srrxrking F.hiceuric," of thc World llealth Organ- ization, and a number of recent hxlividual studies. Only thc rnost pcr/incrtt investigations arc cited and, in many cases, tlrc Brxlinl;s of nrany aro arcrRocl. Where a single stuely is descrilxYl directly, tlie refererrce is given iu a footnote; where s•vcra) ari: abridged or dcr-crilxK) (roor another source, a general h:r}tc reference is given /cr the survry prrblicaticrrr in which the matcrial aplx•ars. Sca 13ibliograplry at end of this booklet for sources of these gcrrc:ral refrn•ncrs nrarkel (S(:1(1)irlbl( (Royall /WIIn). 0 107 50332 8730 1)AN(:I-:ItS,111?NEFI''ti, ItltiK5 Following is da: first Or:rrt to calify in siuipliGwl lcrnrs Ila! clanKcrs.rrf srrwrking, lhc Ix:ru4its of yuitling, arKl Ilic relative risks of srrarkinb low tar/nicrotirrr/Gltar-tilliml ciKardtcs. Al) trrhacro-smokinq ilaru:rgc sccnrs to hc cloK rclatcd: to tIeaKa ai whiclr /lrr srrrakr.r st:rr/ec1,11a: nrrndx•r uf cip:rrvllrs, lrijk-s cu r.i}t:rrs snxrkc:cl Ixv day, /hr length of Iiuw. snarking has takrn Ir1:u'e, wlNala•r crr iart Ilx! suaikrr irrlr:rkrs,lNrw cbvply the srrruker inhales, lurw nrnch of /6 cig:rretle (or pilxe or ci};:rr) is snrrrkrd, tlxeL tar and niccrtine content of thr. srrxrkc. 71nrs, any dinrinutkru, cr clurn};c, in any of tlx: variable rk•na-nis would aQrc•t tlrr srrrokcls risk; and quitting c:nlirrly will rerlrK•e risks Iucq;rc.~sivcly over a IH•ricwl of tiuwr, Ixovirliu}; irn-vrr.ihlr lissru: Ourngvs have rrcd taken plsrce. 'Thc snKrkrr who iprils alWr achicves many iinnrrrlurlc hi:rllh 1p•rm61s. 'Ila• first is a ra1161 cNrlira• in 11w• r•arlNm rrunmxidr k•vc•1 in Ila• I>tiMNl wilhill Iwrhr INMIrs. Ilt:ularlu% aiirl sluucrch- aclics r:cusrK) by snwiking clisaplx•ar. Staruirur arKl vii;lx improvc. (NIr•n rx-suwkrrs uo1Kr a krrurr sc•rr.a: of t:4ste and surrll. liut Ilp-rr are uurrry uuxe irotxirtaAt, amt;-trrrn 1N-rhh arrr) lifr•saviri}; Ixnx.•GIs from ctuilling ri/;arctlcx. Src chart orr /hr. fol- lowin}; two p:r};cx. 7
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170 (>F (:Ult/th:N'1'• IN?('lI1,Ali TFENA('1? SAl()Kh:RS, UNITEI) STATI•S, IN SNLF.(:I'M:1) YI:AItS, BY SN:)t O Male  Female 70 171 50332 8762 "IINe au/burs of 116% wurk vi/•w 1114! (insliNl;a as avr•ry rnr ~NU:rl;iui: sil;u :Ind pri•dict Illat, :It s.INwc fuhnw dalr, tIN•re sINN1It) IN! a deyrlillre in tINe UrriUYl Shlli•s nf llul}; callcrr ra•alll ra/es /1( cil!a- r/•/11! s/lwrk/•rs (xew• 1w11; ~:nurr S/vlillu 11). lANvIb:N h, (!., IlaNl I/NNII1, 1%. C.. (::ufi/lki•1, f.. ill 1trwN•hi:l) N:IliihcIiNNI ill 1(rlalioN/sl/if/ 10 (:iy;alrllr SnNOl:inl,• /!1.'ai 1!Na/ v. 1!Ii/1 1!/17. 'fIN• New 1':III;f:NNl J/NNNal Ilf 'lK1 1!/-09,) Suw4crs Sraukiirf, D1urr '111r. acilr:rl unnrlN•r uf snwikrrs has rb•c•lilw•/1 omlr /lwrr 1br fN•Ir t:qlita cvwl..rllrqrliun tIf cig:Imiles. 1'IC.sildt• vxhl:rlr.liiilNs: 1) 'llwssw cvlwl snN,Icr lrast, are nwlxl ap1 lu yni1, h•aviNy; a hirlmr i1N•ronN•Nt of Iw•avir•r xmnkr•rs; 2) '1'Iw/%s• wlw/ i•INliinn/• suw/kinl; Ilul)' 1w: srrw>ki//K NwN•e; 3) New sNw/kers /luly I>.• sNwrl.iN1; NNne 111211 NNr};-14•r/u sllwlkrI s/S(: 1!/7!/• it. A• 171 tiilwYr /lliN; /Najnr 1•IIaN/;" ill Srlw1l.iNg II:111PINC 11:11 IMY•Nrlr11 iou/w•idr•Illally cvillr a s//•:Nly rlrull ill t1w• s:rh•s-weighlyd /ar 4•IN/- ti•rlt of U.S. IwalNls of ri};arc/t4•x ( i1N•lINI1r1g a drull ill uilYdilw•, cvhk•Ir ks usually in a r•Itio of 1:1/1 fo tar), 11wyN-ics are 11u11 /ha rrlrurilri/lk saNlkr•rs Iruly INS suw/king nwxc ci};:rrrUr•s and inhafing 11NN•<e tN'1`hly ill (H(l/•r t(l IYNIIIN'l1.Cat/' f/lr 11N• 11iw/•r/Yl lar/I/NY/Ii1N: cYNll/•u/ of Ilw•ir llralNls. lluwl•~~•r; :1n rzlN•rinN•n1 /14•sfl;lNV) tu 14w1 11hc•w• 1hi-4•s Ilac iN~liralwl Illal srlN/k/•IS 1Na)• i1N•u :rw• 11w•ir srlwacilll; 14nnlw/r:ui1)• wIN•N sa•ildhirr/, 141 a Mlw '1'/N braoul• 1,411 //rat /lMy rr•Inro Iw Il:rlulual Ir•v/•Is cvlllllll a 51NNt f/Ilw•. 'I1N•r1• is Ihe furlllr.r fact Ibat thc /LK•lilN• iu lar/Nwroline. was IINUe rapid Iw•lwl•i•rl 1957 a1Nl 1lX.i Ihan IN•Iw4ru Miti cuw) 1977. /S(: 1!)!!), pp. A 18-19-201 SAtUi:IN(: M:(Y)NOAll(:S AN1) $PA'1'Iti 1'1(:S 71
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.4 178 SU)iJl•:(:'I' INI)I:X At :1 ( wv Aww•lir,la t::aa.•r 1.N•icly / A11 Ia/IkAaN1, 2 ~1, '1;, (I 1:! aN.I Iaa1; c.iaccr, 25 Aaw•r M•./a ( ::uarr 5.w'w•ly N:1tMMI:II ( aqllllub\wNI /NI 1//MII(u/g 411141 I'/IIdM• 1'IdM')•, 5-) I'1t1w•w•S /Nr /IIIY.w't'i/ qrMl WMILir1/., irl.ak• b/N11 tti/rrr 5/rwa:iuK tv xv1i1N1 prlp;raua, (MI 1lutly ai 1'/ltvtx.rf .uM/ki1rK lMl Iw•al/k ( 1'151), (ia, 76.77 1tu.l)• /1( IMd/l,u aciMN/l icaclmra' t•iKnic111• NIMM/III( wi111/ukK qrMI (/NIMI. ( 18i(1), (i1 511NIy/.( IrcuaKra/lwlkcrw 11975). 5K ISla.kk•r, t-autrr /11 ( vr Uri/l:rry 1/1a.kk•r, cAlwrr 401) 11r+Na kial cqrcilwNlu, 17, 18 (:,uw•cr. 1(1•:1l ( Mv ala) SjwriGc wIt's ) ( :I/larcllc auwa. iwK aad c1a.Nlu IN.qa Id/i.,11. 12, 1•1. a9- l i, 11, •(-S iaal tYN/Nl:rr)' IM•:1(1 /14M':/.M', 11, I(), 12, 1a,:b1-9H :uld t1i:rltlwrd'a• It•sls, fl, •/1, S0, 52-5•i au.l.lapbc..•//11. J, 11,:5!/ -11 aad lir.•s, 53-41 alwl i/amauc aylcul, 4), •11. •15, •Bf.•UI :ualluaK damaRc, 29, •1•1, •15, (k) :/rrtl uw trlNlliwl, 5? a/al )N'(Hic wk'.•r, 9. 1•1, .1•9 alal INC/ta:alcy. 9, •1(i-•6Y aatl auludi., 1•1 J:IUKcrs, 7-'J t•trNaqaaa Aatl sl:di-olics, (!_' (i!1 IunK c:Ull'r•r, AS a M41NIr laaV• tll, 8, 1O, ^7 luuti IMU1ccIwN1, •13- 1•1 11Y11Cr113, /1 luyclw/bKy, 55, 54-(i!) ( a1;uu•U.•z /YN4U1111)I/aN1, 71-7 2 lillcr lip., 7-9. 1!/, 21, J1, (i!), 72 lar aatl nic.tlult•, 7-N, 21, 22,37, SS-5ti, 7:1, 7•! 78 - 1 A•cll k Lllcs, 1 O 12, :15 t'bNlMlt,rn, (5 /1aYl N/MILI'r%, I (1- 1 2 IaNIVIM.1.1'/%', 1 / \YININ'r/ MIMN.I'r3, 1 1-12 I klrK i1/1cr:a-IwNn, •'IU-51, fiJ F:wt i/.N11/M'/dw) n.tNr 1n, 2:1, 25, :17, ,11 •.12 . M:ahrlwlCux, carMrr rd, N, ( 2. :!1, .11-:12 (:r7w•IM• I:It•IrKi, 50 11.NMwN1+1 (:/Nors, 17, 37, 5() 11ka•c., ckuNrh•, 14 1:illla•y, c:r1wrr ld, 21), a_^ 4:) I aryus, cwrtr-r /d, 8, 12, 2U•a/l I ,uuK, ciaIrlrr rd, 1()-28 arM1 Jir )MIIdi1Nl, 25 iUwl N31M.KIlIf, T) arMl GUl r•/i~Mrl ci((aadlcr. 19, •21, ?.1 wlMl tMvY11Y.lIi/M1i/1Iq1/.Ai/If, ^.'i, 2.5 r/1.•{•N/MIIG•ra, 28 ill 1MN1.N1M11i1•r3, 28 I/wNlality, 1tf-17,22 .+•: diar•rr•pcrs, 17 .rlw.~,i/rK ra r ruap/r cwrsl . M. 1(), 27 ?/INM/L~ /k//~c (.•.(a•riaw•u1), •~5•^_(t lWNlw•11, 17, 10,28 SIINIalily ( slv UrA/h rllll'S) %kN/1Ir, c:IMY•r lr(, N, 1'2, 2), :1(1•31 ~I:IIMMI:11 Iu?I/Iall• (IN' ( ll•t9/11:11MN1:1I Sa(ch• a1M11lcaqlr ( NI(1S11), •Ia (>.ral/a/uNla) a1M111u/K carrKcr, 11, 25 w/al a1/wlkiuK, •1•3 / bw) c:rt ily, c:uwrr /1( ( s.v AMNdlI, r•i//MY•r OI ) ( kal t.Nllr:arpl it cs ( ar 1111.11w) 1'ancu Is, c.l/avr /d.!(, 3!1.1) 1'a...i.c.uwll.iuK, •1!1-,•11) ./.16/11., 5</ cb/Gk. a, •'/tl I'1wu ta%. r,la/,v u(. 12 I'111. I la•, !1, .'r I :11• :Ia 1'.n .N•..Lilyr . Ii/M-iaa•:, :!7 / hN/huP, ai :.., /.// /i1 Iw•Ii1.,;-!1,II SaN./:r/s dIi1/11,•i1. :/; di.alalily, h' 11 /i1r r~lwv /aul'~, 11. Lib d., 'i 7 L.a:/••.•1., :.: 'V,/il.(i:i,Mi/.:, ;ll Nt..••.•d,(:",/i71 ti/lw.l, iw/t ( MY• (•IN,d/.'I L• %ar •l ia /!: I'tlq• ://M1 1'1/-:/r .naM.lall/! ) SMUd.iuN,.rw+:ll'wN/ ( w•.• / hlillialt 1 SLNbca. 7(1-77 Ibi/i+It.bN-/urs, ai, 77 I%/III/ N/1/:/ A11M'I a•:111 I.1•1!r N. /la'IIIIq'1~, ,(I, , 1 ( ~.IIII/q1a:/.N'ralt.lla•1G11 ••.nal.'., 7(1, 77, ~LII. :uw16r1u:lb• in 1tt'culr-Pt o tlal,•S, 711. 77 1I.S. \/•1.'/:111\, 7(i, 1, \Ckilr awvi i// wila•'.1alr., 7/i, i; T.raau.• ulw.l.ial;• /!1, .°.I), 39. -11), 11, lil, (ir, li/i /:'(, ;/I I..I,.a r.. r.qdamiaau/., C2 P.'INa111/11•Y, U.\,, G'~ /:1 /cu Ir1iuK, U.ti. 1)rpai/wwvd o( A{;riculllilc, (.1 1 h ioa/ v bl:llkk•r, ca/arr .1(. M, ny. :12-:Rl \1•.Nlqvi :ald baq;. 17, ul pu•/.aqlw•v, !1, 1/1-•1Y u1,/1. IN/l/ar.•INivr ( 1'ill) :), :rl 50332 8766 7J
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14 152 ( )Gcsity AltLuugh m:wy iuclivitluals cvho have givt•n up sruukiul; rt!lx)rt si};nilic•ant cw•i);hl g:rins, /b(•rt• is nu lut•asnrc•abin ch:m};r ill rc•stiu}t Inrlalx)lic rate in foruux snx)kc•rs wlHi have (fuil. (Silus, L•:. A. 11. h:xlx•riuw•nlal ulx•sily, di/•taryi1w111tYYI IIw•rrlu)};rlu•sis, :rlul Iheir taiuicul iolplic•alicNrs. (:linics i// 1'aub)crirw)logy antl Mclalrcr lislo.5 (2); 377-365, july !t1'161 As)G1yul)iu, Ostm)IN)rosis, Vitaa/i14t tiuu)kiul; is liuk/yl witl/ :u/dllyul)i:r (an eye tli.rcl_W-) anJ (ISt(9)IxwYUtil% (loss uf (•al(•iwu from 16(• (wuly). "Snupkiul, t•ausrs dreu)ges in plasura )uul I(•ukocytc CYNNY•/rIrNINMts (if vNaulin (: alxl impairs Ilicx•ht•urical fruu:ticxrs rrf this vitamin. Vit:uuin 11-12 is uu•talx)liic•d ill thtr clctUSdaalwxl IsrtK•ass of cyanick: ck•rivt•tl (rtuu surokin};. St)uu• L( :Ivy snw)kt•Ix tl(•vc•Icl) cul arnhlycM)ia wha•b is rc- vrrst•d 1)y cilhc•r vilarni/r 11-1" srlpplcow•nlataul cx tcrmilwrtkul of .rrw)kiul;. h:vi(Ic•nc(• i.:lisc/ Ixt•u•ut(•tl sufq;t•clin}; that srrrnkill}; nr:ry altt•r thr nw•talw/lisul of (ipicls, Varlw)Iry(Iralc•s, prult•ilrs, :uul (dlw•r vilalnins sllclr :rs vilanliu Il-R.' ISC 1!)74/• p. 12-Iiti1 nu,i;u(utic 7•(sla '1'(•sliul; uurnsrl ilulit•iclual:, lwd sullc•riu}; frow •auy suu/kin);- rc•lat(•tl discas(• or vey u1/w•r diu•as( , roa•:Irclu•rs have ftumtl Ihat ..auukin); caua'. si};Irificant clranl;rs ill 11x•'Iw)runal' valu(•s ill vari- uus 1)i(Kalruriral :uul cliuical lras lhal uray 1x• cluno ruutirr(•ly in a riiuical hllwlralury." Su(•h Irsts iut•lutlo wl/itr l/ltxxl (•(•II cnunis ( I(i1;lw•r ill .nw~k( r.). uu :uun nw nl. uf u11u•r bliwwl t•unywwu•nla (.uu)kl•rs '•a)uwcct in(•roas/h ill b(•nru};I(Ihin, 1u•narl(It•rit and uw':ul culprlsc•ular cOluln( '). Stluu• slrulirs hcrvc• luuutl higla•r t•hult•s- Irrul levels ill bo:rvy sluuk(•rs; utlw•rs Ilavc uut. Smukin); sc•t•uls lu (lcrrt•asc• c•maliuin(•, albuolirl and };IOhnliu levels; ilx•rcas(r uric acicl. Platt•1(•ts, :1 clultiug fac•tur• ill bl(xKl, go ni) in suu)k(•rs, as do uthrr hltxxl viscosity factors: lihrinu};(.n, plasllul visc»sity, :uul rtx) ccll aggregation. ISG 1979, pp.12-7cJ, 82,133, 84,861 ('arc•iu(x•mbryuuic :urii};c•Ir (CI•:A), a marker for c(•rtaiu cancers usecl tu luunilur /rcalnu•ut, is rluvatcxl in sumkcrs; tlle bl/wwl Icvt•1s /lf CI?A clt•clime 14) unrlual levels tllrcc nw)u/lls aflcr (p)illingsw(Il.iug. A/nuul: thc Surgrnu Ceucral's cunclusiulls: "Tllc u/ajc)rity of ti)c bk«xl cvunlxments clevate(1 duc tu ciga- tiMOA1NC ANI)1'J(P.CNANCY 52 UItUC ~1h: fAISO1.1SA/; ttlh:U1GA/.'I'F.S'1'S 153 50332 8753 wFl/• suulGiul; al)Ix'ar ill lvc•rl l lu:llqanriucll(•ly u4lrlual I/•c•rI. afll•r c(•x.aliOn nf sluOkiul;. ...I'lu• ti/nOkiuf; aalus ul :w i(nli~ i~hr/) ~Ilucll(I Iw im b1~L ~I in rrlwllls (/f c liuic;rl/tlial;uO.Iic I(•.Ic lu•rfurnw•(1 lur Ihal ilwlivilln.ll." I S( : 11179, p.12-fi71 Su)uki))1; (nul Flrt's lo llql), Ilu' Na/Gxlal Fir(• 1'r(>r(ti•li(HI Assut•ia/i(al ( NM'I'.•1) n•Ixrrird tha/ r/urrc• (ahl) /ir(•s :rrr (:u/.4til l.v ('if!:ut•11r. ibau Ilv am• ulht•r srnlrtr (1( ( Irnrlwls/um. 'llw u lilrc Ifhnh in cu/ (•slillr.rlrll V'aMl (b•:Ilhs r:lrll yrar ill /lw• th/ib•(1 til:(1l:.. In a slw.i:d trllalc•.i. (1/ Ilu• ic;nilirw/ nf f:r/al limc IvIMU 1rt11u Ihr Uuk•i:rtHxr (tu Ilu• I!1;1 167R, the NF1'A 1(anul lhal c•igarrll(• tauwti) Grvx acc•(wu/I fln• .f//•2 (x•r(•cul Uf fatal fires willi klunvu i},r1ilNql Nu/rCCx :uul :1/ J(w•/tv•u1 (rf cOrntawxulinl; Grr tb :r111s. '1'lu• u(•v/ h•a(linN ar(•Kk•u/:rl iguiliow/ NwIr1Y• ( Illalt'll, lIj;11t1•r, t•:111/11/•) :w•l•/wlllts ftM• 9.1/ IM•1lY•/1t of /iw• falal Brr% a/u) !l.li Ix•rct•111 Ilf 11w• (irr (Iralhs. M:aly of :ur :11•c(1 n•I:II(YI It/ \Ilw/l: iltg. '1-11(' N;cliuual Fi/r 1'ru1(•t•li(al As(IC•i:lli(ur au:d(•ir(I llw• lm-•.1 cunuuun cln:rs of Gr(• (ui/;ill :uul rlrall•lials ignit(•(1 ill 1:11:/1 lils••. .Icrrl(•tl hy cil;:urtlth in'1':rld(• V. p.'i/. lnatlcli/aul lollw• f:ll:llili(•s,:rrl NF1'A aualy.is Gruu(111/:11 a/ b•a-st 25,(KKI Ixtip)G• were iujln(v) tluliu/; 15177 ill r(•sid(•ulial fiu•x il;uilc•d Iry c•il;urctles alul thal apllrusiuurtuly $313/uillicMl in In(111- t'r/y was lost ill Illm• /i/rst l::Ililnlui:r SI:(1f• Fi//• hl:u.h:ll I'hilil/ (:. F:ct(u 1f•.litird frn Alar(•h 22, I!Tl7 ill tlw• lirsl s(•xsi(nr nl ll/r Alrwvi(•an ('auw•(•r Scw•u•W. Naliurlal (:(/uurri.siun twl Snw)kiu); an(I I'ul/lit• I)ulic•y, hcLI ill 1.41% Anl;rlr., Ihal of uuu•1• lhau l.`3 ulilli/lu /ilrs i/) /lu• IIni1/Y1 SI,1v, ill 1975, :Ilwull 19 I>,•rcynl, or 225,/KK1, w(•rr caus/•(I hy slunkiul;. SMOI:IN(: ANI)1'1(EGNAN(:Y 1)lill(: tt11:I'AIt/11.ISA1, ~/ha)1(:A1.'11a I:S .5t
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t 144 tbt cilia-tirry h:lirlikc strut•Ulrr•s wlriell linc airways and Imart, like a waving fir•Itl of grain, Inuviu}; tIN- mlN•us hl:urket arust:uNly uut- warrl. '1'his Irr/M•t•sz rirls 1hr' hlu};• of fnn•iy;u parli/•i/•s. luhalr•d snN,k/• slups lilr• luavt•urt•rrt uf cilin alyd gr.rtlurlly dr•struys 11u•nr. '/lrc r/•spiratory mut•r1s blankr•1 is, it.r•{f, sccrelt•cl by gulrlt•t cclls. When tIN: lining c•t•lls of tlte lunl; ara dt•nrale.ll, tlw rrrru)Ixr of gt>blct cells increases as cl(" mucus prallrclial. Tllis is tluNlglrt to Ix: cNrr uu•ch:wisor that uriliatcs brorK•Ilitii il) s11N>1CCrs. ArN)tlrcr way lungs clear tlrt•n>selves of ftucigrl nurttcr is through thi• at•tivily of nuttrrptihay;r s, a iylN• of ty1) wlursr flux•. (irNl is Irr ingr.t furt•ign Irurlt/•r :rrNl Ir:ulstxrrt il, via llN• bI/NNl or lyuqlh systems, to INKr of thr INxlys cxt•rt•trN•y urKam.s. 'I I/is pnKrss is known as plr:rbircytluia.'11N• adivi/y of /lrc nr:rcroplurl;r•s is'also inhibiteil by cigarette snruke. ISC 1971, p. 17(311SC 1f71J,1l. (3 311 ( Nh/•r EQrcts ol Smoke Two other rlury'cu Ixrs.cibililics of how smoking nury cl:rnrage llre luul;s arc: 1. Altc•rint; l'rutrasc-Antilrrntt•usr Balance I:nqlhy:cr•uul is c•lulrat•lrrizrYl by irreversible dvslrl/cliou of ticsrre, uurinly uf Ibc f)rult•in clastilr, au iuqxrrtant c(1urtNNlcnt of lunl; conut•c•tit•e li.suc. 1?I:rs1i11 c':ul Ix• attacked aua (lcslrtryrtil by enzyuus calll•tl pratcast•s, rclt aa•tl by white blood cc•lls alrtl nlacrtl- plrages, as tkrrt of tlrc Ixxlys 1u)rulal deferlsc mecluurisms. Anti- 1)rotcast•s, fouuil frriunrrily in bloxl sarum, .Wrvc tochcck luutrases. If, fur auy m:l.uu, this balarrt•t• is ut>.Wl and excess prult•:rst• :rcxu- Irtulalrs, it di};r••Is /dasliu, hrrnlanm•/llly rlestrrlys lun}( (issut•, arnl rul:r}(/•s rt•slrircllrry. air a>:u•r•.. Swukiug is Ihr• luaj/rr far•lur ill nllst•ltin}; thc INxlily luilauc•v Iellvrr•n (uulr•au•c an1l alrlilrr/rb•asrh. TINr Ilamagr• is dtNrc to rll:rcrulrll:r};r., tr, tchir•b ci};:ur•11o auukr• is lu.ic. 11'Irt•n Illru. t•t•lls arl• injrn:•/l Iry r•slNrsun• lu sunrkl•, Iluy rlit•. rr•li•asiuy; large /iu;ulli- tir•s of Ilrulrau•% ill thr• IrnNrs.c. Furllu•rulurc, antipr<>tr•auh are iulliirilr•If frrnrl r•uurllrr.ic-tin}( Irrntr•aW• aciil•ity ill Ih:• prrsr•ru•c of c•ihart•l to sluul.e. IS( : 1WJ, (i-'_fraUl 2. (:ou:pruoui..Ly; /nrmuuu• Alrulwni.wns (nllalaliun uf Irrlra<•t•u.r/rukr• IrnNI1N•1•s siy;nificaul clr:ru};rs ill iwru/olc m6•ciraniarls ill INqh :arinlals ;.uul people. 'fFrt• ability of ItiAll'lll'tiITIA• CI1Ul)NIC 1411ONCIII'1~15 ANI) -1•1 (Yr11t•:11 Nt)NCANCIiIi(11/ti LUN(: 1)11EASh:S I 145 50332 8749 m:u•ruphay;cs lu ru};nlf Ih:lt•1r•ria :uld uilN•r furt•il;u sulr.lanl•rw is im- p:lir4•/1 ill snwks•rs, slud Ihr Iirial Iunu1N•r of ur.lrlnllha},~. ik iu on•:1./•/1. (:Ir:ury,rs ill Ilu•ir rr111a.11ur•/ul/• b:rcr:llmr hr I•n Irlr• r•rvrA ill sulnkrrs, wlrit•II clrc ahsrnl ill urNlsuNrkr•rz. I.yrrrplNr•ytrs (whill• r4'Ik )• II/IlN1llcurl i111bv IHM1v'. 1Irl0•n.r syarur, have IN•t•rr nwrw•n•t1 ill l;Iral/•r 1rrlnllw•rs (by hnruan I)r4NN.•1NrIN111rNl/rary l:/v:/}lr•) f//NU srlarkt•1•X tlrall frUlrl INNIN/Mr{:r•rX. 'I1N•sr• rrlrst•rvrrli/Nls iadit:rh• t-1Nrsitlt•ralrl4• physar/4M;p•al irl/- txrirurrlrt o( inunuuc nNV•Iranisuri ill auokers. (S(: 1!!71), tr. tl-:10-a"I ('u)ufimiurr.c .'( a};arr•Ilr au~rkiul:, r. ~ u in y/Nlul; :r};~ lPuolrc, I.r~wllu • Iuul; /l:lwag/•. ( a•ss:llirNl ill .mnLinl; b:uls 141.11 Ir:nlial 1/•tiuh/ lirnl uf syuy)IrNn.c.1'ulnlnrnal). f/nN•liurl a//ul hislrrlrry;i/ ;IINHNrunlilir. havr IN9•r1 I/I/1Prvtrl ill VrNUll, snNrkrrs, t.Nllir/uirr}; t-linira) srr.lri- t:ions of hlult cl:urr:r};c ill 1 his !,r rNq)." ". ..(N1I1/qNlary f1uN•liorral ahuurnarlilivs, lN•lievr•11 lu retNr- st•n1 small airway dysfnlu•lilNl, oc<yrrs (sit•) ill soNrkers ... 11 b:rs IN4•u suKl;csltvl tl/:rl slN•Ir r•haol;rs nulv (N• tnF rn/urrs /rf rrMNr t•slt•/leivt, alhll~rnrit•flulrlirNr:rl :IINNNnralili~s if s/m~lilrr we/e tYN/1//111/Y1.' •• A/uunlN•r rrf Irl•r•/11 inv/•sli};:IINNrs ba\'/• su};,t;r%lr•t) 111.11 Ik•structive Imly; ellauy;/•s ... may rrsllll frunl r•st•r•ss Ii1N•ra1i/N1 ul or feilluc to inbibit, prrrlr•u.Ws ill tbc lung. Cigarette suNrk/• Iars Iet•n denxNlstralt`il to inllfirir a variety of tuuclitNl.c 44 tlu• Iunn:ur alveolar nurcrnrphay;l :" '•Pi1act of IIN• dittrrr•In•r•c in lllo prl•cal:llN•r• rrf r•IrlrNrir• Irn»r- t•Irilis ill s111hjr/•Is Id rlilfr•rirr!1 arulr.Nirar:ll, t•dra•a/i/rlcll, rrr irntiNnr• classes c•an IN• allrihu11y1 In ~lilf~ n IN ~ s iu snaokinl, halril.." IS(: It17!), pp. ti 110•t2) N:Ml'l ll•U':MA, (:1111( rNI(:11111)N(:IlfTlti ANI) (YfIII?II N/rN(:AN(TIN/IIJ Lt1N(; 1)ISI•:ASI?S •1S
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104 1•:\Itl.l:1)I TI•/l.t: rAGr: IutroJucliurr 5 1)angi•rs, lir•ur•Gta, lii•lativr• liisks 7 .4 I htrulalily, l)isability and (:hrouir Illness 1(1 ll Lnn1;C:rniY~r 16 . 111 ( )11u r ( ::uxrrs 2.~ I(r•ar1 Allac•ks. (:irrlrlaliu•y 1)isr•asrw aurl Slrrrkrs :11 V I:Inpli)~rusr,(:hruuit• lir1x1rllili.uud Otlrcr NrNr( :auceruus I.lult; Disr :rsrh M9 Y1 Su1ukiu};:uld Prr•I;Ilancy. I)ruy; Alc/alxdisln. Mcdirall'1'i'st. V11 "Ilu• Slu4rkiliy; I (alril : 1'ryrl/ulugy and I'Ih:u war•utu};y VilI Surukinl; I:rvnuuiir.:uul Sl:rtislic. 46 55 62 75 76 78 tNl 105 50332 8729 1 N'I• It()1)111 '1'I ( )N WiQrin 11wr Irast 15 years, IhC habit of Snxlkillg llrlr:rlYY1-• nraiuly ilr ctig:rret/r•s•-lurs Ixx•n uuivrrsaUy axrrb•uurr-tl by autlxui- tativr- nrrKlir•al grrxyrc arul kuvr•runx•ut uaylK•al ydliarrs crs a h•arlinp causr of rk•allr alxl a luap/r puhlic h/•altlr prr>t/lrm iu /1i•vr1oqH•d ryrrudrirs: :k "As iulprxlald a cause rrf /N•alb as wrrc thr gn•al ryrirlrluic rliusascs that aQcctrx) nrr•virxls I;rrH.-raticrns iu this ctiulnlry "( Ilrilis/r Royal College of 1'hysicialls,1ffT1 1/ * "The largest prcvcntabb <ausc of death in A»Hmica "(Scc• retary Joseph A. Califauo, Jr., U.S. Dcl>artnrcnt of Ilealth, f':drrca- ticxr and Welfare,197fl1a *"No kwgrr any drxdol.... a nrapx alxl rrrlslinly rr•nMrv:rhM rausc of ill-lu•a11h and Ixeroahrr/• dredh." lWrxal llrsrllh 11rl;:urir:~ lion, 197Jj'1 '11rc Ixulx><c nf Ihis INxrklrt is lu sulnurarizl. Ihl• lalrst in frulualiarr ulm/r1 slrxlkiuk :rnd lea/lh, derived frrrrn 1h/xrs:uals of cpiacmiokrgical, biological, hllarnulcrrhrgical, patlNrhrRical a1N1 other studies. 71W present lxxrklet is an ulxlatc of llrc fxre puhlislrrd by 11re Anrcrican (:ancrr Socirly iu 1972 undi•r tlae title "7'hr 1)omgcrs o/ Srxuiking, Tlue Iicrrcfo(s ii/ Oliiffirrr;" s.•lris•h suurraariied key s11xIi/`s, IMMrks, 411141 ru:rjrrr .urvr•ys .Iauliug wilh tlral rii thc lanrl- urrrk rrlxrrt Srnakiug arul IIewIth of Ib/• MIvisnry (.)nrnritler tn the SurRryxr CeIx•ral of tlu• U.S. Public IIc:11111 SlhvKr In 1961. UOn thc 15th anniversary of tirc famous 1!)(rt reyxlrt, Jauu- ary,14rlfl, thc Iu/•acnt Sur};<xxl Ceneral, Julius B. 1ti/•hnxxld, kt.D., issurYl a new report titkkd SAf(UUNG 1s IlliAl.Tll crrnqx/sr•d of 22 detailed sr•ir•ntiGc papers conlpilrd by 12 al;rlx•ies iu Iho I)ehart uN•nt of 1lealth, h:rlucati/xr aurl Wh•Ifare alK) rr•virxwil hy si•irnlistc rt•col;uii.cd as exlxrrts in Ihr rlillo•Ir•nt fti•kls. Tlrc then Scc:retary uf 111:%V, Joa•hh A. (:alifalNr, Jr., a•nrtc In llre introdrrctial that thc nr•W report "dcnxrlishcs the rlaims 1. S"nkinR v Irt.Nb Nwv, flepaA d Rur.l Cwd{rp d I•AyskYw.r law"/INw.w h1A{.kfwg Cw.,1.wwMw, i.w/l.w.l, 1971, P Y. 1. Swwiiwa As //r.lYk, Aorpwr ar /4. Sa.arm r:.wr.l. Us. Uryd..r I1e.11h• F.Iw-.44M A WeY..e, W..M4Oa... D.C.. U.S. t:wr.wwrw P.iw/iy{ Ix4M'"". 1919. Y. N. 3. C.wlfulliy 14. SwrJ~iwR iywM«.h•. \YWI.I III-~h IM/4N{m~.~,.w, CMWva. ~wN/IIIM.r. 1979. pp. 7•8. 3
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, 50332 8737 120 121 Tal,lr 11 .4 ~ PERCEN'P OF TFF.NAGRRS WIU) ARE CURRENT CICARF"1'r!r SMOKF IiS FOR SN:LEI'1'EU YEARS IN TI/E l/NITE:1) STATF.S Percera smokrrs ages 12-18 Year Cuuis ROYs ~ 1908 '8.4 14.7 1 1970 11.9 18.5 : 1972 13.3 15.7 ~ 1!17•1 15.3 15 x ~ Suun•r•: Naliwud Cl,vtrinl;ltuusc /or Suu,klnti a,ul Ucoldl. Puffrrns ulul Prccalcntr o/ Tren•ni;,• Cigurcfftt Suu,f:inq: 100, 1970, 1972, arul 1974. U.S. DtyxuNur•nt n/ Ueall7r. F.rlutwlion. arul Wel/ara. PuWic !/eulNt Srr• vicc, !a•nlrr /ur Dixr•au• CrnUrt,l, l)UF.IS' Publication No. (IISAI) 74•8701, July 1974. •1 pp. I uslsxivr rtllullw•rs (I/ Iill,•r liitiwvl t•i);:Ir/•111 ~ Iw11Ilr :L.uwldiun 111a1 Irnw,riul; s/wur t,( Ihr Ir.lllit•ula1,• /nallrr (lar) :Irn1 gaw•s I/nn, suw,k,• txl/;lll It/ Itrwt•r llw• risl.. '1•/wl:l)•, uw,rt• Ihcln !Ml.t{ Iw•r,v•1r1 u) a);n, t•il;:a-r•Iirs sr,kl irr 11x• Itailtvl Slal,•.:Irt• lillt•r lilpwvl; -1:r v,•ar% (illr•r /ips rt•Irrt•a•rrUvl lrss /lr:ln 11n,•1• Ix•rtrnl uf 1ht• nwu lt•1 %l:lnl/ /:u•lurrls Ir:rrt• .It :ulil~ 1•1sm1,/ tl /br t)•Iw•. ,ri It,l,:n, n in 6 ,r, :uNl as a re.ull Ira.r tlrrlr:lst•t111w• :Illwxl/i/ /ff lar alwl ui, „Iirn• in all hr:uuls. Tlul... Itxlay m:my Ixaluls willrtNd GUt•/. .r,ir/• ,d1 It•.. /al i11N1 /IitYltilx• Ilrall Mrllw• GIIt•r-ti1Nx•tl lxarKls tlitl a tloirn y t•ar. agn. ( Scc 1). 22) h'iltr•rx: l.rml;-7'r•rur Ilrnr•/if Ilu• I/wq;-lrr/u Icw• ( I/l vt•://\ Iw' I/wwr) /11 (ih.•1 a.aw•ialrtl wilh (tnvt•/ r1t•all/ ra1/w lln/n 1//u/, t•:uw•4•1 Ilr.u/11ha1 a•c... t•ialtvl Wilb:ur tvl/la) u/ludwv „1 n„r11il1/•r t•i/,:rrt•/lr. '1 hi••,•.ww•I,t•.i.wl t'/,nw•s frtwrt a rrnmlx•r t,) stu.li,w. Irr a struly u( 552 palirlNs Wi1(r lunp, t•:Ilxrr uulh•Ix•r1 Willr 522tvxrlrolx,Wyndrr t•1 al. f/xlnd 11wd llant• wbt, h:ld swi/t•Iwvl lu fltr•rs Il/ yt•:Lrs t•arlirr ha,l a Irla•,•r rixk uf llnlgt•:uw•,•r Il/.m Ih„s,• tvnUinuiut; In suwau• 11x• s:rnw• uuurlw•r tlf Iw/ufiUr•r t•i9:IrrUt•s. (S(:1M1, p. `375.1 Turrmd Nirt,tinr• (n a rtvv•/d l:1rl;.• tn4,%lwr/i%•r s/utl)•. !i!)7;K2i nw•u :Ilu1 a nlum•n snrtrkt•rs in 23 sla/t•S wt•rt• tlivilh•d 6114) ll/rlr t•alt•pnil•. :u'r/w,liul; 10 tar alal nicvdilw• Irvrk', aud rrauuottil wil6 rt•.Ixrl l,r (luq; t rr. '1'l ll . art r lt • msu • . I lna u / '1' • In a ld I l , lxllv °a l lirlrrlilv Ri.ckx a/ 1 euv Tar For nlalcs su/qkinK 11m, soluw nulnlx•r r/f t•igart•Ilrs Ix•r tla% •. llw•rre aplxarrs to Ix• a 19 Ix•rcrnl rt•tlruiiwr in ri.k n( ,Ir.•,•I„I,in); I/ul}; t•:rrxrr wilfr Ilu• u.v trf Itta•'I•/N t•il;:rrelit•s. 1'n/ I. nctl. c, /h.•1r is a•1(1 Ix•rcrlN rv•tbu•tuwl in ri.k. I Imwt•vt•r, irr a st•I,ara1c ur.lluhr.l }mwlp :ulal)'+is, Ilw• rrulnlx•r /,( t•it;:uctith suw,kr,l 1>,•1 ,I:ly %.•a. (twtnt) (ir I«• rt•lalivoly nw,re i111ixw'laut Iharr Ilu• 1:u' au6) nicidis/r cvuult•nl of cil;:irr•lles. In llu• last 25 years. there bas Ix•t•n a};rt•:rt tlr,qr itr Iht• lar antl uicotinc nxllt•ut u(11w. snwlkl• (rtxu ci);:Irt•11,•c tvrnsuln,•/) in Ilw• •11kM /u .ml wir.d««• (Y'/N ): 2 1.4 /« 715.7 /«1(. 1«.: !.w I« S_7 lak. 7:•N: 17.6 1« 2.5.7 «.r.. Irr• 1^. a• 1,t/ ,.y 'I' N 1.•.. 11.... 1: ~: «.r. 1... rrl 4•+s /lu.w 1.2 «al. «i..1w•. LIINl:1:ANr:N:H 21 20
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• 118 N'il;urc 2 10 -I 0 ~ ~ ~ ~ ~ Ex-ciRarCtte slnOkrTs I I 1 1 5 10 15 YEARS SIN(:E SCOPPING 20 Fig. 2 Relatiwrs6ip between tiNr indcknoe of bronchial carcinoma and time since cigarette smoking was stoppod, compared with the relationship in continuing smokers and naunwkers. Sowce: Doll, R., Practkal steps towards tlNr prevention o/ broncldal carcinoma. Scot. b1ut. Jd.15:438-447,1970. 18 itlt( )N1:I l1Ai. (:Alt(aNObtA t:oMinuing Clgaretto smoking • i I 119 50332 8736 lunN c:mrvr dcath rate is rising fastr•r trKlary auaxi{; wuutcn Ili:ur a11xNOr riN•u, a% NNxr :rurl uxxv WuuN•ri SuNrkriS upwi- irrtu thr are l.r4x1irs ill wbu•h luul; r•:uNV•r IM ~~xnrh prr~aN ul. 11tnyal, (qr. roI /i11, 11: 1971.1>tt. 1'it-25ft1 lu 1'KN, burl; carNrr a:rc tile Gteh k:ulurg cauw• rd rk:r/h frrMU carN:er iu U.S. wrNrN•n. It rrbsa to fiNrrtb (4actir in 1'X1l arNl irt third plac•c in 1f)fgl, 1):Issing t:arN'M of tile rricnrs. lu it)77, IunK c•aucer nrwtality passed that of carNxr of tile c.lklis arul rc•c•truu as tile secvMUl k•adiug c•aruc of ckatb fraru caucrr In U.S. wrwrN4r. If prexent trends are iNrt rcvcrsnl, ekiring tile rN•xt ek•e•ark king e•suuerr will INxsurN• tiu: k•adinK c•ausc of canrcrr nrnrtality iu U.S. wiMIN•u, exceeding deaths friNn cance.r of t1N• IKC•ast. Sex ni ff nrciN•et in SuuA-in/; An English ckrctcx cak•ulatrd in 1984 that tile lifctinu car,- surnptinn of cigarettes anNUrK •/7-ycar-okl ux~r was frNU 1iuws as great as auwnK 47-ycar-okl wrNrN-1r, arxl that the nraks king cancer dcatb rate IxNwcrn al;cs 45 arNl •>19 was five IinN.•s as great as anNNlj/, w/NINMI. /itrryal. p. (il/.l'11N• ltritish note that snrdcirg has lx•cn iu- tYPNslnl; nNN'1• raiN/lly a1/NN1}; Itrltlsll wlNiK91 llran aNNNi/; Itrilklt IIN•11. (1t11'•al Il. M.1 7 ixlay, althar};h tbcrc are still tcwcr U.S. wcNrN•rr suNrhing tlurn U S. ux•rr, tIN+ gap is r:yiiclly narrowing. Cigarette suN>'kiug auuNrl; U S. tecuaKc girls has IN•cn increasing stcadily, su that as of 1974, cequal Ix•rcentagcs of Ix)ys arul girls arc gmoking cigarettes. But there have INrn rm•nt declines as slNwvn in Table 11 on tile fiarGrwiuR page. Over 11N• Ir:rst drti:uG•. t1N•rc lurs INerr a 2.6 iN•rrrol rlrru :rW iu tile nondrer of adull I/.S. (cur.rlrs who snarkc cigarr•tecs, sc•her•c:cs tIN•rc lurs hccu a 13.6 iwrrrul nKbrc•Iiaur, in tire nunlxr rr( adidl U.S. uuak•s suxdunH cigarettes. Filter Tliu 'll1c public Ixrgan Itl IriYYN••c aware of tile cvaurcdias !x•- twccu cigarettes and lung cancer and otiNSr diseases in tiNe early 19S(Ys wilh the lurl>ficatir;Ni of tile r-rlir•st prospective smoking and lN•altll stININ's. 11113 growing awarPllN ..i has had a strong imp:ct on (11HS s11N)kini( haI)iIs Of (1eYr1)1/• all over the wrxki. In tile years in which key studics and rclxxts were i.ssucd, tlNeve wcrc drops in tile overall cmurunptiun of cigarettes. Ancl sowken have swildicd in LUN(: (:AN(:h:1t 1{1
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1L/ , - 127 50332 8740 A nn1u1N•r of (Ings tli(•11(Inrin}; lln• t•alN:rilurnl. hot uunc was a nullauukrr. AI 1iu' ('n/l uf Ihr rXtM'1111N'llt -IO tl/l~~ \\Pr( xa( riii( (11. A I/lulllN•r u( /unuas \v(•rt• fiNlrnl ill Ihc hlnl;s of Ihc aniuclls. 'f\vu uf t•il;ht IluusuN)kiu}C(Inls (2'i'F) hatl lunN)rs: ftNir uf 10tlny;s (41P1•) wiwarlN)kv(I (ill('r-tipiN'(I cil;:lrc/lt•s ha(I Ib1nN)rs; livcuf 10 (5(r.t) of a};roup of uuniiltrr sun)kcrs (.vlNl suuaa•d tudy Ilall as Irlany ciga- re11(•s), and 12 of 12 ( I/llO) uf tln• fllll-(i1n)ta INUlfiltt•r group, had Itnnur.. UO(' ilrtCrcaillg fact: 11N• (udy inv:IsivR tllnarrs were ftauNl iu full-quota uonfiltcr snwkcrs, :uul two of these were carcirlcunas similar to tile type I1NMt Oft(•11 sCen in men. Lkol{s' hlnis were also anal) iml for clnirhyscnla, and tissuc ~ an(1 ccllular cllaul;cs. By far 111c largest nurnlNrr of Imllw/logics werce found in thc dt>ls who had sualkccl tile full quota of n(fisllltcr cii;a- ' rc•ttcy, considerably fewer in tlu>sc who snlokt.•d only half as many nonGlters, very few socll changes in Blter-tip smokers and none in tile rxmsmoking dogs. Comparing the results with t/xuc of studies of l1M brngs of Incn the authors conclude: '. .. the types of histohogic changes procluccd in tile hulg parcnchynla (main lung tissue) wcre f(icmcl to Ixs the same in tile Ix•agIM as in nunl; in both species therc is a dcuc relationship; in 1Nd11 ... thr d(q;r(e of daula};e ... illcrrases willl incrcasing (Inr:ltiun uf cit;ar(•it(1 sunlkiug . . ." I:xtrapulatiug t11c bcaglc study tu wan, thc autla/rs stale: "h•indings ia this siudy sfruui;iy suµ(r.st thut suluking (•ii;art•tlrs Initlt (u/ CQcient fiUcr luill iu(uluce less damage to the luulum lurlR ixireucllynla tlurn smoking irlcnticul cii;urrti(•s (aillun(t ((Ilcrs" (autlwrrs italics). (llalnuuwd, E. (:., Aucllzlc•h, O., Kilnl:ul, 1)., (:arGukcl, 1.. Elfccts of Cigarette Smoking un D)l;s. Archives uf Envilunux~dal Ilralth, 1)(•t•rnnlu-r, 16Y1(1, p. 752.) Pro-Smoking Criticisms 1)(•fi•INlcrs of ci}i:)rrl/r sulukiuf, raisc Illn•e (dlhor (/l)j(r•iaNls to the cause-an(l-elf(•ct r(•lationsllip (xNwcxn cigarettes and lung cauccr: Objection 1. The evidence is olly statistical. Answer: This is not true. I llmdre.•ds of epidcnliologic,ll, ex- ix•rimcntal, pathological, and clinical studies all Jclnalstrate that cigarette smoking is hai.irJotaw llcaltll statistics are tile hasis of most disease contrul. And all biomedical rescarch, whether in cxixrrilnt•utal anilnals or lluman lulpldalious, tnust use statistic•a) t(•cllniclucs to analyic ancl rcach S(NIII/l, R('1(•Illifl(' (YNN'I(1S1tMli. '11N• Royal (:ull(•l;e of Physici:ols 1>rlints (ult: ". .• it is 1>,Is sibl(• to (l/xcrva whal is, iu c•Qcc•t, aul cttu /inN u/ in whi(•1/ nlilliunx of Iu:c>t/le who have Ie(hl snlokiul; cil;arcitm often tl(wcltrp lun/; c:nNrr while millions of others who have al)stai/rctil schia,tn tlu s(> " ( lioyal, p. (il j (1bjrdion 2. 11re asstx•iatiinr is tNNlslxY'iGc irr tlr:rt nrany different discau•s are associated with cigarette solukiug. Answer: 'Ilw great fog of 1,(xlrMn in 14152 increased the tlcatll rate for rnany diseases, particnlarly respiratory and rnr(xulry discase. Cigarettc sn>,)ke, likc tile I nNNI(ur f(>K, ls nnt a xinKic cIN'llli- cal, M/t t11cu/.satxls of clmrnicah, many of thrnt krM/wn to /H- harln- ful. It is unreasonable to suppose that cxlxrsure to this range of chemicals wouW increase tlle risk of only orre diaease. Objection 3. The genctic theory: pec>(s1e inhcrit a terKlcrcy toward lung carlcer aucl a eksire to sux)ke cigarettes. All,swc.r. While thcre are sarx: luyc•hobgical a/ul physio- logical diQcrenccs l/clwrcn snm)kcrs and Iwxlsrrsclkers, tle'rr is no evalcllcruf an inherited kyulcllcy 1n.vard IunKc•alu•cr. Wln•11 ulalny British (kx•t(xs sl(qil>,•cl snw)kin/;. Ihs• lunl; calxrr (b•a1h ral(• ftx that Imufc•ssiou w(iIt duwn-\\•hiclr c/mtradic/s tllc prenliar of an inborn th•sire to suwkc., a1Nl an in)wrn tendency to hlnf; cancer. (Nl/cv easily dispruvallla criticisms arc: 7bat the rise iul lung canccr is fictitious, carwKl by hMtcr cliaf,nuuis; diaprooc•tl hy the fact Ihat the rise has been greater in /IN71 tl/all ill \Y(u1N•11, IN)111 IN•Illg (i1:Il;INos(`(I IIN. sa11N` way. Ift(/yal, 711at llfe ri.a• in lulll; ( au(rr w:ly Il:wc rccuh(-f I frnol a fall in tile "17i (I(•alh ratr, (li.rprov('(l by /la• fac'/ that while Illc fall ill 'IB ultlrtalily has INxn greater in \vluncu, thc rise in lun}C caru•(•r l/as 1NY'll grCa1Pr ill IIK /1. Some C.orurlusiorls l. 'Cigarcttc slnoking is the major cause of hulg cancer in Ix)tll mcu and wolllel. Tllis fact has Ixv•• ~r-t)fx)rt(Yl by pr(ulxrtive aucl retrospective ('picl(•uli(/l(1};ical sludi/•s, clinical st»dics, autnpsy stndics, and cxieriua•ntal studics in anilnals. 711c a11N•lusiOn is I>ssccl al eviclelce which exc•cecls by several tilru's tile cvulencre available whcn this saole conclusion was first reached in 19M. LUNG ('.ANC:rat 27 26 LUNG CANCEII (
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RISKS OF SMOKING pisk: ikorlaera NN oxpedaecy. 25-year-old 2- pack a day sarokas have tl/e I expectancy 8.3 years shoria than non-smokkrp c0otam poraries. Other smokirg levels: proportional risk. Olsk: Lwp aeca. Saiokinq cigarettes "Nrljor caYSe k1 both men and womal." (SG 19791 Nsk: Laryex ra.ca. In all smokas (including pipe and cl0ar)0's2.9to17.7Umes that of nonsrnokers. Risk: Moetk caaer. Cigarette smokers have 3 to 10 times as nrany oral carrcers as non- snwkers. Pipes. ciflars, cherv- Up tobacco also major risk lauors. Alcohol seems syrxrpistic carcinogen with smoking. Bisk: Ceeca of esepMayes. Ciyarettes, pipes and dyars Increase risk of dying of esoph- ageal cancer about 2 to 9 times. syncrQislie relaliar.s/Yp between smoking and alcohol. Risk: Curca d klsW.r. Ciqarette wwkus Iwve 71o 10 times risk of bladder cancer as nonsmokas. Also syner9istic with certain exposed occupations: dye- stU1/s. etc. Risk: Cancer of parwreas. Cigarette smokers have 2 to 5 times risk ol dyinp of pan- creatic cancer as noaumokcrs. 108 BENEFITS OF QUITTING lnft Radom rWce/ prewtrra ~atk arm+dathrcty. After 10-15 years. ex-smokas' risk approaches Ihat of ltase who've neva sawked. Oeu6t: Gradual deaease In risk. ABer 10-15 yars, risk yprackes iVt M Ikou rrM eerer s.okal. teoest: Grabwl nwcU.. ol risk after snakbq cessation. Iteackes eorelal alta 10 years- 5er1e01: Reducing or elinnkrat- irq snwkGr~/drirrklrq reduces risk in first /ew years; dsk drops te level of narsewkers le 10-15 yeut. •eu0t: Since risks are dose rdakyl, rwtikmnq w daninab ing saroking/drinking skoW kave risk-retaed.8 ei/ec1. Beedp: Risk decreases 1radeaNy te /lul.l w.- snuken ova 7 yeus. sewQt: Since thae Is evidence of dose-related risk, reducing or eiinrirwtinp smokinp should have risk-roJucinp effect. RELATIVE RISKS: FILTER-TIPPED, LOW T/N BRANDS ONend risk ei reatk from calahr diseases (see below) implies iacreased Mte ex- peclancy- FilUr Vps rNen dsk, but 0 Is st10 5 tfines that ol rwn- sarokas. Low T/N Orands reduce arale risk by 20%. /enale risk by 40%. FNta Mps nrauce rNk 21 to 19 MnNL No iderUi/ied benefit RISKS OF SMOKING Iwk: Core.xy keal 0lsase. Ciyxeqe smokkg is aWor tacla; res{rurrsibb for 120,000 excess US. deaths kom corarary heart disease (CIW) each year. . tisks: Ckreelc krackqls aM prrkN.rlary.arNrysas- Cqa- rette smokas have 4-251irnes risk of death from these dis- eases as nonsmokers. Damage seen in krrqs of em young srpokers. Oisks: Ei8liMlt eM few ikllr- weigkL SmOkkrQ nl0thers have aare stUiWrths and babies of low Dbthwei0bt---Inore vulnerable to disease and death. IUsks:1310dru1 o/ saroktq erolhsrs sma0er, waea- revdepN physically ruw s.daNy. :•ven yeus atla klrlk. Risk: hplk rrlca. Ci0are11e sarokers get nwre peptic ulcers and die more often of Ihcm: cure Is nwrre di((kuq in smokers. Risk: AMeqy ur krrpairwe.i ./ Mwiw.e sp/wr. Risks: Nias pkar.uolo0k eqecls of warly.edid..s, IIa4.esUC lesls aN fireaUy ksaases risk oi Uuotaiosls wUk aal c.elruepllvos. 109 BENEf1IS OF QUITTING OeeeNt: skaryly Oureasa rkk aila eee year. Aila /0 yeass ex-sNwkas' risk is sanra as that of Ihnse who neva snrnked. OeeeOt: Cwyk aM splrpw dsaryear durNp first /ew weeks. Lwy IneNim wary Mprove and rate of detakora- Uon slow down. BeuW: Weu>err who stop suakirg bcloro 4111 month of prewwlcy epwbrue rist el slipkirik aY k+w WtMwdqkl caused by snwkkq. •eadtt: Sbux chGdren o/ non- srnokbug nwlhers are bigger and aare advaxed socially, lu(er cnce is lhat t+o1 saekby tinrley Ne9eaecy rn1yM/ avet/ sock lultaerdeyeloped ckNiral. •eedp: rx saakas get uc/as but lhosa xe.ore Mkdy to kcal repidly aN caepleteqt thair those of smokers. Benefit: Since Urese are dired, MurNnN:Na c//ccls rd :.uMskMyl. Urey are obviously aveibkle bY.ol smokky. Benefit: Ma/aUy N kloorl cotwpo.e.is devoled by smek- kN reWre N.orreal.fta cessr,liotr. Nonsnakers on Pill have nN/Ch lower risks of Ihrmnbosis. 50332 8731 RELATIVE RISKS: FILTER-TIPPED LOW T/N BRANDS Lew T/N.ale senokas ka1 12 pruN klwa 010 rab, M.na'de kow r/11 snrokrr:. 19 pcrmrl knwer Iharr Mqb i/t! anrvicers No kterdiliM bcireGl
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t 150 A(lu1t lli•ur•titun ftr Puuxiur Suupkilil; Irl a!f)7.5 tvIc•liliune surw•y, ss)lukcrs aucl Iluusmukc•rs wclr :tsketl: "Is it :ma:yinl, /u Ia• urar a la•rscm w•h) is srm)kin}; t•igar- t:Itt•s?.. •1•hirl)•divr tH•rt•cnl uf usrk• xua/kc•r:s )rnd :34.5 Iw•ret•ul of frlualc• sua/ktxs replied "Yes" as did 77 pt:rc•cu/ of ulalrs :nul Ki/.5 parc.•cnt of fcuutlt•s w•lut had ru'vc•r sn>.)kcxl. I:QtY:ts of aurhicmN suulkr vary w•i1b 11w iutlivirlrr:rl, rarrgiu); frcan uruwr cyre s//ul throat irritations to al)Kinal atlac•ks. /Nati<uurl ( 2r•arinkluxrsc fcK SualkinK ur)d Ilrallb. Aclull Use of '1'alraccu, 1975. US. Urparlna'ut of 11ra1111, !'alrrc)dMat, and 1Vrlfsrrr, Ihrhlic• Ilraltll Srrvirr, Center for 1)ist:r.k• (aadrnl, Brrrr.au of Ilt:.rlth 1?clru.•alitsr, Na/iurlal Trl..ti- tlrtrs of I/t:rlllt, Natawral (:alu.er Irrstilulr, Natiurull Clrariu);Irxrsr for SnK)kiug alul I It:alth, Jr)rue. 1976,21 pp.j Ppssir)r Irllialutirnr iu Cluldreu "Thc risk uf a ytAr/lg Il)fal)t developing IlrtAl(:INtls or Illa'1r- rnonia in the first year of life is duublrtl if its Ilart•nts xnalka. 'I'lrr risk is 4u:rcasrtl if lln• il:uerds :IIsNI cY)N}(II ar)d pr.tKbare td)b•);nr. Wlavziul; iu chiktn•u ap lu agr five is IIN/rC CINIUINMr if IIN' Iwarrnts snaikr. A stucl) ui 1,/NN1 I'aris sa iNM/k Iriltlrro aral sto(k•ids a/;rs 1/1-^II chuwc cl 11~:~1 a~lu~~itl~r/~NUV ancl/ur luusillrvtcauy, r6w1.iclrrr4) as au ir)clt•z of rrlx'alrcl uplx•r rrspiratory tract discasr in rarly chiWluaxl, vv.is vt•ry si/;nifNrautly rc•Ia1/Y1 tt) tIM a1luAlnt O( xnN/1Cirl}; by oac•It Ir.urnl. I\1•I I( ) 1979. 11.221 1ulcrracfiuus u/ \wukint; coidt ( ItIN•r 1uGshtla'c:r Si/arr t•ig:)/1•114• srla4r i. c1 .•uuqAr% Nci%lulo tuf rlu%irlus sul) staucrs, it is nul sorprisiu}; Ilral it t•ao alfrct alul bl1c'rat•1 willl clrngs, ItaNI IYHI\Iltl)t•uts, :tta1 rrslaaviex to tlia};/ustic• (t:sts. 11/ut•1s of tbc c•xlurriuu•ntal svcu'k iu nuw, :uliwals alul lissuas iuclicalc•x Iba/ llu: tluwin:uil tlrul;-ir)trracliuu uQc•c1 uf smokiny, invulvt•s r))zyna•s iu 11u• livrr. I'hc luir~ li~~ w+il7'heut/hylilu• Ihc• Irc•ilurucy uf allrrt•cl clisl>,/siliiNs ancl ph:umncolu);- ic:J c•Ifvcls cif m:wy ttinr)na/u dru)s iu sualkc•rs makc• it aJqlamnt tlml cipri•ttr siuipklls/; slNUll/l Ia• c•caisich•rc•cl :IS /Na: of Ihe Ilriowary sclurcxs of clrNl; inic•raclious iii man." /S(: 1979, p. 12-23j As ona esan:pic, stutlics ill 1n:al :uul anilnals y;ivt•u pIu•rlutrlin, :1 (YqU11aH1 lr•ull killc•r, aa,tv Iuwrr Irtrls u/ phc•Nac•t•liru iu mawkrrs lluau ill iu/rr- SMOi:ING ANI)1'lil:(:NAN(:Y 50 1)1(U(: l.'1'A11(/1.11it, MI•:/)I(:AL'17•:`T:1 M 151 50332 8752 snalkrrs. Ito•warchc•r% alirihulec) Iili. 14) iuerrasvcl ua•IalN/linlI fif IIw 4In:l; Ill• 4•ni1'u:r,%. "l:it,an•114• aulikiiil; ur•y rl4•cessilalr ImNli /k•aliun uf 4Inil; Ihc•r:y/y :uul lalrr tal;mn fiaorlicab ~>t Ic sl>,a~.i.~ - IS(: I'17l/, It. 12-.^.RI '17w dusinl; uf 11ay)pll)•liur, a bronu•la/ dilator wi11t a iulrruw• lla•ralx•olic r:at);r, is srriur)sly alft•rtcrl by sualkin};. Anrtlgrsu• cuul I'xVcduNrupior /)rul;s "Sualkrrs differ frorrr rNHrsnN)kc•rs in IIN•ir lxrbr tlu'c•slulWl, flsyrlNRWM/M/IN` l IK1r:N 11•rI511tK aocl clrug cyalsnuyltinn; lla• pn•s.•rar of xuf)x/arux:., sla•h as rru'l/lira•, w•6inc (;tucr tcnulx•tiuKc)r adclilit'r llllannacv/loy;itsll r/ft't•Is. ul:r)• txruqdiratr tlu• ac•lic)n of clrrlgs ustYl in troaliug pain or anxiaty..." (S(:1fl70, p.12-05/ Afari jua/as ltlarljualr:r srralkiu); als) alftrts liver cozylnrs calrNx•rlutil wilh tlrro); dislio.ilicar. 11 Il:rs recently lartil rxtiuralc•tl that 13 Inil- licaI IHtit1)Ir iu lla• (lrlitc•d Slalrs rlutv s)lalke tu:uijtr:aca. (Al)rauar- wirz, N/. (1{clilor), AlcNijir:ru:l. A/(•clir:rl le•Ilrr 4141 "I)rrll! :mcl 'l,l)rlalw•Nlic•.. Iti ( 17): /i'.l ill, Anl,usl I:1• 19761 'I'l)c I'il1 lu 11r13, a rrlw)rt wes pNhlishc•cl slalin/; t1mt cti};art•Ur snalk- iul; mi1;h1 vrlll:ua•r Ibc• ria, c1/ tllruullNa urlMdislu ur carcliutasc•ular disrasr iu w(uIu•u w•lu) r)sc• tn'crl c•ulrlr:u•c'Idivrs. A xuhWyurrd r.•- IH)rl slN/wcti) that w•rlua•o wiul ItM,k Ilu• pill :lu:l suulkc•d c,ia• tca"k a of ~ il;n~ 11~ s IN-r clay lca4l :1 .^AM) lwo a 4 •rll iut•w::.rt ) ri.k sit a>Ilu/ r. 1(:oll:clabralivr (:nalll fa)r /ilr Sluth• nl Slrukr iu 1'cwr)/l; \1'caiw•u. Oral ccndrac•t•Iltiws cuul slroke iu yuun); svuuN•u: Assut•i:rictil risk factors. Juurnal of tb(- Ana'riu•an Ab•tlicrl AsscKiation 2'il (7): 71li- 72y, Frhrrlary 17, 1975.1 In anollu•r sthuly of ornl cyndr:ati•Illivr cr.rrs, tt)e 1rl»livr risk uf lawl auurks irN•rc•asc cl Irwn 1.2 irl vvuNa•u sua)kin); fi•wrr Ihau 15 c'it;:urltrs a tlay, lo •I.1 its w4/NU•u snu/kiug 1510 2•1 c'i};arrttrs a tlay, aud to 11.3 ill twnu••n shulkin}; 251N' /1aNr riy;arrllrs a tlay. (Atnnu, J. L, Vcxsry, A1. 1'.,'1•INa'ogcwwl, AI., I)oll, It. t(lycx•:udial infarctiorl irc ycaml; wibna•u %t ' I>,•tti:rl rrfc•rria:r lo oral mntractiplivr I/rac'lic•r. /1ri1i•1/ hlt•clit•a) JurlrruJ 2: 2.11-9_.15, May 3, IS)7.i1 A third slwly shciwt•:1 c•xtrss anuual cb•albs of I IH•r 1Q1KM/ fnr ur;4l tYHrlratrl)tivt• usc•rs wla/ h:ul yrlil snalkirl{; aucl I la•r 3,/MM1 ux•rs wllo cslutinrltKl lu sualkc. Sf.N)t:INC: ANI / 1'l(F:(:NAN(:Y 1)IU1C RIF"1•AIIc 11.1SA1. r.iFa)IC:AI.'1'F:SI:C 5 1
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I 128 3. "I.uug c:uNY•r nwrlalily is incrc•asiug itr woUNSN oorc rapidly lhau :rny ullw•r cauWr of cll•at6. If prrs/•nl In•ucls ctilulimN•, lunl; c:uNrr will IN• IIN• Ir:wliul, /•arow uf cancyr cll•ath anruug w/Nnru in IIN• uc•xl cicti :wlc•. 5. "'17rr WNr};-tc•rNr uu• ( ll/ y/•ars or NNUV) of filter c•i};:u-/•Itcx is associated wilh lower .u :rtir ral/•s (r/Nn lung cancer tirau tlw,.sc• uf Ix•rscNrs w1N) srrwlkc• an cylual uuNilx•r cd rwwr611c•r ril;arc•Itr~s. 6. ". ..'llu? risk af Ikwrlrqiuly, IurrK c.rrxrr for c•x-srrw/kcrs ek•Ix.•rNls orr tla• tylxe of snx/l:ev Ir.- or sIN• used to IN- (and is ixlpwx- tunral ) lit the numlr/•r of eil;:rreIttx IN-c•vicarsly snwrkcyl lk•r d:ry, Jc(;rc•r of iuLalaticNl, the agc when suN/kini; wcc.s starlrcl, and clura- tic>tl of snx>king ... It Iakrs from 1(/ to 15 yc:rrs, how/wc•r, uutil llrc risk of ck'vClt)1Hrlu (II/IJQ t:rrK`I•r (//f rx•smokc•rsJ appro:rclw•s tlult of nonsnrxikars." /SC 1979, p. 5-.3L) / 28 LUNG CANCER 50332 8741 Ill -( yl'I I I•:It (:ANC:h:1iS 1'cllha ~ u snw/kiul;a/Wlr:rrra x,/N is ShlNq;ly:l.>wi:rl/•, 1 "ith• c•:uwrrs uf 11N• I:uyu,%• uwnrill. /.uldul/;ac, mirurrv h1.w10b•r, p:ul crlas arwl Jwrssil>fy kNl/w•y. (:rourr aj Nra I aryux A lytm•tcl p:riir•ru/ wilh c:.rraN•r /d llw! laryux is aW 1•c•:rr ukI rr1:111•. wIN) 11i1x INN•Ir a IN•:1\•y 1'i};:rr/'tll• sIlNlkl•r :rrwl :1lN1 :1 IINNl1•r:ll/•Io•lu :rry ukylh~d drinl r r. / Al:rrks, It. 1).,1'nhN•y. I. ).. tic•rn/1:.,11. J.. Adkius• W. Y., WcIl1:N r, Al:ur•1};c•nn•rd //( ('arw v1 //f Ihs• l.:u yux. J/wuual uf /IN• '.'"Nlllh (::Ilniirra hlc•/lircll AsuM•ialitnl -1 1( 11): aal .'i:Ni, ll17.5) '11w• rl•lalivr li.k inr /1/•vrNylio} laryugl;ll r:uw•ur ic 15`i 1411 nutl/• cii;:rrellr• snw/l:O•rs :1nd 9.// fnr frnsrlr c•i1;:rIr111• .rlN/ker.. '111rs large sex diifc•rc•rx•1+ is rKlw (1rN1/11/S1/111g, INUlMI/h' INY•a/1Cl• uf 1b/• irw•rc•asa lit fchrurk• ci};ar/•U/• suMlkrrx. (SC: 1979. p. _5331 1'il>,! arN) c•i};ar snNlk/•rs have a ri.k siaril:rr 140 lbat /r( cit;a- rrl lr snwrkc•rs nf dl w(/qlirr~ I:u~'ul;~ :d /:rlNrr. (til : N17l1. p. 5:t(i J '1'IN• unuriN•r ul 1 il;:u.•11/•. suN.k~•111» r~la~ is ~.Iwn~;h~ 1.•/at.•J t// tlwr risk of cle.•rbry)ilrl; c•:uw•1•r of IIN• l:uyllx. lit Iw.• <tulh• 1rLIIiw• risks fGrr urah•s raul;ril Irum ^.c.l IIN' SIwNI b•rnr light suwlkers,1// 1•i.•i for !N :rvy, kNll;-1c•rnr .Nwkc•rs. (Willi:uuc, It. It., ( l/an. J. t1'., Axul c•i:1t11N1 of CallY•r sill•% willr l/1i1:rcYY1 arNl :IkYllwll tYN6C111111rINH1 :uul NN-NN•lYNN/1I11/• St:11/1S I/f 11:11N•/11s: Illtl•rvN•N' sIrN1\• frlNl/ (tN•'IIIi11l Natiorurl (suwrr Survey. )/wlroal Ilf tiN• NalicNlal (':nwrr hlslilull• 5.4 (3): 5`?.5 5 174, Alarclr I J77 J Aulnlr.cy stlNiicc n•vr:ll :l c•II•:/r cGra• n•I:IIi/Nl•hill h.•la•c•1•n Ihr Numlw•r c/( ciy,arl'tlrti snr/sk/•/1 :uu1 :11y pic:d 1•1•11r11ar irl lhr I:Iro'/ls/•s uf tlw•/1 wlwl cli/l nnl /lir /91 1:uvus 4•:r/wrl. .d a park•or-Inor/•-a-clav s11w1icYl k1:N1 wlyhic•:rl /•4•Ilular 1 h:ull,.. Iiw• uN/m ci};arc•Ilc•x snNlkl•cl, llll• /INNI' slN•11 cell c•lrsulgr.. Itul 75 tN•Ir•rrll uf Ilrr. rNN1~IrN/1./ rs Il:al 1141 :/Iruur/r1:11 (rll.; anll 11wnr a•Iw) IIG1, haJ very few. Of IIN' nw•n whn Fr:NI /lllil sNw/king• •1!I Iw•1c•1•Iri Irad ah- Nc/ruurl cells '.vIlic•b wc•rc• Ili.iul/•/:ra/iu}; Ilra/ ix, clisalltw•:rlily;, :11w) IN•iui; rrtdut•/•/) I/y u/0l1r1:11 w•Ils. IAIN•Ihacb• 1).. II:InuuuuJ• P:. 1:.• (:arfink/•I, I.., Ilislubl};ir (:Ilalq;ex in Ilw• (.unNS in Itr•I:IIuNn 1/1 Smukin}Cllahils,(:auc•/•r'Li: i'ir.lM?-I(11, Janualy 19701 A distux•1 syn};r.r};ism Iw•lwrrli alcYllw)i a1Nl I//hacc/) in laryn- 2t1
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I 122 '1'al)la: II I ACE-ADJUSI'ED LUNC CANCER MOIiTALI'lY RATIOS' FOR MALES AND FEMALES BY TAR AND NICOTINE IN CICARETfES SMOKED Maks Femalos High T/N 1.00 1.00 Medium T/N 0.95 0.79 Lvw T/N 0.81 0.00 •The uwrrtality ratio (ur the urtegory with highest risk was uraJo 1.00 so that the relative reduclions in risk wilh the use of lower T/N cagaretles could be visrralized ~Sowc.r.: Uaurutond, E.C., C'.orjnkel, L., Sefdmarr, 11., Ltw, E.A. Some recent findiugs curuxrn:ug cigarette snwking. lrr: 11taU, U.11., Watson, J.D.. Winsterr, ).A. (Fwlifwsl Origins o/ /lunl,an Caucer. Book A: Jncidenec o/ Cancer in //unwns. New York, Cold Spring llarbow Lalxaasory, 1977, pp•101•112. 1 22 123 50332 8738 11ni1voI SLtlrs. A n•r•vnl :uilulmy au4t). :LLr41: air Il1r•14• /lilir-14•u4•rs in Iunl; d:Image iu .wuLr•rx tclu/ rli(•il (u1 1liW•:ra•. u11u•r Ihau 1ung t:uu~ r) in Ilrc Iu•rioKl 1!1'>5-1'.Ni/) ((:ruup A) as aunlurrrtl Willl Ihu.rr Whurlicyl ill lla' IK•riacl I'J711-1977 (Curt,p It)l hl f:rcl, xthurlur:r) c•Ij:rnl;r•s r)f variGwrx s.W/s - c•r-11s wiltb alypi• cal uru•1t•i (Iravirr/; Ilu• allhr•ar.ux•c of c:UK9`I' (Y'lI 1111tk•i), Ir-sitars with ra) ttilia arrrl bas:rl cell hylrr•rlllasia- •tw•rt• fo,nul far IIMwI• (n•- rpu•utly in tlw: hnNU•hkrl clli/la•liuw (liuiul;) rrf CnMrlr A wrNi1.1•rx tlr:ur in CrtH rp 13. (Sttir lrigrrrn• 3, p. 241 •11is mNynrral;inl; sign Ir:rs prIarrp1c•t11hr1 au/1NM's Uf tl/i\ irr/t1111Ky 811N1y Irr twwla•/ tlr:rt :11 xo»ru• [rNuro date, tlrcre sIN)tlkl he a d/Y•lirrc io Ilrc rk•atlr ratcs of cig- arctlc snwkt:rs fronr hrng canccrr. (Arrcrlr:idt, O., Uauuruuxl, E. (:., CarPnkcl, L Changts in Ikarclria) P.I>,itM4iurn in Relation la Cig- ardta Smoking. 14155-IcJ(iq vs. I970-1977. Tlrc New r.rrglarKi Jrurr- rwlof Mt:cllcirrc;ItMl (8): 3$1-tlti(1,14174).( t)urrl;s•rnus l 1t•c•u pwt furr.c 1.111% c:aru.•rr is carr..c•c1 11414 ou1y hy cigirrrllPS 661 is alsu as.ux•ialt•tl witlr cxpr .r•ure lu c•t•rt:rin nriru•rals arrrl clu•uricals, :rutl, in a.•c•ry surall ch•I;rce, witlr 1xrllult•c1 air. 11ownh•cr, altiurrrl;h tbt• risk of ha/l; carrcrr is ftwr liurr•s as grr•at, arrw»rti (say) cil;:rrclte snNrking uraniurn luirw+rs as iu tlue };1•rM-ral cig•,rrl•ttr srrNlkinl; IwpHr- laliorr, it is 1t/ tiuN•s greater auulrK ur'.rnium rnincrs wlu> suarkc (11U11 aliNNlg 1NM1SIrN)ki/lg IlraUi11111 IIIIIN•rs. lit n 17-year ftdb)w•op xlurly uf 1;11•1 urauiu/u milu•rs, /hrrr wt•rV 60- lun/; t•alu•c•r tk•alhx hnl unly lwu ul llu"• tvrrr• nf nnusuuila•rs. (tit:, 1971. p. ::56) t:ill:urll~ s1n4P/.itq! arll) 4wv-utwl/imia) r~lMnrnrs :ov .:ull lit Irr• syncr};istic, aMinl; lu};rthor in a t~mrplit:rlrYl way. Most (aai.rrJ- Olls tltx111k11NNra1 t•xiwsur4•s irrvrrlvc sin};le srd>}taucrs tw iurly a frw. (:i/;:ut•tto snu><aul;, huwrvi •r, rt•auhs in eyMwsurv 16) uuur 11h.un 2.10) c•lu•Ilrp•31( tYHr11Nn111lIs, auuiul; tt•bic•(r arr t•art•iuufy•ux. Innuw iuiliallws arul (worwd4•r.. (St: 1979. p. 5.^.7.('/•Iius, Ilie nnmlN•r anol 1)•Iw• uf iuler:rcliuus t•:ul (u• %-A•ry I:u /w. Aslxhttx+ wakt•rs havc ri};ht liruus 1114! lunl! r•:rIN•r•r risk ))f Iha general lxrptd:rliun. 11ut amumi; uxlr,•sttrc wurkr•rx a•hu sunokc- ciy;+rrcttt•s Ilris risk luls 1>,•c•n caiuult-1 Itr IK• !)2 liuu•s tlrc risk of rurrrsouAcrs wlx) do /urt work .vith :rxl/,..Ulx. (St•likuif, l. J., Itadcr, It. A., 1{:ulcr, M. E., Churl;, J.. Il:uonumtl, 1•:. C. Aslx•slusix urul Ilcoplasia: '1'Ix. Autcricau Journal of Mt•tlic•irK• 42 (4): •1R7-49fi, l.llNt: !: \Nl :1•:Ii 2'1
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i 50332 8743 132 (1): •1 15, july, I'•)ti.I Suri;con Cencrufs Ctmclhtsion '. •.(;ig:rrctie snurkiul; is a siguirtc:utt causal factrrr in tbe dcvclolHncrrt of catK•rr of tlre txupltal;us.'Ibt•• risk ..•(in) pipe arrrl cigar suNrkiul; is alrrNrt IIN- sauN• ... as Ilr:rl ftx t•il;arcltr snwrk(•rs ... studics also irrtlicate a syrurrgkctic relatiorrship INNw(rcu the rrsr• of alcol101 arHl toIHICYY) a1N1 ... uuxY•r r>( the rsoptral,nu. (SC 1979, pp. 5-44, 45j Gunc:cro/ the Urinary /ilatJdcrarul Kirlury A number of studies have slrowu a higlK:r fncick:rxx of can- cer of tire urinary bladder amnng smokers, and a higher •dcatlt rate frorn this disease anwog smokcrs Uahu attumtg rwrrsnxlIkers. Tlus increased risk-as cmqparcd with uarsuurkers-of contracting Wacl- der cancer ranges up to more than sevPIl ti11N's anN)n(; all snarkurs, and is tcn timrs as great ill htavy suwrkcrs. Alxart 40 Ixxcwut of nulle bladder c.vrcers and 31 percent of fcnrale bladder ccuuxers may Ix- attributctl to suwking cigarettes. lu cx-sruokcrs, the risk of devclrloping bladder cancer tk- crcasrs and aphr(xrclu•s that uf ruNrsnurkers alwHd seven ycars after yuittingsowking. /Wyudrr, t:.1..,(:oltismitlr, lt.'11recpidamirrbl;y of Irl:altl(•r c:uurr• A>,•rYNNI l/Mrk. (::unc(•r •11): 12•1(t (NS, 1M71 SNNrkcrs also Iravr• a higher risk of kidney t•a1Nrr, rantiinl; from alwut onc aud (rrre-half to two and tmic.-lialf times rxrrnral. (:ertaiu rttrup:ItirNral exlxrsurt•s /o dycstrdfs, ruhlx•r, IFatlrer, priutiul; iuk., Ir:rint, lx Irub uur, :uul other cla•noicals iu.•roa.w. Ilu! risk of rlcvclopiul; bladdcr c:uu t•r. A u(unlx•r of substant•(•s, ill tia• chcmical fanrily of aront:rtic :unirN•s, have Ix-cn idauti6cd as risk factors in Irunurn bladder c:rucrr autl arc also forwd in cigarette smoke. Thus, ci};arclic suiokinu aloew, or ill crNU•r•rt willi rx•cupa- liunrl uapu.(u•(•s c:n( at•t as al;(•rrls ill Ihr rlcvt•1(qnut•ul of hlatbl(•r c:ru(•cr. IS(: 1979, p.5 -17l Surl;r•on Cr•n(:rul's (:uru'lasiun "l:pirl(•miol(il;ical sludics (Icu(oustrate a siguificaut asurcia- tion lu•Iw(•ru ci},an•Ilr srNUkirr}; :nul (•a(u•(•r of Ih(• uriunry hl:ul(Irr in both N(co auti womcu .••(:il;arettc smokinl; acts indelx-nden/ly as a c:aiw• of bla(ltli•r cancar au(I probably ac•is syuergistically %ilb other risk factors sucb as (KY•uhatillilal exposure to cr.rtain aromatic ... Slusliv~.llucr 1 Irnwn•.l1 .ilr4 l :ul :(%sIx i:(liun ofI I1r°• wilh r:uu•(•r ((f Illr ki(In(•yam4xil; mrn." (S(: (Ji!1,1(. !-i /!Il ( :irmrrr uI Nar I'unr•rr•us 'lla• inci(I(•ru•r o( c:uu'(•r ul 11u• p:uu•r(•as (t:rs iru•rr•aW(11I(r(•(•- /(d(1 ill IIN• l)uilrtil ti/:O/rs .iu(•(• 1'I:p/ atul o(rw r:rnL. (nu111r ill fn• aI/NNII; Ia1aI IN•r111I:(ai(• (/im•azr•s, ISr•irlur.u(• 11., Sih•crlx•rl;, 1%.., Ilul/(•h, •1.1.• (::uuv•r Sl:di.li(c, (!17/i. A(ti~uqr.ui.(xr rr( %rlri/(• a(ul hl:((•k Ixrpul:di(N(s. (: 1 4i n'J• I!)7(i) I':wrtcatic r aru ~ ~ ix uuxr ('u1NUMN1 auu(nl; 11.S. ruvrr /h:ur wouu'n but /lu• ma1(• tn I(•inalv r:dio is (Lru•a.inl; s/r•aflil}•. Il/u(- tality ra{IcS f/N• sNNrk(•rx frrrm this rlis(•au• are la•ic(• /h:11 Of rNxIMIH/k- r•rs, aud (ivc liuu•s tb:d foi uc1lr•x xI(Ntkirr}; IINNP /h:u( 1wir Irackti (rf ciy;arctl(w a tlay. Surgvar (.rN(•nrr•c (:nnrhrainu ". . • OsNa /rurri Ixn (x(Ii~( :(ra1 r(•1((r.tW•r1i.r im(aira liurnc Iracr• (1( nux~slr:~l( r) a si* mli/i(•arrl a.mx•i:rti,(u rn ril!a(4•111• sinrikirrl; and t:uurr u( Ilu• lr:uu•(rms ...'11u• r(•1:(li%(• ii.k ... is aluurl fivc tinu•s I;rr•alrr f(x• a heu Imu•k-a-tl:rv .nu(krr Ih:un lor a tu)nsuarkt•r.' ISC l11'Mp. 5-.'r91 1r1'111•.U t:AN1:1•:I1S aa 32 (Y171isR (:ANC:h:11S
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.4 116 / I I-I.UNC CANCEIi Smoking cigarettes has IH:en irk:ntiGc•d by ofGcial cY,nmii.c- sions arui scientifn: sttulic•s in many aHintric.•s (Australia, (::nutrGa, lknnwrk, Finland, Fraucr, llollatul, Ncw Zealand, Sweden, United Kingdom, the Unitcd Statcs) as the cause of the eturruaurs rise in the incidenn• of lun}; cancer in Ilrose c•oontrics sim-r: World War ]l, a rise so stcr•p that it has br.r•n called an epuli•mic. t.nug cancer is fatal in alxart 921x•rcunt of rnale c:r.u•s, anJ in 881wrcent of fcmale cases. Increase in Afortulity In 1914, the death rate from lung cancer was 0.7 pcr 100,t1t)l) lwpulation in the United Stales :nKl (:reat Britain f(u lwlh mcu :nul wranen. By 19•51). Ihc lung c•anux•r dcath rate fru U.S. mr•n had risen to 18.41vr ltq,t)(lU/ycar. bt 1961, it had naounterl to 37.6 and in 1977, tu 5•1.8. (:owpaAablc figures for whito fcuada were 4.0 in 1950, 5.9 in 1fXi•1 anr11-1.y in I J711• lu lr.y'il), there cvr•rc 18,313 U.S. lung c:umcr deaths; in 190, there wr•re •15,8-Ni lung cancr•r•.Icathc aud in 1977, 90,510 dicYl of these lwnors. For 1f)li0, Ihe prcYlictum is 101,!)t10 such deaths. Sorne of this increase is due to an aginl;lxopulatiai. (Vital Statistics of the Uni1cJ States 1!)fil), 1fl(i1, 1!r17. U.S. Covernnusnt Printing nffice. J llowr•vcr, the U.S. Sur}p•on C:eru•ral rellotta] in 1971 that ". .. cif;arclle smokinh is thc nuain carice of lung cancer in men ... ill womcn ( it ) accOuu1s for a.mallcr fwrtion of the cascs /han ill ~neu " (SC 1!77/, p. 11 / In the 1979 Surgry,n C'.encral's Report, this conchisiarn was stn•ngthcnr•rl: "Cit;arr•tle \nNlknlg is the n41j(N ca1LsP of lungca,urr in (ndh uscu aixl wouK-n." ISC 1979, p. 5-.31) r1u iur•rr•:ru•iI ri.k uf lung rxun•r•r lr.GC lxrcrr Giurnl fur cw•ry s,nokiu); h:rbit invr•sli);:dwl. •f'Iw•rc cur• rlucc-rr•sfNNIGe relationships for developing Imng cancer. 77iat is, the numlwr of cigarettes sua,krKllw•r ilay. Ibr• cluralir,n uf snu,kinl;. degree of inhalation, tar anrl nirx,liuc cuulcut uf cig:urllr•s, all cuulribnlcrl au,incrca.ced risk of developing lunf; cancer. 11ic age at which tx:ohle start smoking is also related to the ill cffects; mcn who started smokinl; before age 15 had a death rate 18 117 50332 8735 frum lung i•anr•rv nr•arly lunr lilnr•c hil;hr•r tlr.m Ihua• .vhn hr/;:m aftcr a);re 25. 1'ilw! anrl r•i};ar snN,kr•rc havr• hi),hcr lun)g rsrur•r•r naulalily ralry Ihan usHrsnN,kr•r:c, bn1 r•rtnsirlr•,ahly lower ialr•s /han r•il;arrttr• snKikcrs. (SC 1979, p. 5-231 tiu/cl J in Stai+irinl; '11rc. risk of drvelopiu); lunl; c:uHrr i/K•rcasrrs with age, for lwdh xnN,kcrx anrl taprsnwkr•rs; la,wevr•r, the incidr•ncc rd lung carKtirr in ci};:urtlc xrrarkr•rs is nn,r•h higlw•r. A tvnufr,rlinl; r•rnr,li:ny (rn IIN,rr• wla, a,r. ahlr• In s/rrl, cun,k. io); r•i};an•11cx: ...f•hric is aJrr•,r:,a• in risk r,( rlrvr•Ioy,iu); lung P:UNY'r, whN•11/MY•,u:e mrr a iN•/I/Ml Uf suvr•r:d yr.ir..' Alter 10 tr) 15 yr :,rs, the risk of dyinl; uf (nn); r:,nrrr fur ex-snn,kr•is hac rlrv•maNrl tu Ilw: lx,int wla•r.e it i.c rw,ly sli);hlly alr,w• tIN• risk fr,r rnw,.nMrkr•rs of Hue s:uiKr age. All of Ilw• ua,jr„• slnrlir•s show this rrYlru•tirnr ill risk. Fi};nrr• 2 r1n p. 18 aa,Ws lla• dillemnl i~N irir•~N r c uf hrrW chial carci,Kw,u, ill .na,kr,s :nal r•x-snN,kr•rs, arrrrnli„/, lr, yr•sns stU111HYI, aIn) aaa,xourkr,.. Al rrir/ Fc1nal1r 1)i/)rrrnrr .. irs l.,my, l:ruu rr Tllc rli/fcrr•ncr ill 1im); r•:uu•cr inr•irN•ik•c and nNmlalily 1x•- twcc•n malc aiHl fr•malce snu,kr•rs has uflcn IHvn ci/eyl by crilirx as c:rstillg (I/Mll/t IMI tbr! itimnrrliuu IN.-Ia•crn rtil;:ucUr snN,kiuB ,uKl lung c•amr•r. Ilocvr•vr•r, it usually lak(•s 15-20 )•r•:Irs of .,nukin); 10 lurxh,cr• Iw,); c:uNrr iu a huwan IN•ing. :wrl hr•:,vy sr,a,ki,ry; :mNa,ti wunnr•n is rtinu•r•ntralrtil in 1114. al!r g,rNrq,s in w6ir•h lunl; is h•asl lrrcvalr•n(. 1)illr•n•ur•r iu hr„upm:,l nrakrnp un:,y alcu pl:,a• a part in 11u• rliffrrr•aw•v• ill 11a• (mq; r•ancr•r ralr•s lw•Nvr•r•n n,a6• :uul fcuuaGr soN,kr•rs. Wunw•n l;rnr•rally snN,kr• 1r•s.c r,( oar•1, r•il;arclle than uw•n. lln,s avoirlinl; 11ue hr•avy r uur rutr:,lion r,f niwdiur• anJ tar ill thr• lasl I,:ul of thc ci);:1u•11r•. l/n Ihr• ac•rralv, ct•nuN•n :rlW, inh:rlr Ir•zc fntipmonlly and lb•ss drrt,ly 1hai, nu u• :mrl .na,kr• fillr•r lilrywtil r•i/,a- rclles wilh lower lar :nul nir•ol iru•. l1ui,id Int•rr•u.w•ul Fcuurb• l.wn;, (:rmr•r•r Iluwr•vr•r, lun/; ccuK•r•r nnrrrtalily is i,x•rr•asing in cwnur•u nN,rc rapidly tlaan arry other causc of dcalh. 'llic lunf; cancr•r ih•ath rate in worna•n h:ws risun ucarly 1•IKN/ lxrrcanl since lfl9O. 11,e (t.S. 17
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I 134 1~' IIh: ~It'i':~'I"I:~(:I:S.(:IK(:t~1..~'fOItl' 1)ISI•::~SIa ANI) ti'1'It( )t:1•: ' ( al;:u1•111 • sua)kiu); v:u1u•s a hi}thrr rleallt rctlr• f,'111i1 tY/rlalar\ llrml disrasr iu thr Uui/oil Slcdes. Il Ilas Ia•r•n rslirnaltr) IIrat naKc 111.411 I'a),tNN1 t•xcrss tlralb.. /ruu) this slisi:asr t•acb yr:u' in this cuutdr)• :uc cau.vtl by rigatrlle .uaol,inl;. (.kut. Ilr•:Irt AsMa•ialawt Itrlaat uf Arl Iloa: (amuuillt•r• rai (:igarrIlr• SuMbkiug :tnal (:ardar- vascul:u- 1)iw•acr, Ant. 1/varl A.wa•ialilln 1)ta•ttua•ul I1/10/77/ Studit•s uf uawc tluut Iwu millimt itulivi.lu:tls slww tlutt cigarette suwkinl; iocrv:G.cs Ilrt• risk uf sudhltrr c,trdiuc cM:rllts, and :dla•r«a•N•rucis (G:.im>a, plailnrs utal tK•t•IusimU of arteries, IK.irt and other urF:tus). Ihrtvevcr, thc asWx•ialitut Ix•twtYrn cipri•ttt: suk4inl; :und strukt•., crual augina lx•clorris (cht•st hain) is uut ctxr clusivc; and there is txi apparent rt•l:ttkxrship Ix•hvern stnoking cwd 1h4• incidt•nc4• tof 6ylx•rlt•usiutt (high I)kaxl Ixr•s.cure). Nt•vt•r- Ila•1e:ss, lt)•prrlriuirrn :ual t•il;:rrrlli• swulin}C. tvhrrt Iwr•sr•ul tn- I;rlhrr. ntultihly risk. ( suti• la•low ) Oi1ittin;,, Sliurp/y /(rr/tu'o'x 1(isk Stulj)iu); swukin}t sharply den•re:ra•s tbr risk u( la•:trt nt- tacks, aud uthwr circtd:ttary diw•:~u +. 'Iliis la•I;it4s ln haplx•tt wilhiu unt• year aflrr slnlthinl; :uul ctftcr tO years, tltu t•x-suwki•rs risk is almost the sawe as that of llse Ix•raut whti has nvvt•r sua)ktvl. jllaumitual, l:. C. Curfiukt•l. 1«. Cnruttary 114art 1)ist•aW• Stroke :uttl Aurtic Aoeurysut. M:aclurs in the 1•:liulugy, Archivi•s uf b:u- viraata•nlalllrallh 19 (°): 1(."i•18?, Au}lust 1tJ(il)j lu a stully uf :d1 British d4a•l4)rx, a1;(• -W(il, siuct• 1951. ntany oF these physit•i:uis hut'e- l;it•en up i•igctrt•Ilr• sua)kin};. Itul frwt•r Ilritish ua•u iu };i•nrral have stOplxYl snalkin); t•il;art•Ilcs. In 1lNiH th•at6s fruin all la•:u 1 und IA4aal ~ rss~ 1~lis~ as~h a~nunl; lla st 1lrilish dwlors ball tIruplx•d by six lx•rcrtd siuoe 1953; whilt• lla• tlvuth.c frwn these distascs in all British invu had incrc•ast•cl hy nina Ix•r- crnt. / Rnyctl, p. Wi1 'llhc tuusl ri•cuut U.S. iufururaliun un suwking t•r.ssatiun in Ibi• fulkiwin}; labb• sliutvs sil;uiGr:uwl tlecn•asrs itn Ilx• probability uf tleath fruut curunruy la•arl tlisrau• Gar tbust• wltu have stuplx•d smokinl; fur Gv.• ur nwrt• years. ( Str Tahko IV, p. 3S). /tisk Factors Several majur "risk f:a•Itirs" have IH•on id.•n1iGeKl in biart 34 13.5 50332 8744 Tablc IV ANNUAL PItOBAAI1dTY OF DEATU FROM CORONARY NEAitT DISEASE, IN CURRENT AND 1)I.S(:ONTINUF.1) SMOKERS, BY ACE, MAXtMUM AMOUNT SMOKED, AND ACE STARTED SMOKING Atps starlel saaakiax 15.18 40.24 wlASirraa,r (:lamnt l~.~rd'waual (:ararat 1)iMYN11ia1a'.1 .laily maalw•r snaAns 6K fn•r rK sumkrrs f,K 111ve ar .rl cip,arrttrs aaKP y.•yrs aMMe yrars ' Age snaA.•J ( P14darbiliiy s 1(Yt ) 55-04 0 501 501 - 10-30 798 508 811 551 21-30 8o 700 872 M 85-74 0 1,015 - 1,015 10•20 1,.501 1,10fl 1,478 1,213 21-3t/ 1,710 1,339 , 1,578 1,008 tFix age grutqt 85-74, Ixdttbilities Gw Jisaailinucd nmokCrs arc for 10 or nwru yoars of dixvnHnruua;r. sincn dala Gw 1hc 5-0 yaar diac•radinrmnix I;ri aip arc rait given. SOURCE: U.S. Public Ilcalth Scruire. Th. llealth Coruequcuccs a/ SnuakinR. A Rc/rrrnca F.r1ltion: 1tJ78. U.S. Dcpartnureu ol Uralth, &lucation, aru! WclJara, Public Ilcalth Service, Ccutrr /ur !)iscasc Cunerd, IIF.W PuWica- Hon No. (Cl)C) 78-8.9.57,1778, (iS7 pp. :15
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." 164 at 4,.`336 cigarcltes, and tk:clincd iu 1J('r1, tilc year of the first "Sur- gc:(ln Ccnrral's Report." It dcclint•d again Ixrtweu 1M and 1970, lbc lxxiotl uf iutcu..ivc: bru:uk:astinb u( ardi-suruL:inl; ua•xsal;rs by the major 1y and radio networks and stations. (Tllc value of these nNn'sagtx in (:uarna•rcial tiul(• was csliunaltvl at $75 rnilliar.) ISC 1979 pp. A-5, 0, 71 In the last four years, U.S. per capita currsurnp- tital has darlirrLK1. hr 1979 it was at tlK! lowest point sirrcr 19%. lt is assunu•tl that the events rnruti(w>.:d in ctiHrjtnrcti(rrr witit the declines in tx;r capita consumption were operative factors, lxrt there is rw way to prove this. Until 1967, tlre only assays of tar and nicoline content of certain popular brands of U.S. cigarettes available to the public wcre published in Reade{t Digest magazine, and Consuroers Union Reports. In 1967. tile Fc(kral Trade Gunmissiorl laboratory began publishint; its own assays of tar aral nicMinc in all U.S. ciga- rette luarrtls and has cordinutxl to (lu s(1(•vrry six rllunths. Per Capita and Total Dccline Ikllls titc per capita and total cigarette consumption have declined consistently in the Unith•d States since 1973, reversing a general 9Q-ycar trerrd. The estimated percentages of nlen and women over age 18 who smoke cigarettes have also declined. Among men, 52.6 pcrccnt of adults sawkcd in 1955; this has droj)lx.•d to 39.3 percent in 1075.' 711e percentage of female snxlk- crs rose frou124.5 percent in 1955 to a peak of 33.7 percent in 1960. and retrc:tt(:tl to 28.9 IH•rtti•ul in 1975. Prrccntal;cs of ex-snxrkcrs among men have risen fron110.9 pcrcent in 1955 to 29.2 lx•rccnt in 1975; annonb women from 3.9 percent iu 1955 to 14.5 percent in 1976. (ISC 1979Tablc 2, p. A-101 Although tltc )x•rccnta};c of tlu- U.S. IwlurlatN111 that srnok(•s is surallor th:ut it was a drt.rdo• ago (srM Iw-low), the lhtital States n•lains its lunl;slanding titlt• as liht- wurkl's premier ci};art•ttc- sua,kin}; (•(Hinlry: in the mid-uevt•nli(•s, annnal U.S. cigarette c(m- sumptiun was 2,7.">/l ci}tarettos pr•r (•atiila for all cilin•ns o( :rll ages; J:qpan was s(•(•rndl wilh 2•fi(N). Uuw A1uiuy Suuikrrx? In al>sulute noaulxtrs, there were an cstinu:ttctl 53.3 nlilliunr OSI.rrrld u/ J,w•ph A. t.., Smori.ny -J 11r~11M• Y.uw-Nh. owI 1Yrl/ror. AlNY tA, 1979, s.w (:ald. 1'wMadrd w IIkW NF:WS. 04 SAtOKINC f:CONOMICS ANt) STATISTICS I 50332 8759 tI.S. vi~;:~ro11~• snnIlI•ts ill I!N:i, :u141 i1.1 Inillifin in 1!/~!i n) %~ ln•ni •Iti Inillions wer(• n~(•r the :y;r to( Iti. '1his srn:111 iuunriical po%clll h:ail(•d Iw•himl /hr in(•ll•a.l• ill (MIlN1Ia1i(ar; it r4•pirW•n1., ill ala+olydr• nurrdw•rs, 3.5 Iw•1tru1 I~•arr rrr.rk• snu,k(•rs ain) 1(.1 IH•14•rn1 nNn,• fruu(u• srrwlk(•rs. ISC 1979, pp• _A• I I j tllucl (•nrrt•rul ( i);:n~ /lr +nNA~ r+ IM t;:rn .uNd.int! in 11u•ir Irrns. 'liplay, iu Ilar llililr1l ti1alo•s, lla•u• urt• a't rnillinn irt!olar 1r4•na}r suNrl,rrs, 12 In 1:( s•r•:rrs iri cu;r•. rrt~~~ulirry! 1' la•rrrnl n( Ilus al;r t;ruull. •Ilu% is :1 (holl nl Gau IN r~ rnl:~l!~ iwlinl% sint•e i!/7•1, arrorolirq; lu Srti•Ir/iuy Joecrlrh A. (::rlifaiwr, Jr., ril 1I1•:\V. IItc gives Itis wrurtre as sluv(•ys IM•rfnrumA hv /lu• Naluaral t'1r:uilit,• (u(ua• (nr Srrnrkiu}; rm(1 11r:rlth in PM:ti arnl 1l/7•1, :uwl /in• Naliunal Instilnta uf 1'•.tlrrtati(rrr in 1!179. AnaNrt; l(rualp• suaokrrs, }'irls (1.7 inilliun)(Klw(NrtuunrlN•rlMrys (1•(iluilliaNr)• S(x lahlrs pr(••r•nIeri hv funnrr S(rr(•lary Joseph A. (:a/i (n(ar, Jr. nf Ihc 1r4•(a1x iu .uaokin/; in 4Ii/1t•r4•ul 1o-l•nat,i~~nmt~:: p1o. (i.i, (i(i, (17). Wlll) til1141'J Atlull uurl(• ssnokin}; is in invrr.r ralio lit (amily in(•INoN•, while adult frnuale suurkiol; hw•r(•awc wills f:uiuly uNYNINr. Suu4:- iul; is r(•krtivt•ly uncoanurun :wNoulc prufi•.sioNrrls lit Iwdlr irxvx. (.S(: 1ir19, pil, A-l•/-1•5/ Rul auNoug nsuui{;rrs an(1 u(Inriuiaralivr lx•rsunu(•1, Ilit• IN•r(rulal;r of (1•us11r snmk~ rs is llil,hrr 111:ul lls11 to( nralt•s. /S(: 1979. p• A-lti) Alaae wlutr r61ll:t woliki•3. (I1ru14•ccidlor.lk anll 1o•rlnrif•al tv(trkcrs) hav(• tht• 6Oo•rst suoukiut; rales; blu(• tollar a•uikt•rs (hl- Ixrr(•rs wid rraflsnK•n) have• Iht• high(•:t. \Vuna•n shotv lhc aplxo- sitt• t•urrt•lati(rrr. llpwar(Ily nMobilc nrrn li•n(1 tn snok(• Irss and tluwmvar(Ily narbile uu n are uworr likely to le b(•avy snNok(•rs. (S(: 1979. pp. A-15-IR1 A sludy u( foor h(•alllr proles.iims (ph% •%i(•iam, (Irn1i,1., ph:rma(•islc, nurW•c) in 1975 (onond oady 21 IN•rt•rn1 uf t'hY.u•i:ulc snaokuq; lit Ihal y(•:n; '91 Iw•s(•rnt h:ul IK•ro .onwi,int, ii( I!Nii. '1'w(•nty-Ihrc(• (H•rtvnl of (N•nlists, arnl 28 IH•r(•i•rrl of pharma(•ia. wert+suw4rrs; IMdh l;rnups chuwl•(1 salrst:lntial (1(•clinrs in.Iuukiof, IN•/wren 1!1(7 (:`i aial 1!/ii. (hdy alnNaq; u~ow. ha~l cn~~~kint; cr(•ats(•(1, frwn 371Henrn1 in 1tlIP/ tu J3l1 l«•rt•(•nt iu 1975. Itut 11k };n•al nraj(aity of all h(•:Illlr hruG•ssiuuals al;r(YVl thal 11u•y slwIul(1 xrl a SMM INC 1'1:ON//AtN:.C ANIISTATISI U;` 1iro
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.4 110 1-t+1t)il7'A1.1'1'1', UISAIiII.I'1'1' ANI) CIIItUNIC:II.I.NGSS i TtN: uloxt direct result of suNlkiug is visible iu lite dilfer- encrs ixstwcen tIN; drath rates of suw/kers and nonsumkers iu the same age Worqxc; and in the differences in the nundw:r of years of life between tlw two groups. "Ueath rates are unifonndy highcr among srnokcrs than among nollslrwkcrs, in both scscs, ancl whatever the age at death. The excess mortality of cigarette smokers is proportionatcly greater at ages 4554 than at younger or older ages. A smoker doubles his risk of dying before agc 85." (WHO 1979, p. 91 Death Rates Arr>,»lg suNAcrs, lite death rates froNll all causes increase with the number of cigarettes srrx>krYl lter day, lite number of years the snulkcr has sux>hed, aral the earlier the age at which smokinR started. Other variables include depth of inhalation, tar and nico- tinc levels of the snwke, ;uNl thc numler of IH16s per ciplrctte. All of tlw-se contribute to lite degrcre of risk involved in smoking. (SC 1979, p. 2-20-251• In eight major pnulx•ctivc studies of about two million peo- ple, cigarette smoking is associatc•d with a 61 pereent average increase in overall death rates. In the two most vulnerable age groups, 3.5-4a aue14.5-54, the death rates of smokers arc 86 percent hii,hur anil 152 tM•rovu/ bil;lu•r, losiN•i•livi•Iy. IS(: Ifr19,11. 2_-11/ 77u: death rate for a/;iven uuullw•r of cigarettes smoked is higher among iulullcrs /han analnl; tlw/se who don't inLale. Iscbi•nlic heart disease, lung cancer, and chronic obstructive Inng disease arc IaN as likely to develop in iudividnals wlul do lu)t inhale lo/r.ux•o suaOke. Death Rates: Male For groups of lul•n smoking fewer 11kan 10 cigarettes per day, of the types prevalent until the 1cJ(K)'s, the death rate is about 34 percent higher than for nonsnx,kcrs; IN-twcen 10 and 19 cigarettes pcr clay, it is 70 percrnt higher; lx•twccu 20 and 39 cigarettes per (lay, tlle death rate is rJ(i Ixra;nt higher, and for those who smoke -NWe: Tl. 1970 SarRrur (:rw•ral's 8.•IwA Y 1..R{wrad by ChaWwr'. rtllwr Ik.. canan.tf.rly. TAr c6yNrr awwdmr..v wwkrlarvlla diurpirh Urw In.w Ilw PW{. wuwdicrs. 10 111 50332 8732 •11) r•iy;arvIti%s or wore aday, Iilr dh•a16 rate is 1l3 IN•r/•1•ut higlu•r than for aonsnaiki•rs. IIl:ulunoNUl, /•:. (:., It1Ku, 1)., tiuwkiul; and lA•allh 1i:d/:.--1i4•INN-1 un lorll' /owlr uawdhs of follow op rwl Iti7,7SCi nw•1r. 1':ul I,'1'/Aa) ktor/alil)•: J:\N1:1 1/ifi: 11fif)-i2, Nfi`il'1'hrllealh ratc of suokrrs is suhsl:lnlialh• higher lor ua•rn wla/ slaule.l (u•t+lrl• ugr• 20, (luul for Ilalsr• svlo slallrrl af/er al;/• t's. l.ow lar/nktiNine c•i};:ucllr snwekrrs have lower umrlalily rales than nw-dinm or high tar/uicYNiuc cil;arritr• suwlkcrs; Iww- cvcr, overall death rates of low tar a/N1 uicYrliuc (less Ih:ru 1.2 rnR niallirlc aud less than 17.6 ing. tar) cikrrdtc snwlla•rs an+ 52 Ixr- c•calt hiKlw:r tlwn for raawenwlkers. 1)rutb liates: F•crNUlr Wonlen who snulkr cii;arrllcx have a significaully lulr,lwsr ik+ath rate than tluhr who have never suwrkitil regularly. As with nN•u, lhc relationship IN•twrtieu dr•alir and suarkiuk is direclly re- lalrtil to Ihr• number of cig:urltew aucl IINS duration of lite suNlking habit. T11e overall nrrNtalih• r.111•s arr! stN1N`what lower fix wlll»en xna/krrs tlalu for nullc• suwkrrs of lite sauw• age. 'Illis rr•llc r•Is lower past r•xllosurr to r•i};an•11v suaike, such as slartin}; suaokinl; laler, smuokin); ciy;are//es willl lowvr tar alwl IINYIIIIN• r,Nlt4•nt, auld snN/k- in}; fewer ri};andllh 1>er da)• Ihan ulrn. As wcN1N•u are Iw•ginnin}; Io suurke rrarlirr vld snN.ke nw/rc, however, their snwlkinl;-relaleKl ilhN%si•s arr• inc•rl•asin};. NirruNal /1ruth liulrudd /•:uv•xs lb•u/h.. For r:ual age } roup Ihere is au rtlN•deYI Ilealh rate 1>rr 1/KI,/KK11w1prdatiiHl for iN•rWms who havr ni-ver sna/krd. '17a• diifrr- i•IN.r. IN•hvc•rn Ilwe wunla•r nf /1.r:11hs of snulkrrs, :uN1/hr uuullN•r of deatlhs esi>,clrd- h:rswl 4111 uowzmnkrr: dr:/lh ralrn an r.~ ~ ss ib•atlis... FrN' na•n IN•twr•eu Ihe a};/•x of a.i lo •/9 who soalki•tl cil;a- retles, lite excess numllcr of draths Is 39 pcrcti'nt; for ages 4.5-51, nulre than 40 pcrcent. In other words, if no one smokcd, there would bc at least 35 hcrc•cnt fcn - n>alc dcaths between ages 35 and S1. (l lamnlrnul, E. C. Sualking iu relation In /lwe /Ioa1h raws of out• million rncu and womvn. In Ilaensze1, 1'V. (1?ditor). I:pidemi- oln};ival Approwu•hr•s In Ihe Shnly of (:anirr aud Other (:hronic 1)iscasc. U.S. 1'ublic Ilcallh Service. NalioNlal Canccr Institute /1
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t 156 'I'h/• rl•sulls arc cunsist/•nt wi11I /hc irlca Ilral Ixnqilr sruukc lulr.lccu tu ul)I:liu uicutinc allbuugh sua)kcrs will sn)uke uiculinl•- frcc ci};arclles. Alauy rct)urt that they sna)kc whou stressed. Slmus iuresli- gaturs cuusiclur Ih:rt /IicvNinre i.i tla+ priua/ry rc.iuforccr (»x•culsc: of i/% lulc ill rcllu/•iIi}; (rlrsilal a1a1 IliSlrr•ss, a.Nw'iall•cl with uiw)IirN• licprivalion. 131ri tlw cvichhu•c is la)t •ixan•Irlsivcs. (Jarvik. A1. i:., Ilinkogical faclurs urHlcrlyiu}; Ihc srnukinti hal/il. In Jarvik, (+1. F., C:ullcn, J. W., Critz, 1:. lt., Vol;t, '1'. M., West, I.. J. (1?diturs ). lia- scarch on Snloking Rrh:rvikx. NIDA licse:u•ch Mcxlugraph N/r. 17. U.S. l3Cy-Aartnrent uf Ilealth, M:clucation, and Welfare, 1'ublic Ilcalth Scrvicc, Ak.•olarl, Drug Abusc, aull i•Icntal )le•.r11h Admin- istration, Natioual Lutihde ar Drug Abu.%!, UIIh W Publication No. ( ADAI ) 78-581, lkrcmlxr 1977, pp. 122-1481 [SC 1979, p. 15-81 Cenc•t ic !'rcclistx)sit ion Au rulruint; strr/ly uacint; idcntical twins has rch/)r1c•cl evi- clulcu of a};rnrclic prcclispusiliou to snx)kl•. flowevcr, this sccnrs clouhtful. 'fhc ua)st rccent rcvicw cc»rcinrlrs that "ihc thcory of gcuctic preKlisl>.pitio/l is clislxovc•cl by thc suxrking discorJ.lncc anlonti ua)uu-r.yl;alic (klcallic•aIJ lN•i/rs." I liamslri'»u, lars,114., Plr.l)., 'Tha Swedish Twin Stucly-Publicity & Criticism," World Srrrokbrg 1s Ilc•ultlr,3 (2): 14-1J,1cJ78J llorwouat Factors l lorrnoual clranl;cs i)1 pula•rty oc•cur at ahord the s)Inu: time lhat incli.•i/lu:lls +I:u-1 sualkiu};; 11111s, cnclrx•rilrc resla)n.Ws uncl s)nokiog h:wc Ix:cn cxanriuctil for 1>,xcsiblc links with snwking. Crowlh huruxmc :urd ACTI I were measurccl in nonsnlokcrs after smokinl; two cigarettes. A rapid incvr:rso in hotlr horuconas was ohsen•ccl, hul no si};IriBcant change iu uihcrs, c..g.1.11 (lutcin- iziut;hnrluouc).I-SII (fullicA slimulaliul;hc)ruNmc.'1'S11 (Ihyroi.l stilnuL•rting horrnonc), and tcstostercx)c (ruulc h(xnrouc) Ic•vcls. (Wiuternitz, W.1V., Quillc.n, 1). Acute Ilornaalal restxll>.se to eig:rr- cttc slnokiul;. Jourual of Clinical Pharnlac)lul;y 17 (7): 3.`I"cJ7, July 19771 V.•rsopressin (a launa)nc affcti•ting llur contraction of 1)1(Mal vc.sPls) levels are :IlN) :Itf/•t•I/VI IIy IIic-olilat. Srnokirri; Cessation Significant physiological chaugc a occur imrnediatcly oir T111•: SAfOKINC 11ABIT: 50 PSYCIIOl.(X:Y ANp YIIAItAtA(:QI.(xiY I I 157 50332 8755 in h/•wl ):)1f•, Ili:l.lulic III/NNI 1111•>Clll/•, 1•u•n• lil~u ul :alrcrlalirl :ual n/)n•1)iucl)hrin/•, /SI{(:, clnlir:ll all)lsr :Irlivity uf Ihc hrain, :ua) car/li/q)uhnnn:uy lula•li/al lrsls. Many rs-sna)kr rs rc1uH-/ Gr1ir/IS uf %lrll-la•illt; :ual inl- prmr/l la -aII1/, Irul utla•IS c sta ricla c awirl/• va/iclv /)1 1r)Iltaw:ll} ulq)N•as:ull sicle cllcc•Is ila•/ralirq; cravi)q; Grr Ir/1n.1cc 11. irl il:lhilil% r/ alc ssncss, /lnlhnhx, sl6ti•1) :wcl /!aarninl/ cliu:rl cliarrrh:uars, :IIISN•1~'. inlt):lirrla•OI //f r/ru/•/•Id)a/inn. jn11~/IN•ul, all)11)'.y/•11,)nadul IM'111H"III:IIIt7•. Witlalrawal sl•rut)Inuls nf var}•illy; s/h't•ri1v //dl/)a'irll; c/-%.a Ii1xI ara Ila• prira•il>:rl rca.Inl./•ii/•rl fnr rclapsc 1u sna)kir1l;. \`•1q)a•r1 Ilrc /la)re likely ta fail iu snuk-illg clws:l/irH/ cl1/N1s Ihtlll Ila•rl, and it is Ixnsiblc that tlrcrc is :r s/•x Ililtcrclar iu Willab:rwcll syluptr/r11s. [(:uilflrrd, J. S., Factnrs It/•la//•d Iu Srlr•rrscfrd Ahslila-Iar f1/i11I Sr/a)killg. 1'i11s/11U~11, Ana•Ih•:nl /u.lillydPC (la' 1tPM'a1cII. J/rlv 1!Mi/i• 171 t)t).J Snrukint, irr Adub•sc•rn(s and ('bil/lrcvr 111e ckY.•rc•:ew i/l alI1iI1 srla/killg si1NY• 196 1 iis 1>:Ir:lllckvl /o a lesser clct;rccr auaxrK trrnal;/• Ixys :wd ylMU/l;cr Iccua};c };irls, al- ilaal};11 crualog okMr 1lti•ual;e girls (17-1ti) It l9Mltilllws to iucloa.c slwrply. Ilhnalnx)s of slodics havr• Ixru crn)ductcll by la•hava)ral sc•icnlisls io sul cQclrt Irl rna1l•ISl:ural the crlnqdar f:lclurs illv/)h•ltil in thc i11il1nti1N1 cd snlul:ing in this grcHlp. Snch infurnsllioNr k c.ccnlinl /oc•rc•;rlcrffcclWc Ilru}!ranls I/I lK•rsnallc Vu1u11;1N•nl,lr nnl to start stla)kiol;. 1it•Iw/yrl Ila• :rl;rs uf •1 lu 1) or 111, chilkln•u :a•cc•p/ tllc fac•1 that snx)kinl; is hai»rrclulls to hcalth. At this al;c• Ihcy cxpresx anxicty whcn Ihcy r)scr.•e :I parcut or olck•r sihlin}; soa)kiu{;. 1'ct as thcry npprnach cldl>tcscclw•c, ulany of these s:rn)r ehilllrcn Iu:ly (a•I;irl lo snrukl•. adulr•.cc•c•nt Tnurs(lilal Adnlcsccucc is 11)c tina• 1)f II:u1sililin fuarl .~ 11-11~ Iinililnl as a faulill' ua•Inla•r 14) idcnlitic:Uinn wilh Ibc• larr };luul) :IS a s/alruc uf sl:rlus. Ill•ctnrrinl; a snu)kcr may havc Ihc iolna•clialc %•aluc uf Ix+inl; acvrlUcY1 hy Iwvrs• uf frclin/, I1a)n• uurlun• Ixr:lusr s/no)kiu/: is an :ulrltt IH•havicx• forbilldcll thc chilll, :,Ial ulay alsc) .crlr :Is )ul act nf rlcfi:uux Icl autla)rily Ggru-cs. '1'lie srlu)kin{; tulrcrr/ I«•eY)ua•s a lurxlcl fur Ilae cllibl. If la)ib •1 •11 F: S A///K I N( : I I A lt l-I' : RCl•(:111/1.1r1:Y ANI)1'ILAIiA/ACO1.(K:Y 57
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I 136 ill:u k.. The. Ilurr• Ir•atliul; risk fachirs arr• 1) cig:ucllu snuokiul;; 2) 6il;h I)Ioatil t)mssure (hyfH•r(rusiou); :ll"l :l) Iul;h bI1MMI Ohulrs wrul. I.acli uf IIu•.r risk faCt/q:\ IIM'1.•:IGY a ix'rsoui s c1auM•s•s ol having a heart al/ack. 1'r'nplr• who .uuikr• r•i/;;m•Ilr•s, IHq Ieavc ur•it6cr 01 t1w 0thcr two fac'Irus, haVc a dr•atb ratc IriNU IM•art at- tack q/ Ixrnmut greater tlaru that of rMrrrsuM)kcrs. If all tlrrc•rr risk factors are prr'x'ut, Urc risk I;ot's up 1u .1/N/ I)Crccnt that r)f Iwrsar• without any risk factors. Risk is also related to age arul llrc auMUU)t of cxposrrrc. Arfcry Discuse Studying tlrc arteries of cigarMtc suM)ki•rs at autopsy, lxr- thok)gists Irave sccu that tlMr blooi) wrswls of smokers cwrtain a great nund>,er of Lltty plaques, whid) aJberc to t1K• walls atKl clog' circul:diuu. This cr)nrlitiou is keM)wu as atbr•rorclr•n)sis, a fonu uf artcriruclcrosis, and is tlMUight to predispose tlre srd(crcr to lwArt attacks. lu a sludy of this type, 11a• arlcriak's (snr:rll arli•rics) :u)d artcrics of ucarly 2,1MM1 meu wlu) died uf all causiw wrrc cxanriuwl. Ilbcxl vr•ssr•Is wi•rc rcuwvrtil frunt various parts of t1u• Ixxly: tlrre trachea (windpile)• brra)cbial tuhcs, r:uwfrl)al;us, stornaclr, luru- crcas aud adreual gl:uids.'11w scierltLl"ts tlitl IM)t klMlw lIN' smokiu}; 1)abits of thr nu'o uutil after they exaorirMYl tlu:we tissues :urd recorded their /iuJiu/;s. It was found tlr:a lhw walls of tlu• bkroJ vcsscls iu all 11u :W ur}; )us Iria14•d In tl)ickt•u N•itb a};e• in all sub- irt•/s. 11111 Ibickouirrl; wa. rnn.ido•raMy I,i.•A.•r iu sruak.'r. 111.111 in ueansnrukers. :uul wa% din•cIly rrlalril tu Ihd• uumlw•r of vit;arrlles mnukr•rl. "W•I;arrllrss of IIM' uu•r•Irauisu), it suruls likely tlcal Iht• Ihicki•uiu}t uf Ilu• walls uf a)Ir•riulr•s aurl surall arlr•rir•s IrKatcrl in an urgau has at Iv:rct a sli}ll)Ily dr•Ir•li'rious rlfr•ct rqxal lbat rffl;au," Ilu- authnrs curut•lu.lwl. "If widespn•:ul. it may hul sunu' s/raiu tywu IIle cardiuvascular syslvm as a wla)Ir. If so, this ruay have somc bwarin); ou thc• iucrcau• iu dcatb ratm frum a rnultiplicily of discascs will) advaucinl; :a);e: unrl willi au)uuut of cil;arr'Itu su)ok- inl;." IAur•rlnch, U., 11ammond, I:.(:., Carfinkr•l, I..,'11)ii•keniug of Malls of AP1.•riidvs :uul Souall Ar14•ri.•s iu lirlali..u 1ie Al;r auul Snwkin); ILa1)ils• Nr•w Knl;l:uul ji.urual ul (Ilr•cliciuv 27tt: 4),`il/-J.'I•1, May 2.151('>f3.1 This study was Ialer.:xlcuckYl tu :r ruicruscY)f)ic examination 38 111•:AI('I' A'1-1•A(:GS, (:IIK:III.A'I'()ItY 1)ISI•:A1Ma ANI)S'I'llOi:1'. t 50332 8745 uf ar14•riuli•s uf 1u•ar/ nw.4•L•. Filuuns II)ickvuiul;s iu Ihe• %%•atls 411 Ihw:W• .mall bI/NMI v/•SS.'1s %%rn• hrnnrl iu !M).7 la•rirnl uf /lM,.r Men h:ul smukr•rl /a•uru' uu.rr Ir.u•ka aday, iu 1'i.•/ IN•rr•.•rr1 of Ilh4w• oliu b:ul •uuokrd L•.s Ih:ui .tur t.ark :I iI:y• :sru1 iu rMww n/ llwo..• %%luo h:u) rM•v4•r snMrki'4I r~ ).nlalh'. (.\urrh:M•h• /)., ( »uWr, 11. W. (:ar (inkrl, 1.., IlauuiMm.l, 1':. (:. (:i}Cau-U4• srrM.kirut; arMl vnruuary a1tmy di.t•a.r•s: A uuacrosxvp-ic a/ul Uril9Y/.NYrI)K'study. (au•s1 7/)((!): (1!17- 71)Cr, I Art•urin'r 197(1. ( A'ir•uli»r (:Irlx O.syi;eu rrnil ti/N•r•rls llrurtlx•ul (:i);arr•Ilc suMrkiu}; slimul:r/r•s r•r•rlairr K):uul'c In u•b•3xa al1c atlrrualiu :uMl olhr•r IlowI•1fUI IMNIIMuN•s .rlrich caaa' IIM• m of Ile la•art tu tsu)Iract uMrri• xlrrurl;l)' :unl uHUr rdlrrr, iui•lo•as.• llu! hiarl rall', arMl IIM'rrby incu•au• /la' IN•:ut's urtvl feu alal oNla•r uulrir'nls. (:r•r•Iairr blrwK) s-.•ss+•Is r.urlract slrrMrl;ly onulr'r Ibr iullui•ucr of Ilu:.x• IM»'uMwk•s. 11111 al llM• c:ruM• IiuM•, llu' CarlM/rl IIMNM1sM1/• (CO) in 6t;ar- r•Ile snMikr' rrpliu'vs :rs rnur•h :rs t.vrhr• IN•rcrrd of 1hr ury);.yl whir•h w.Mrlbl rMUrur:rlly IM. varriey) by Ib.• 14•.1 c.•11+ iu 1111. III/NMI Wi1h 4•:rr IMr~}h~ua~};k~l)iu (('UIllr a lil;hl hmull of (Y1 a1u) hvuu-1.in.) ti.o• whilr llu• sruMikvr's luvail urv.Is uNN.• 1/\y/,I•n• it grl. Iv%'.. 'Ihr lai•k (of r)xy1;eu irr Ilu• hkrNl ura)• r•uulrihule lo llu• 4ltwelupnir'u1 uf atbvrosclewrsis• (S(: 197 1, p. a(i) l:'x/xxscd ( )reu)Nifiuu.s A xlurly rrf 1'arisiau /:&si dhivr•rs ahuwytil Ilr.)1 .ouukri...l 15 .•il;:u.•Ilrs :r rlay barl /.ntr lim.•s 11w (r%.•I o.l r:ulhI.% l1.•uwl;b.l1irn :v. llum• snwkiul, frw.•i Ih:uo livr. a~la~'. ItLra Iu1n:is .%% uil: 0.1% wo'1r Is•d4•4) a1 1h.• 4•n.l ul 11a•ii .hifl: 11.141 0,11 I.0 aud •1.91a•uvut I.) 104a1 (•arlM1% % h.•lniq;l.d)iu. 'Ila1m• .% lu , ':m"i.wl iutue lhau 2/ ci};:urllvs adLay hmiI IdINal Iovi•Is 4118.5 Ir•1r.•n1. ' II is I•t•irl.•nl Ibal if air Iwlluli4m i% a Imllu,l;, •uir' Lu•l.a il is .ur.d1 its connparisru) wilb sutokiul;." (W) I( I 1979. 1i.271 S)nukiui; l'iluGs Risk I)rufh A 45•yeavuld uurlc airpl:mc pi1o1 %%•IMt .mukv. °I).•il;aio•11r0 aa1a1' bas a ri.k elf su.14l.•u dv:l11, :'.a liul.•s grr:1lr-1 Ilh:u0 11i.11 0.1 :1 unusnNrkin/; pilr.l. irrr•siH•r•tiv.• od ullu•r ri+k far'Lrr.. 'I'ulwcu cn suu,kr si};ui/ic:wtly interfcn•s Wi/b llu• Idl}•sical•and 1urulal abililirs tlrat are su imlx)rtaul for piluls. '1'br+ (iwit:tlirnks iuclurk' visual inqlair- III;Alt'1'A'1-1'ACKS•(:Ilt(:I,I.A'1l)lll' I)ISh:AtM:SANI).1;1'1U1kh: 37
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lf;i 50332 8758 t VIII-SMOKINC: ECONOMICS ANU STAT151'((S "Surokiu}; r1•snlls in a clNr.cith•rahly irK•r1a.a•rl uaxhidi/y ra1c, wl/lr its CINrs1Y1rN•nt loss of wurkinl; days, aluttilttyisul and r.xc•cz- sive dclnantli tNl IIU%lic:rl services, both for priolary alul fur hospital care. The cost to the community of premature death, Increased ill- ness, and loss of productive capacity resulting from cigarettc snx>king is very high in countries whcrc the habit has ba.m common for a long timc." [ W] f()1979, p.101 In the United States, it was estimated in 1076 that the avcragc suwk•r spent $240 a year for 5116 packagrs of cigarettcs. Total retail expenditurrs for tobaccYl accounted for approximately 1.5 percent of disixls:rhlc ilcyrrrur. [SnNlking a/ul Alcohol Abuse; 1.rrcc,B.1R. alul St•hwcitiarr, S. O. Workl Snarkiub and Iltaltlr, Vol. 3, No. 2, Surnmcr 1978, pp. 27-31] Per capita cost for smokinR-related disease is estimated at ;•f54 annually in the United Slatcs. '1 iltal cost iu the United States for ur.r jor snarkiul;-rcl:rlt•rl dicr :rsr• ;ual Gr1•s, irarhalinl;la•allh care, lost carning.s through nulrlddily antl nrlrrtality, and lxr>nr•rly rnsts was t-slinarltwl at j'17,'),:N1,7(N),t/l)t) iu 11176. 11ris is 11.3 tw•11-vut of the comparable aggregate costs of all U.S. illness. Total /alt-of- pocket health care c•ost of smoking-related diseases was estimated at $8.2 billion in 1976, approximately 7.8 percent of all U.S. health care costs. ( ibid ). Tobacco Faruling Peak pcrilxls of tobacco growing coincide with tiuues wla•n agricultural labor is ne/xk.Ki for other crops; hence, in developing countries tobacco farming may interfere with the food supply. Farmers in s/rclr c.rrrntrics are generally in ckbt to private rnm- panies; a large proportion of their income goes to tralsnational tobacco companies. Since most countries export little of their tobacco crop, it does not a&1 their balance of Iwyments. [WHO 1979, p. 331 `l'obacco-growiug is helping to spread dcscrts, because lulge quautitics of 6rewaoll aro cot annually from threatened forests to provide heat for curing the tubacco." (WHO, 1979 p. 331 U.S. Tobacco Economics Tobacco is a cash crop in 16 states of this country, and I I Ibrnlinalr•s 11u+ agriculturc of u vcral, must uolably Nurlh (::rruliua and Kt!/ltuckyl. It is also a Irrlior ilNluslry, whose crlstt/lru`rs sIN•ut $123 billion for ils uuluuLu /urlrl tn-IMlrrr-ts in 11a! II.S. ill 1978' uof which \vrnl (I/r t•il,arr•Iirs. M'/•+Ir•rrd, s1:111• a1N1 l/M':1) t;uvo/lurw rrls t Irlb 11.11 ~fi•.^.7/1,INNI INM/ iu 11rIr.llrrr rx/•is1•, s:111•. an11 t•rrsllNlls taxes iu G..cal 1168. I1•S. UIII:N7Yl 1-rlHKls \w•rr valul•d at $2,12I1,1X1),/1(N) in that ywr.'liIIXKYY) i/nlM/rls the sallll: y/ "Ar (tltakYl $,i28,tXX1,(MN/ exclusive of dutys. The U.S. Drpartrncalt of Agriculture has spent w/•ll over ;1.5 billion wl tobacco progran>s since 1fy3.'i• Current t/lhacra txice snplxut kranx of the Dcp:rrtnx!IK's GnlulKxlity Credit Uxlwxalitur total =7t'i0 million. Total of all such loans since 1913 is about $(i hil- liwl. AIIINM/ INl interest has INY91 lX/itl /MI I1N'Se ltra/1S to tIM i;()vPrll- lucnt, ahlawri;h the lh!IxsrlnK•ut of Ai;rk•ulturo Ixlid wrll nvt•r;•'>tNl million in interest to tlas U.S. '1'rlasury tluough jrum 90, 1974, to IriNr/lw Ihe IIMMNy. Net hRS1•s r»r loalr t>rilr: itr.d Iulallr•tl $SS ulillitNl by 1974.3 Drpartunent of Agrictdturc 1)tldgrt for tohacco llwlu scr- vicr, trlh:u•cn irlspr•di1111, uiarkctinR news a1Kl trrbacr.o research was $!'A million in tiscal 1978.2 It is iutt•Iralinl; II/ 114114. ihal all 11•hisLl/irn/ tluls f:u passl•d has 1•xI•n11r11Y1 U.S. ri};ar1•111•s .Irbl ir11•xlHrrl frrNn using t1a- warning I:IIM•I, t's1•1•tN /INm-AIItrINyl 1/1 IIII• tl.S. Ar/1NY1 I•IHIY•111\'1•1':.':1\, (~rrl.cwla•rs lla• world n\vr sIx•nd au r•slinratt•rl *gS tn $IIN) billinu cach year ln 1»ly (t>,1r Irillia„r ci/;arcttt•s, about l,(NNI cip,ar- cttes for every nulo, wonu•lu alNl c•irilrl in tlre workl. (Erik F•cklalm, \Vorklwalclr Paper 18, March 1978, Worklwatclr Institute, Wash- ini;tolr,D.C.,( (:unsuulpliml Fu»u 1025 l0 1l15111he iH-r rnrpila collsmuplilar of t•it;:ru•111•s of pt•rsoos 18 years rlkl a1Nl u1/11•r in the United SIa11•s rrw! strarlily, frtwn 1,1M, lu a,5?^ t•ii;am/11•s tM•r y-oar.'17a•rr w:la a Ilitl iu 1!1.'i I, Ibe year w1a•o tlle Auu•rit•sw C AIKr.r Sucicly first puldishl•d r1•.ulls of its first Inajtx prosix•c:ti\•te strldy of 11w ;Iftrts of sux/killl; ou health (src p. 77). U.S. ixer capita cvNlsnuqNitwr rraclu!d its t>,!ak in 11J(i.`3 1. Tulwrlw f. rAe N.IY+wI Fxw.r.wy, V.i. Ib•i • •.1 n1 AR.h•rMw., A."_. LLa•11. 1970. D. 3. 2. Tul.w.w SAwrr4.n• qrnM, ///T!R p 17. 3. 11i.MMy A Rrqlwr/i.w u/ "rd..w•- 1'ur!.rw. 1H74174. !:. 1'y+.. 2041, N..11.w.d Ta1w•.w W..d.n Gw/rrrwr. IrM. 27:N1, 1fl7'.. 11,q,,,lAhlr.1. Ih-,d, ot Ap'rwMan.M•a.wr.d. M 62
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• 146 VI-SMOi:IN(: ANl)1'Itl•:GNANCY DIiUC Mi:TA13OI.ISM, Mls'1)1CALTCSTS t'rcl;uunr•y and ln/ant tlcuUlr MrKO atKl uusrc data show that cipur.ttn smoking durinR hrapiarx•y has a sil,riGc an/ advrrsc r.Qrrt ulxwr tlrc well-being of the fetus, tlun health of tlus ncwl>onr baby, arKl thc future dtwck>p- nx•nt of the infant arxl cluld. Stillbirth arul Lrrru lltrt/iwcigbt Womcn who sowkc durinq pregnancy have signific.ntdly nwro stillbirths, and more of their hahics dic during tIN• first uuwrth of urfancy, than those of nar-smoking mothers. One shuly of 2,/llMt pregnant wonxsu rwu:(udrxl that 2) Ixrrccnt of the urwC1uYY:xsful prcbnarwics "wovdd have luru successful if thc rndhcr had rxK bccn a regular smoker." f ltrrsscll, C. S., Aiwtlrer llaisard of Snxok- ing, New Scientist, 41 (631) p. (i1-Q5, January, 1MJ A prrrslxcaivc Iirili+h sturly of 17,(N!0 hirlhr showcrl that "thc nxrrt:rlity in babies of smokers was siKnifiu•itly higher tlam in tllose of rurusuiukcrs:''1'INt rcasun: "thc excess r>< k1w hirtl1wr•ight habir:s" (13utk•r, N. li., AI1N•nuan, 1".. 1)., 1'raradal Prnhlcn4c, r.din- burl;h, E. 1h S. I.ivinl;xlonc, Idil. 1fMi'), p. 72-84( "L.ow birthwci}(ht" refers trr Irabic:s prcuwhturc by weight, ( nnder 5 i Ix)unds. ) In a study of 111U,iMN/ births, suNokiol; nothcri 1palbiles wcigIN•ll INg Ihc avTrJl,c (i.t 4NNNrS less 1h:u1 IINItiP Of ,NNI- snxokin); nudhcrs. (S(: 1971,p. anf), also Table 2, pp. 3317 .`•rl<)1 IA»v hirihwci};hi is rclatal nN1rc tu sinokinu Ilran Ill awy uthcr factur. And it is rclat4til lu Ihc 14•nl;th uf tiuN• IIN: prc);iainl woman smokcs Ix•Grre };iving birth. In 48,/MX1 prcytn:nu•ics, Ihe m4oi1N•rz whu Glid unl sNNikc huJ Ihc larl;ra ladbics; 1hn.c w1u1 smokcd Jurin}; only thc lirst part uf their prcl;iranry, had smalh•r babics; and thusc whu subukrv( rhning IIN! entire Irrc};naur•y hoNl the smallest babies. (SC 1971, p. 389-3JOJ 'l'lic mure a wunian srnokcs rluriut; pragnarncy, llN• greater the rcductinn in her iu(ant's birth weight, amrnding to a large number of studics. 11owcver, if a wouwm Kivea op smokink chuinK pre};n:uncy, her risk of dclivcrisiu a Ww-hirlh-wci};ht IHihy be.- rnnics similar to that of a nousnNrkcr. (SC 1rJ7f), p. 8-12) In unc large stu<ly, lhe nxwst si};uiGcsult ili/fcrclNVrs loe/wcen sNioking and nuusmokinK prcgnant wumen, in risk of "1Nxinatal" 147 50332 8750 4Ioaib (iu thc di•vc•lup-l 1011% ur smw aflcr hir/h) :uNl in prcg- nmui•y ~ nuq~licaliuux, wcrc /41mNl 141 4M•4•tir al Ihc graalilHCi) aE,cs 1111111 rhl weeks 141321 14) :31i wi'ri,.. IAIc)cr, M. It., '1'miau•ia, J. A.. !11alr~ual snN~kini:. lNrgnarN•v 4 •Nlip1icaiif ins, :nN11N'rinal:d u1url:rl- 1nN'liu :an J4arru:11 Ill 111I.Iciin•s unll l:}'nrcOrbry;)' ('28 1 5): 1!11- )rrl)' (, N)-5( I'6yaulut,ir ?•:JJrrls in I'rr":wurry tinN/knll; laI1.N'ti all IIK•rcasr• in IIN• HIINMn1i r/f l•ar(MM/ nNHI- irxirk,. in /hc bhMx1, alKl, tIN•rrlure, :t decrease Ill its uxyKvn arntr•nt. WIK•u a p(egiautt weNIam suN1kcs, this oxYl;clalxMrr hWwMl cir- cu131r•s thrunl;h /(N' fclns. I)r. I.. 1), I.ANII;u stated tlr:rl "tlN• rhr. crc:r.WYI availabilily 4 us)•}y'n . . . is la4d1ahl)' injnriurrs Iot fc1:d /ivaN•." ((;arIMN1 M1NUrsith• iu 1114. 1'rct;nanl I\hothwr :uld Fetus, Annals id IINe N.1'. Ar•:Nlem%• u/ ti~•inN•v. 17•1 ( 1): 31:3-311, t k•hdN•r 5, If)7t1J X1'iN•n rals :aNl rablgils are e\IN/sP/l 1// IINY1/nN. ur r•il;areItc suNrkc. Ihry lawi• uwrc u»srrt•crssful pu•goulN•us nmi snaallcr rrlf- spring Ih:ul roulrul :ulilnals. Stuilics in Inicr have shuWrvl IIaN IlivrNinc (and ils nlc/alwililrs) :N•t•uuwl:rlr in 11w• hlac'•nta 11N• mvnrl1r:mr arfam4l 11N• fclns au4l Inass iniis /IN• fcllls. IS(: ISIi I, lryr. 107.11141 1151 hi und• of /hc irw ciudir•, tit siouillalr41 ui:uijnana s1uu/,ing iu :miuials, il was rriwutr4l ihal I,uinra liig.s csiNlcrYl 10 wa~ijn:u~a .m4)kc shuwcd :us incrca.cd ncilcl ual hc:ul riNc rh1fing Ihc >uwk- in}; IN•r4H(, :wdl ch:ui};es wc1c ulrW•rwwl in Iwdl1 nlatcrnal aiNl f4•tal c1iY•1/YN'INV•t)h:1l4 n,rams. (Silii,6•1, I'. It., Scihci/a, J. J., It41.4•N, AI. C. Siiuulahtil nauijuuna smokinl; in thr Inalcrna) :uHl fclal };oliuru Iril;. Ainciir,us Juurual nf UImh•liics :nNl (:ynvywlio};)• 117: :3'31-a1t1, (a•I44N•r I, 1!)7a1 l.un1:-Tr•ruo I•:/J1•rt.c in (:Hildren .% kNi}; Iorul lull, rw-ut)atNh ahuws•4I llaal whwn tiN• N1ul11ru:. h:Nl IN•4-u hi:avy xmAcrs 4lu1iul; 1'rc•"ua;N-c, IlN•ir vhil4hcn at Ila• age od scvcn a•cre slNxli•r iu slalurc alNl had rctanlcd rcadin); abiiily aiNl 6wcr raliu},s uu "s4K•ial :NliuanN•1rt" Ih:ur 1b4• childhrrr of uunsntukin}; nmnthcrs. (Itodler, N. . A Natiuual I.ring'fcrni Stucly uf 1'erilla/al Ilaiau•ds, inrW•utwl a1 (i11l 11'fwlil (:11NI,1,•.e i,i (:yn~ rti~luqy-t)ha~ Iricw, Ncw 1'mk, Ai»i1 12 19, 1!rl,, l I pIv 1 AiNdhrr I41ng lcrnu sln~h ~IrnNnra~:~lc~) W~NN .il,uilivanl di/ -l i 48
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t 138 Inlrut, liulillg ur temporal ilupHirlucnl, :uul inq)airoN•ut in ll/•cisi/lu- luakiu); an/l c/H/nlinali//n. A/:uly aro Ila• r/•.ull uf ilu•r/•as/Yl car- ININ ) hru/ut;l/~hiu h•vrl ill Iln• h11NMl. IW l l( f 1!17l1,11. :.'7 J t /lhrr /•:/lrl f.s qF SnNlkiug cll;arctll•x alsu/l:urult;rx hrcalhio};capacity; thus, a slnokcr takes in less air with cuch breath than a/xursllwlkcr. This fIn 11Kx dilninisla•s th/• amumlt of oxygen available to the ovcr- workcd hcurt of a suxlker. (SC 1971, p. 146 ct scy.J Another Isechanism related to snlokinp affects the platelets -a fraction of the blood which c•auscs clots. Slnoking scc/ns to c:aul.cu the platelets to adllcme "which miKht c•clatributre to acute throullHrs (clot ) foruutti/ul." (SC 1971, p. 91 C:onclusirnrs ". .. Snulkin); is un.! uf Ihr/r nulp„' iu/IVlx'SKkrnl ri.sk fact/ws fur lwart atlacks, (IwdhJ fatal alx) nonfatal ... and slKkkn cardiac death in adult ml•n and wonwn. Atorcxlvcr, the efrect is dose re- lated, and syla•ry,istic Willi /MIK•r risk factors fur heart attack ..." ..(agar/•I1/• sulukin); is aX.NM•I:IIIYI (in limil/•II aulnpsy slutlics) Willi nw/w srvcre a1Nl exlensiv/• athcrnscller//sis of Ilu- aorla and cti/nxlary arteries than is Gnlrnl anNarK n/>tlsualkcrs ... Whik• more /lala might Ise rh•sirablc ... there is no r/sls/nlable Jolrbt that ci);arettc s11N1k1/1};1•nhaua-s alhurogcncs (/•stahlishing) a flrndamcntal rationale fiu tthre tindinf;s ou the incidence of h4-mrt attack, including sudden car/liac dcath, aorlic ancarysrn, and peri- pln•ral .:ISCUIar dia•asc iu rcLdiuu iu urN1killg. It iY 1(HINSWIIat IIII- certaiu, bld likely, tlult snalking has an adverse effect on thc rccnr- nelrcr, of hcart attack alnl>tlf; survivors of a priur ury/xstrdial infarction." .. l:piclculioluf;ic data <ul thc asslwiatilm Ix•twcrn cil;ar- r11r sllupkint; al/ll :/Ut;ina IHti•1/wwi1; cnal .yT/•Inuvati{•rdar /Iisl•:aur (stroke) are not c/mclu.ivc ...'1'lie-rc is IK/ apparent rclatulnship Ixawccll snlokiug and tlus inciJcuc•e•of hyhcrtctilsion, (altlNwgll) smoking joins with hypc:rlansil>,1 to affect the patient Willi the car- diova.cular burllcu of Ixllh risk factors. "It s11/u11d 1w• noted, lalwew•r . . . Ihat risk (of airo/rary heart disease) in sllurkcrs reverts lu INlrwal or u/>,umokcrs' levels after they ccasc to smokc..." (SC lfl79, pp. 4-Q4-8) 38 HEART A•)TACKS, CI)iCU1.ATOHY DISEASES ANL) STROKE 139 50332 8746 V-1:N11'I IYSEh4A, (a lli()NI(: Bli()NC:111TIS ANI) O'1'111•:1i Nt)N(:AN(:1•:ROUS I.UNC t)ISI?ASf S "VI'hl•n palicnts Willi br/NH•hilis are ask/-d if Ih/•y have :1 cyHl};h thcy rM/t infrcvlocnlly reply 'ycs, like cw•ry/NN• elW :' '11ivy Ibr not realize t1ur1 peel{ilc Willi IN•ullhy lungs Iwve t>,1 cough alul Iw/xluce no plrlcvlr "( Royal, p. (s")) S/nokcrs caMlgh uaxe Ilwn tlnllsllwkars and prodlrce nxxc s/nltnln. This can occur very soon aftrr the onsr•t of srrNrkinS ancl even whcrl the nonJxrr of ci);arctlc+s snxlke<1 is very small. (Snrok- inK Or Ilcalth-'111irJ 1l/•IwKt //( (:I/llegc of Plrysa•ians, Pilman, I.rnulun, 1977. p. 77J liiKpiralory inflctilHls, ilKludiug plxst/qic•ra- tivc /nlcs, are mnr/s ccululum in sluokcrs, who take l/»/gcr to recover. ('i);:rn•tlr.ol/rkiugacls indl•tw•/al/nltly /d a1Nl sy/l/•r/,islkalh• Willi Ilw otlK•r risk factors IyNllrilMlting to Ix/H/c•llilis. hl d/•- vcbqlt41 c/>tlnlri/•s it is now tlK• nNRSt iuqlnrtant call.til• of cllronic Iu/uchi1 is." ( W 11( > 1.7Jt1, p. 201 (:hrunic hrlnlchilis an/l hnlln/mary /•Inphys/•,na arr ufl/•n Inik/al, INY'a1154 IIK'y al/' fr/'1f11Clltly f/H11N1 Ingl•IIN•r, all/l INY•a11-SA` Ilwy sc•crnl lu Ix• pr/xllrc/•/) by xinlilar r.nlscs and nu.lulnis/tilc. Clinicyllly pure furnr.r of chronic bronchitis and clnphys/•u1.1 arc the rxcrlHiluls ralla•r tluur tle rllle, and luil{; cancer is oflcn :dso sc/•n in Ilu• sanas lullicnls. ('hr/NliC hr/alc.hitis is IlcGnrd :ci tIN• "chn»lic ur ururrcnt exc/•ssivc In1x•us s/yr/•ti/a1 uf 1h/• brunwhi:rl tb/y:" ISC 1'.)71. p. 1:iJ1 11 is identified by two Sy/upHlur;, (1) l'11r1U11C tYN1gI1 wllich I/ru- ducY•s (2) slwdnul. 'Illc .pnlum uuly h/• ch•ar, Iwrt //flon lYwdain. INm IN•c:uoa• fN'lyll/` willl cI11ANUi• III///N•I/III% ar/• hit;hl%. .u.oo•INi1,I4• tn lullf; infct•liolr.s. Trcu-agcrs, wlal slunkc as few as Gvl• riHarctics a day, c(AIgII a11rI spit al1lN/.st as U11N'll as au adull heavy suxlkcr. Thc Mllgrhr a Ix•rson Willi chrluric brarchitis swukcs, the worse tlru awnlili/H1 Ixvl/nMs. 'I' • lir I/asxages iu 11u. lua}Cx IN•- 1Yq111• flrugrl'x%ivRly wlrr//wl•11, nu/iiUg it Ilar/h•r :ulll h:u/l/•r (1, hrcalhe. '111is is uflt•11 wl/rsl•ued by 11a? f:u•t /11:11 so nl:m)• 1>,r/plv Willi bronchitis al.W 1 have cmllhys/•nla. Pulmonary t•Inphysl•nul lh•stroys thc tiny air sacs in Ih/• bin); wlu•rne oxygen is a14GIrlN•1I 1111/1 Ihl• IHKIy. As lhc walls IN•lwlv11 Ihr sacs arc destroyed, lh/• sacs h/•IYnllre largcr-but, Iw•causr fewer its ~!/
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04 140 uwnbcr, thcy ulfcr Icss Inlal stirface frinn which oxyl;cn can la• alr• sorik.d. llurcc, ruurc :u1J narrc breaths arr: required. A norural adidt cx)xrncls alxrut 5 pcrlunt of his cnc•rgy in breallriu/;; a/x•rsrru witlr atlvaucccl curphysenra uxs up to Ilt) lvrcent of his strerrgth just to brcathc, llc is cYnrsl:urtly exhausted, gasping for air. 1)callrs from pulururr:rry l•ruphyutirra IuK1 chrorric Irrlnrchitis (known together as COI .1)-Chrwric OIrstnrctivee I.rurl; 1)i.w•asr• ) have increased grr_atly in Ihc Uni1l•cl Stall•s in rrrrrrt years. In 11J15, there were only 2,(kiii irrdr deaths listt.•cl in Ilur United States. (Dichl, f38-flOl ln 1977, tire figure Ir:rrl risen 10 2,4,lNtt) dcalbs lxrr year. Chnuric• Irraic6ilis and curplryscur:r r:rnk scctiNrd only to coronary artery disease as a caaic of Srrc•ial Sr•cirrity- cornhcnsated disal>ility. (SC 1979, p. (1-7) !n tbe United Kingcllan, witll a IKqwiation urrly rrrrr. fcHmh tlrat of the United States, tbcrc arc ururc• than 90,(XNl sucly dc•atirs cach year; aral :35,1MlU,OpO ur:ul-Jays are krst frrrrrr wink annu:rll)• as 11a+ result of curlrirys/•uur and lfirrrrric IrrlHU•bilis. '111i% is Ir•n br 12 tiru.x tbc numlx•r of d:rys la.t through irrlbrstri:rl /lislwtcs. (Royal, p. 691 SruokursVrrb+crnblc fo COLD Deaih Cigarette srnokiug is tllc most important causc of C01.1). Cigarette snrokcrs have highc•r mortality rates frlao cbrcaric brun- clritis and cmphysenur, an irx.•rt•au•d prcvalcru•c of respiratury synqrtunr.., wrcl climinisln•cl Ix•rforur:urcc on pnlwonary fluiclirrn tcslin}; compared to nun.mnkt•rs. 'Tlu•sc• dilTc•rr•mr•s Ix•rrnur rucrrc rrrarkwl as Ilu• u1nulN•r ul ciH:urllrs ba•r4•a.c.c. IS/: 1!)7!1, p. l1-71 "I•he owst rr•t•cnt Jala fruur a 2)-ycar fullowulr of 11;11/1 lirilisb nutlc physici:uis fcrrmcl a 1.5-fultl 6ip,la•r cloatli rate froul (:OI.1) ill smokc•rs who iulr:rlecl tlr:ur io smokc•rs wlur did ncN irrlralc. (1)ull, Ii., 1'rlu, li. Alurl:rlily ill rrl:rtim tu smukin};: 211 vcarrs A- sr•n•atiuus uu usalr lililiar rlbK•lurx. lirilish P14•1lic•al J(nirn:rl 2: 15`3.- 1S•3ii,1J7!)( A uwula•r o)f rri•vui sirrdivs hav~• cslahlisbvcl a higher Irrc- \•aG•ncr of rr•sliiralor)• symplcnns ill adulrcurnt, tccnagc, :ual ynnnl; atlult swukc•rs as cuurlrarecl willr ucinsuarkcrs. In a stncly (if 1•1,(L`l.` c•hild sukiikvr., a);rcl 11) ill I•_'!7 ill Iht• l/uilrtl l;iugrluwi muro were found Ihan their nunsn>,iking t•lassm:rtcs. (Ilmlcy, Il., Blancl, J. M., Smukiug and rc•s)rir:ktury symptuuu ill two );ruups of schaolchil- tlrcn. 1'rcveutivc Atetlicinc 5: fi3•fi9, 19761 L•:\/I'lll'SI•:MA, Clllll)Nlt: (IIarNC11T1'IS ANI) 40 l)Tlllal N/)NC:ANl:lilt/)l/ti Lt/Nl: UISN:ASh:S i 141 50332 8747 A snn•cy n( I?,5!Li hi/,h ,clriail shulrnls ill Ihis r-wnlry n• Iwni4•cl Ihat rcl;ul:u• wru);b, pld4•I;nl IxrKlncliuu aull whcY•iin); cm- rr•lalr•cl slrcqrl;ly wilb ci);arl•11r• suNpkiul;. (Iiuslr, I). (:hciu/,cs in n•.Iriralnry symplrnus rclalc~~l tu suurl.in}; ill :r tc•rn:rl;c• Iwrlud:dicrn: '1'IN• rr•sulls 44 t.vo linkrrl snrvc)h u•1>.•rraliY) by cNK! yr:u. I1A4•rna lirwralJcurrualrrf h:piclr•rrririlsrt;1'.5(`t): 17:1 17K, 1!T7(i1 Alurn- &'nvilir.c' HrrnNrint;7i•.lv New rr•lirn•nrvirts ill iru•a.urinl; lmr); (uut•licai noa naake it IHtcsilrlr tc) pirqxriut c:uly ch:uigv. iir sm:dl airtt•:rys rd 11u• I1:u•br4r- Irrnrrchisil tn•rt, tlurcc willr rliauu•1r•rs uf two ruillina•Irrx lw• lrs. t al;arcttr• suwrkr•rs slarw srlrrNonnal clr.ur};r•c ill IIN• snuall crila•ays xt•Iric•h arc cdreu/ frib/n IIN• Innl;s nf mnrsluukers. (:il;arctlr .oarl.in}; c:ur ulrlilcratc urrnl• tlrau i(/ la•rccnt uf lla• snr;rll aint:r%•s Willrrwrl Iwrwlucinl; sil;uila :ur/ si/;us wlu•II 1YNnY•rriilloal urr•16rw1. r1f nn•a.rrr- im, lrulimurarv fma•Iirtio :ut• irm•o1. 1•:.•ido•itre frurn a nuudM•s ni oIi( Iw'o•nl 1aINpralorir.:u141 r•linir% inllicalvc damal;r 14) suuall aifa•:rvs ill /rrrru M) tr) li(i la•1rc•1d oil :r.ynqblnur.rlit• cil;:rrrllr snNll:r•rs. I/.rnr age lu 11rr srrrall airways bas a1m) INV•u rrlwnlrrl ill 11•4•na};r .nNll.c•is witlr bislrrrics uf snurkin/; as hrit•f as rNU• 14) 6t•r years. (S(: 197!), pr. (t-Ip-22 J 7lrrsu scusilit•a ru•tv 1csls nn+v o/G•r 11N• I>,rs.ibilil~ r~( drtec1- in); carly si};ns of r nqd~~:WVU:~ aud 4•I1rnuic hrun4•Ibili. 1hw Iralirrrl cIc•\•o•lu/n s% •nrplrnnkx. Air I'ulluliun A mmnlw•r u/ audliv. har~~ Im•ru m.ulr iu dillrrvul I~Lu r. a1 clilferc•nt liurrs sunnnt; wurl.ers c•xlHi.4•4I 14) high cnn4rnl1alifIu% ill Inillulcvl air at tvork..Altlaou/,h a1) Il1r•sc wirkc'rs hat•r 11Mnr Iwi}; tli.rasrs Ilran ill llrr resl of Iht• laqmlalism,lhr l;lral I)r4•INlnt of .uc•h rlisc:rw•s i% iut•:uialllv (ulnrul, as 4d hmi, 1•:nn1•1. :unumit tiludies of \t•nr{.r1s ill /Iu• iurdh;uiic:al. 4.I14•rrlicaI. u••IjIuiI•.. Inun~ln nr rnarlble, 4•urn-mil1, miliiut;, lirr 4•1dlitq:, a.llv.1w:, 4•nn slrur•litni, r1•1nrn1, rublN•r, vork antl nlhvr imbisliiv% h:m• .homn n highvr invitlrncr frf rrspi/atul )• di.rascs aw0ml; snirnl,r1. Ihan :ummn}; nimmnuki•rs l•' laim•41 lu thr• umN• iNr11l1atiunal lr.rimil.. (N\' I I/) 1979, p. 2(i 1 Int•masctl 4 prrlIuIInar)• ilisc•a.cs lms IN•r•n clc•m- uuaralt`d in an•a% of air Iit'Ilrrlimn in Ihr Nr•Ihvrl:nalc, Jalran and 1:All'lll'11:~L\.1:111t1 I\I1:1t1ir W :111111 ANI ) l i ll ll•ai Nc INl :A W a Iu 1115 LI INt: DItil•:ASI•a 11
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1 130 t;cal cauct•r has Ix!cn ctiHtGrnuKl, vcrifyiu}; Iht! link trutcd iu over 14 carlirr slu.li.•s. lwyud.•r, E.1.., (:nvt•y, 1.. S., Mabuchi,1.., t•/uslrin- ski, M. l:uvirarnta•ntal fac-tius in c:nkrr of /lra larynx. A srx.YUrd look. t.^,anc.•cr 38 (4): 1591-1(1(11, (k•tohcr 197(i/ 1.otrg-tcrnn cil;amtte snxokc•rs, MAh males and females, who use filter-tips, rc-ducr their risk of laryngeal cancer by from 24 to 49 percent, and the risk among ex-srnokcrs droin gradually after ces- sation. Aftcr approximately tctir years, cx-smokers risk of larynx caneer approaches that of nonsmokers. (SC 1979, "] Canccr of tlre larynx is often cured, usually by surgery and generally by rcuurval of the larynx, tho main organ of shccclr.'Ibc p:rticnt thus c•rur•d cau hc taut;ht a new netlrod rr( slecxll, arxl must live with a IerrnarN-nt ot>Crrina in his throat. A new expcri- nx:ntul operation call stHnctinltm create a new "vocal corcl" out of pharyngeal tissuc that makes re-learning speech quicker and easier. Sur f;coar CJcucruCs (:oncf rasiorr. .. Ist~iclt mitdr~;ic:rl, extx•rurK•utul urKl autopay slrKlicx in- ditate that cigarottt• suuAin}; is a sil;niGt :utl caus:rtivc faclrx in tlrc development uf cancer of tIK: larynx. 'lhc risk of developing laryn- geal cancer in i>ipc and cigar snKrkers is similar to that for ctigurettc snrokcrs, [and] much greater for lwavy smokers who also drink heuvily, cvrnyurrcrl wilh indiviuluals who rutly have extwxcrui: to i-ither suhstancc. Tla•rc is a suhstautuil decrease In risk ... witlr tlue. ltut{;-term usc of Gller ciy,••rreltes (1(0 years or more) compared to the usu itf uutdiltrr t•il;:n.•Iti•s, larrtll a grathutl rc•chrctiou in risk of ... laryngeal cancer after cessation of smoking." ISC 1979, pr _5-37, 381 Af outh Carrcer Au:tly.is tif u lar/;t• nuudN•r of slutlit•s reveals fruut three /u tcu times as ntany mouth cancers (cancers of the lip, tonguc, floor of thc moulh, hard and snft µrlatc, etc. ) io cigarette snu)kc:rs as in nonsnwkcrs. Pitx smoking has long been rccognized as a causc of lip cancer; pipe and cigar smoking as well as tobacco chewing, also contribute to canccr at other sites lit the marth. Alcohtd csmsumption and possibly poor dcntition also alr pear to be risk factors. lit wle sludy, 76 percent of oral canrcr in males was attributcJ to Iltr' intrractictu of tobacrw and alcohol. 71tc 30 OTilElt CANCF.nS I 131 50332 8742 risk fur the heavy drinki•r Mhn :rlsn .uNrkrs is fruor si.-4 lu 15 IinN•x greater Ihan for Iht• inrlivitlrual who tltK•s not Ir.sa 1tdt:n•c•u tu ak•ohul. I lirrlhnuut, K., Keller, A. '1'hi• r•!ft c•t uf joint t•slwxane tu akydarl aral ttrluwr•o on risk of carK•r•r of Ilu• nN»dh arxl Irlr.uynx. JtMtnr:rl rrf ( auonic 1)i.a :rse 2"r 711-71(i, 11172.1 Mrwdh t•urwrrs artr rrlb•rr Pnr1YI IMY•arr.so IIw•y arr n•atlily suru and treated at an early slagr•. Of tNa• sr•ria•s rt( 117 Irrlirntx cured of n>tuUh c•:uxyrs, 43 quit suwkinu INrI 74 carrdirnarl to snMrkc. AD ntiruriruKl free of synyNomr.s fcx UucY• years. "Ilaht 24 of tlae 74 smokers devr•Wpt•cl new <•curcY•rs of tlre morrtlr Iwt orrly furrr 44 tltc 43.v1w had quit snwking rh-vr•ktlxKl cancrr :1 s/Y•rNHI tilnc. Ilnr.s, lhe rrlx•at rate of mrutth carNrr was fG»u tiurr•s as great among smokers as unront; those wlar stoplx•d srratking. (Marrr, C., Multiple Atorr/h=llutr:rt (:arnrr, An>t•ric:m jtNrrnal of Sor{;rry, pp. .~i•41•.59(i, (kiitlxv 1'!(Al Surkr•un (:r,ar•rul'x (:unr-hrsiun . . SuNtl;int; is a sil;uiGcaut causal facbrr irr Ilrc dcnrlop- nMM/t Uf c7antti`r of 11w+ trr:rl .•uvi/y ... Ilw• usu lit Iritw•., t•il;:rrs :nal t•la•wint; /4rl>:utiYt i.s a.ux•iatt•d with r:nN•t•r of the oral t•ac ily. '11rr• risk nf rrsinK tlu•sr• fornrs is 1hc s:uur• 1;crN•ral nary;uittuh• as that uf usitq; t•i};arr•tlt•s ...'1'IN• nst• uf alrYt6al and ttdstt•c.r tu}(riht•r n•- sul/s in :r higher risk uf th*~r•klllintt r:narr Ihan ... frotu Ihr• uxr o( t•ilht•r srthst:ux•t• abtnr.•• IS(: 1979. h. 5 1^1 (:unr•rr u( flu• h:auphm;ux (:i};arrllr.ntn{,t•rs h:rw•:r ri.k..f tlyiul;of rsrqrlcqvalr•:uNrr :rlNNrt hve to nint• tiuu•s Ihat of ruNrsna)kr•rs, dctH•udiu}; rar tlrr: unudter nf ci};arr•ttr•s snrukrtl :rncl tur thc ;ur,uwnl rrf ahaltul drnnk. 'llu; known cancer-cantsinl; chr•nricals in ciRarcttc stnokc disuth•i• iu nk•uhul; +tud in this 1t1nn th4•y natro n•adily IN•u4•Iratt• lizsues. Ylui.. whrn sw:tlLmt•tl. Ihr~• :ur :6I1t lu ~ trl~ r Ilu %%:tll. .lI tlr4• t•snlihagus.'I7ris has I,.•t•n dt uN~naraltvl t slw riuu nlalh in :utinctl.. (S(:1!17!),ft.fi-{1, {~i) A stutly tr( Ila• t•supha};i uf 1°(W uarn wlar dit•tl uf r:urst•s olher than csoplr:rgcal catu;t•r showed Ihat ahruunral cr•Ils-pn•- cancr•rons cells-were funntl tuut•h .1 w friMttN•nlly in Ilx• lissur•s of suwkers Ilrin ia nonsnrukers. (Am•thach. 0., Shrnt, A. 1'., Ilarn- ruunrl, l':. (:., (:arliukt•I, I.., Iliattlu};it• l:hany;us in 1'srpthagrnx in (ivlalitnt lit Snuiking Ilabits• Uhiw•. nf I•:nt•ituunu•ula) Ilt•:1Ith 11 O"r11Mal (:AN(:hatti 11
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I 148 (•n•ut•rs in I:rt•ur of nun.nurkr•rs' t•biltlrun witlr n•stN't•/ tl) lu•haviur icrliup autl .r•IuNd Id:rcruuul. (Ih11ur, 11. C., hIcItirulu•y, A. K., lu};ram, S., I luu/r•r. (:. M. Ma/r•rua) cil;arcltr• xmnkinf; riurinf; llrr•};- uanr ):urd Ibu chiltl's sldl.u•yucnt tWvclupurt!ut: ll Ncurulu};ical curd urlt-11r'r1ua1 ucrlrlralirNr lu IINr aylr• of Gy'i years. (:alr:aliau jrNU-- nalrf 1'uhlw• Ilcalih(i`i: •13-rAjauuar) /1'r•hnrary 19771 Peptic U/cer Alalr+ ciKaralle suulkr•rs I;cl uarre slrululch nlrrrs arul alsu diu of lscplic ukYer uurrc tlfbvl tlran rkr luNlsllurkcrs. Antacnl Ircat- nlcut Glr sluuulclr ukcr is lt:.s r•IftYtivre in snu/kr•rs tlu/u iu rwur- suurkcrs, and lu'aliug is slower. IS(: 1ft71, p. !n ala study, /llc intcrrelalialslups auuulg (AM!, akp1u11, and slnr/king were vxanliru.•d in 3(3,Q5(3 men and woutcn, aged 30 lo 59; 2,597 of them had a history (lf peptie ulccr diseak!. Alen who snu/ketl had a 2.1-fold greater frtylucewy (lt ukcr di.uasc tllau tlulsr! w•IN) tlid ruN slrNrkc :uul wtNru'lr luld a l.(i-fuld Kreatcr (rc qucucy. Nci/llcr tYl(fec drinking nur akYllwl crnlsron111uur aNuu' was related to increased occurrcrK•c of lxrptic ulcer tliscasr.. I h'ried- lnan, C. 1)., Sic.l;claub, A. Il., Seltzer, C. C. (:igarctles, alcohol, co/ftre aud Ix•ptic ulcer. Tlue New England Journal of hlcdicirlc 2S11) (9): 4(0-S•17:1, Fcbnlary2.`l,1lrlaJ lu sturlir's rlonc at diRcrcut tiuu!a and in faly di(foreut countrir•s (Ilritaiu, 1'oland, Israel, aud tlle United States), lw•plic ukxr was fuund 70 to tJ(1 lx•rcrut murc frequently in INrtll Imn and women tvho snu/ked tlan in uort.nurkcrs. Ex-snlokrrs al.al had cuuxiarrll ly grcalrr cvitlrncr• uf IN•plia ult•cr. (.S(: 1979, p. !) Rl A1ft'rgJ wul I'hurrrun•alut;J 'I'rd)arcu arltl its puNluclx, iudrrtlirlg srlurkc, cau a/flx:l Iluc irnlnuuc xyslr•nl ill hvo tvays: as :urli/;r•ns, wlN•rt• they interact wi/h the iuu1xu11r•.yslt•ul tn iudrur sIN•cilic nhprNr.a•s sru•h as pnwlru•liou of a111i1wNIiPs or W'lISltlztYl lY•lls; or as irritant, pharnl:uvdugiC, alld luxic af;r-rll., irltrr:u•tiul; willl Illc lurst tlr•Ir•usc syslr!ul antl irl- (luvur•ing lllc• fula•/iun:rl :rlhilit)• uf.tlw•sr• clt•ulculs. '111crc is cvidcucre that tahaccn leaf and its prrwlnt•ts arc autif;t•uic iu airiinal. and su:us, llut tlu• rwitloiCC that tohac.cl snuikc is aiiliprnir iu ur•w is rur:r};r•r aurl c'rqllruvrrSial :11 tlrr•S1•nl. (S(: 1979, p. 10-91 Nicotine is not the rt!cfN>nsible antigenic component of lubaccu It•af, Ilu1 fivc Ill:wl prnlt•ius have Ix'cu isolated from SMOKING ANI)1'11F.(:NANCY .18 UIIU(: AIM: PAIS()t.ltif./, A/l•:1)1(:A1.'t•Fti•1-S i 149 50332 8751 1nt1nr-r'n I4•af :mr1 frnnal In Iwos,r••:x Ihr• I1rulN•lly of luocilti/:llinl; Ilnnr.m Wra, il test fllr anti};ruit:ily.11:u1:ryMuluudrrs, S., Cu1.is, N.. 1';rllazrl/;lrul, N., (:rxu'rmlix, I.. Arllil;r•nitc slotly rrf uilYdiau:t lalra rron arut msr•an•b rlll prrripilius al(a/mt t/rhacYYl au/i1;rYrc in tlu• sr.lurn uf srlulkcrs :unl ruatsnurkr•rs. Alk•rgellrlt;ia e/ lulrnnruql:dhn- Intiia 2(1): 11U 1 I•1, jauuary/Fr•bruary 11R•1/ Aslluna rx laly fMY•t i1111Y•/ as euru•b as 15 Irl 17 Iw•rl•rul ul /hr• IN1prd:11irN1 il/ tIN' tbib•rl Slalrs. Slurlw•s u( arlier• :uNl tm•%ive xuNlkiu/; Iravr• slunvu Ihal :r/1rY-/;ia• irulivirluale, t•a1wY•i:llly IIw.W wi111 astlutar trr rburili., nuiy, iu (ar•1,1N• rlurrr' s.•u+ili.r Iu Ilw• ruul- sfNY•ifk• uuxirnls cllrYis of rigan•11r• arwrkr 116611 lu :d11q• imlivirluals. (SC:14Ylfl, p. IU-21J F://rrf u/ PO.ti8i/N! tiN1t+kirrt;r :'/rnnunr'rr/rq:N •I'u11atYYr suwrl:r• c:ut IN• a.il;nilir•.u11 srNUrr ir/ :rluwir• tNlllnliurl its t•ru•Irnr•d arras.'flwr trd:ll snurl•.t• c.lwr..rur ui rwru.urnk crs is r11ut•Ir srlullk•r Illau /h:H uf srluokr•rs, INit Ilur aulloir•rll .uNlkr• uury IM qualitalivr•ly riClu•r iQ tY•rlqio.Ylnqltuualx, such as uit7ldiur, rarlNirl r1NHn)xNl/• arNl aunrNNria. 71N•rr• arr ras da/a linkinf; in- crramwtl risk of lung cmurr /u passive iulr:rlatirur of ttdwtY:tl slu/rkt•. NNY/li1Ne its IhP air is r/f tYNItY'rll INY:ur1/• it is cYnlsirlPocll (n IN• rlrue of thr• fat /ru•s tYNr/ribuliut; lu allw•ruw•Ir•ru/iv ralrlirw:ra•id:u diW:w• iu ci};arr•111• sawrkrYs. Ilrra•r•vr•r, uriuary rlirtiilinr uN•:lanrrl irr urlusmnkr•rs nudr•r rvaulitirms 44 +r•t•rrr lulr.uv•n Souol.r ludlsrlirrn xlwrttt/1 ~:rhus .uhsl:udi:rlh• lN•Imw Iluo.t• lur tuiuarv uitvdiur irl SUNIkr•rs. 1IIIrS.G•11, M. A. (1.. FryrralN•nol, (:., IN/NN) :uul uiiuan• /li(Y>tilltt i111NNI511wr1:Prs. I.:uurl 1(71XK1): 1741•181, 111751 (~lrlNUr nuuluxidt•, :11 Ir•vrls arasirusally found iu snurkc fillrYl rtilvil•rN111N•n1s• cau prruluu•r slight tlr•Icriurr:rlirwr ill :Itlr•ulit•r•- rN'.s anrl rYrl,niliw• fuut•tiurl. Ikll r•Ilr'rt% of c:11IwN1 nwnu4%idr a1 Ir•vr•ls fluulrl ill uwdrlr vr•liir•Irx, (rN• 1•x:urlplr•, "•r•rr frwrur) /lr Ia• irl siy;nilit•aul. '17u• crlurhiwYl r•1fr'r•1 uf alr•rr/u4 arNl t•:niNru ,ru1n46cir14• tYNlkl Ise tIv11NNISlr:11rYI. INIr'rllCGil ('wrllvgc of Wiayalsiu. 1•:A:wnmc of lliuuaus 141 c:uluar nwuuxillr cuiubinrrl tvi/ll iul;r•slirm of r•illll alcrrlwd and llu• c1NnllariWN1 of lurur:ul IN•rirrruwrur r wlron r%IMr.rtil HN• varyirl}; IN•1-i/wls pf (illu• lu c:rrlwNt tlu/urrzidr•. Medical (:ntlrgr' of 11'iscrunsiu, 1)r parlnuYlt of 1:u~ irumui u/a) A1tYli1 inr , Mil- wi1111i/Y!, 1 f174, 3J pp. j tiA111/:1 Vt: ANI)1'lil:(:N.~Nt :1 1)Illq: ~I/:1'A11/r1.IsA1, A11.1)1(:A1.'IT:SI:S •i!1
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.4 142 1'ul:lnll but IIN-.c slnllics w4•1c 1Niorl)• ('vn1leulllYl for slN i/xt uuu~nic slalux :uN1 smukinl; h:Jrils. Ill a s1oNIy uf Il•b•IdNine insl:lllcrs :uNl rcllairmrn in Itallimorc. Ncw 1'ork (:i/Y, 1WashingIon, 1).(:., and rural \Ves1cIN:.Irr (aNnily, Ncw York, rescarchcrs wcrc utstblr. Io /ind :u/)• rclalilxn IN•hvccn pnluwnary symlulH)ls and tlcKr/•e of urbanizaliuu of Illatr rrf t+•rrrk tx resitle/n.•e. 'I1wy sw•rc, lu)wcvcr, al/lc lu cstahlisb a slnnlg c/)rrrlaliun (xaw.yIr 1NIN)killg IRlhits a1NI I)ulnxHlary s)•s)qituitt.. (l txn.bKk, C. \V., SbNN`, 1{. W., tiak,u, V., Atatstrya,'1'.,'1'twulscia, J. A., li.•spirallKy G/ulinKs atNl urlarrr living. Archives of h:nvirtwtuN•nlal Il.:rllh 27 (3): 1A.'3-15(1, Sr1Acu>;Ix•r 1:rt-3. J b/ a 1964 ssurvey in the United States and an earlier one (1951) in tLc Unitcti) Kingd/Hn, rates of such illnessc•s as chronic broncllilis, asthnw, and emhhyscma, wero grcatcr amculb thosc in lower s(X`i/xLcoDonliC WYlnllt. I;etY•ntly, lu)wcver, a sltxly of 9,226 nrsidcnts of Tcxum.cch. Alichip,un, found Iluit most of tbc tli/fer- euces in incid/tilir of chralic I)rtNx•Iliiis in INY/pk: of dilf/•ring oc- cnll;iliunal, cducatioual, /ir i1N'ININr cl.•lsW's wcn? a11ri1Nllabl/• lu /1ilfcrl•isvlw in suN)ki/i}; hahils. ( amqr:rrcll wi1l1 snalkio}„ Ixxrr ocx•tr- paliuus, cllucatilNr:d Ir,x•kl;r/nuNl, anll cwxnomic t•ircomst:uunh lwul /Ntly a weak llck Icriuus ulllrt. ( I li};};il)x, AI. %V., Keller, J. Il., K1clz- ncr, 11. 1.., Sllx)klllg, ti/xTIIxYYMlollllc status, alNi cluonic respirattuy tli.K'aa% Mu/rrican Review of Respiratory Dist:4sa- 1l(i: 4/13-41(1, 1977.1 As a rcailt of IIN :w• :unl ollhcr slutlivs, it Is lYxll•IIIl1/Y1 that if air INdlnlirnl i~N rr:~srs ri.k 4 ( a)1.1)• Ihix ilN•rcaw• 1u11.1 IN• snclll cuuqrtr/•ll lo tlual rclalccl I/l ci);arcUr. smnkiul; utNlcr t•l)n/lilioN)s uf air Iwlluliuu lu whil•h Ibc avcra};c IN•/:aw is exlxx.ctl. (Sl: (WA), f). (i-3R) /'/ifi.vh 1vurkcr.r , A 1'uli.h sl/nly uf •_'.ti// wnll,crs ill IIN 1':Ilv tru-n)c. hauical (dNllx'1alivc ill NV:u:.aw, /vm/•onl1aliul; om 11Nm• wllo lr.ul suwkcd a pat•k or mur/• a day G)r t/•u y/'arx, rcvcal/xl llwt: 1. Smukcrs IxtiYNoN- ill :1.51iou1•s:ts uften as uousuwkcrs, and that aliu•nt/•t•ism c:uu.cd by snlokiny{-rclat/•d discasc was ul/ to five tiu~cs :)s frc/l~~cnl amon}; smokcrs. 2. Nonsmokcrs wcrc 1.5 tlllll•s as Illllllllllc to tY11lIS as snwk- crs. Smukcrs "often Ix.•camc the first to conlract influcn•r.a." 3. Smokers havc twic•c as ulany nn thc job ac•cidcnts as ulm- 1•:All'l Il'11•aNlA, CI /IU /NIt : IiU/1N(:111'1'IS ANI) 42 O1'/11:11 NIINI:ANta 11/~1~11.I~N1: IlI1h:Atiha 143 50332 8748 smuki•is. (Jul/ Alrm•nlcvism ain/aol; 11aIbilual Smukvix, Kuis:lk, A., \1'uoI/l Siaokuig:uN) 1!Ii7, ly. 15 171 I1Nd•rurtiull /it•tuv•t'v/ ti)su'kirnt; uuil ( )/r/t/)/tti/n/u/ /•:x//usun•z IIUIII s1lNlkill~ arlll /KY'It11al 111/1a1.•slxasures arl' k~x)wn /u Iribu//• Io tliawst -uatinly iuvuh•iu};11N• Itntls, .ar/liuvasctdar .)•s- Icm, ki/bN•ys, h1a461/•r, and 4•t•nlra) iN•i.•/N)s syslcur. Now :tUr/di/xl is Ix•inl; Nivrn to /(N' wa~•s Ilx'xc 1 wo GN•Itws ulay ati ItqyIlN•r: 1. '1•ol/aclti/ Iw/xb)cts ucy' si•rrr as t•/ti•I/)rs l»• Iwr'tNrelq: tYN1/a11N11N/{KI willl losic slNrnls; fx' 2. wiN'khla<Y• t•hcuok':Ils /lla)' Ix' Ir:ulsf~x'nN•tl into nN)rc hcu wfirl a};clds by tlN: cbolnicals ill snu><a•. G'rlain tuxic aKcuts nuly Ix• f/N11Nl INllll 11/ t11P workplate alxl in tt)lxlcco, ilK.•reasinl; exix)snrc, causinl; an acklilive or, in s/urae cascs, an cxlxHn•ntial clfcct. Snx/kinK may also cot)trilx)te to acci- dents in tlx• workplace. 1 iaxicr•n CoutaullnarUx '171r. NataHr•11 /nslilnlr f/n tkrupalitNal Safely an/l IIca11h (NItl,SII) has i/lculi/iril a nundN•s uf 1NoIciNial c/ndaoniuaol; f/NnNl ill IoI/:N•tYl IN'/NIIR•Is 111/•laliu/; inurg:mic (bNrri/ics aiNl uN•r- cury. Itxld, diuitu/•txllNl crc/iad, fln'uulldclrydt•, Ix)rlal trilltxxiclc, orpnl/lin, oN-Illyl parallrinn, aud carlhuryl. In addition, Ilydrogen cyanide has Ix•cu found in ril;arcitc suulke in significant crnx•rntra- litxl.c, anxl cigarette snwkiul; al.wl cvn)trilxrtcs to ilu•rcau•d cx- Ix)surc to carlxnt uuxlositk•. OIhcr Islrnnfol cIN•mical al;culs foiuxl within (/1l/:I/YY1 an/) in 1184. wnrkl/lact• i/N•IoNI/• al•t•IanN•, ;N•rulein, ul~lrhf/l~ c, ars/ ui/ , t:uluuum. I,an1a1/l1•16% .1ic, 1/1•4Inry-1-u .n1/iJ'•, kr I/N)cs. I/:al, uN•11q•) niirilc, niloduN•, uilro/;1ti1 lliusal/•. I)IN•)No1• au/l Ix/lyc)•clic tYNUIHNnuls. (S(, 1lTi J, p. 7-7 J/ In a sludy of It/)slu11 firc fiKht/•rs, 1N)t11 /x.Y'/11A11N11/ anll cil;- ar/•l/e s11N)knlg 1Yx/1r11N11/Y1 (// CIIrINIIt' (nNlslxriGc ri-spiralory tlis- 4':k.sr. 1Si/ll)r, lt., 14•tcrs. J. 1\1., 1'r4•v:Jcncr r:dcc of chr/xlic uuu- slxx•ific respirallxy tlia•as/• in Grc Gf;ldcrs. Aa1N•ric:m Review of Ili•silir:l/ury 1)is/:ast: 109 (2): E5•) 21;1, Fcl/ruary 1Ji 1j NIOSII has r/•tsNnnN•n/lcd thal wurkcrs cxlxiuvl In ct'rlain suhsl:uN•cs rcfrain fruul sonukinl;, 11111 Ibal this c•urlailmcn1 shoul/l also Ix! acrnmllauicd hy siluldlau" .: axdrlr) uf a•ciqrlli/Nla1 ex- posures to toxic physical suld clemical agents. jSC lf)7J, p. 7.1R1 f.uul; Prldccticn AuN)ng the wain Ix-nt/•ctivc uechauisnu of tllc 1nnKs arc h:All'll1 ~1:\IA, (:1111()NI1:111t1)N1:111'1'IS ANI) t)T11h:t1 Nt)N/:ANt:1'111/1I11.ION1: INSI:A1Ia /.1
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.4 l 5K part'nls SuiukI', Ilu-14r is a I;n•311'{ lil.t'l1/1tNNl lih:{1 Ihr rlrild %%ill IM'I;in .nwi.ir{} Ilsn{ if uuly nru• ur rn•ill{cr i1arr•rr1 swirlrz. ()n Ilsr ull{rt 11.61141, I1alrnla) di.a1rlN4.val ill stawl.inr i•: uul a sil,nificarrl lartor lu /ltl' 1f'ruu};o'{. 1iu11r sn{nkin}; arrtl u6N{.nrir{,inl; jruritN- high scbtNr) stralt'nIs ill ont• s/:rdy rtYYrgnii.ryt tl{ul Ilrttir parents dis- approvtYl of tlu'ir suNrkinglN•b:rvior. (SC 1WU, pit.17-13,141 Tccuai;c !n/iur'nccs '1'be snM,kin}; bclu{vitrr of oldrr silrlink.s is a possible in- Oucucc .Nr ytaruger children. TwtYrty-.•ight ill atl Ix:rcY:rd of the buys and 25 to 213 I)t•rca•ut of tlre girls who rcport regular snwkiug also have older sibliug.c wlKr sntokt•. If an older sibling and both parcnts smoke. a child is four tinxs as likt•ly to smoke as a child who has no smoking rruxlel in the family. (SC 1979, p.17-14] Teenagers who arc rnrpkrycd tHrtsidt! the Ironrc are twice as likely to surtrke as tc•crr:rgt•rs wlar art• m{t r•nqlkiyrxi. Studcrrts who plan to go lo college arr Iht• b:ra likely tu.unrkr. Mildrvn in lower SnCitN•tYNNNn/t• srN-irNY'noonrit• b•v4•Is arr• uNxr likt•IY lu snNrke lust sl:rtn\ tYNn'latts h'ws wills sn{rrkinl; llr:rn .vi/h pan'rd:rl snxrkiu/; or INN/r 51'INilaait' IN•rl1Nrr{arr.'1'IN• i{rlhu•{NY•ul /lrr rr{:rs.c uNY1ia iu IIN• iuilialiun uf suw.kiu/; iS I li/li.y{I/ ln t'./:{blizlr. 7'txnagt• s{nokcrs scldom cYa{sidcr tiN• tlrcisiorr to smoke a wise ttut•. In an Arncrican Cancer Society study, 78 percent of 4th gr:rdt•{s associated snNrkiu}; with carurr. Sevcuty-srvcn percent of tt-enaba smokers lx:licvc that it is Ix•tter nut /o start smoking tl{an to have to ynit. 1•:ighty-forrr iw'r('cut say som{king is habit fonning, vul f.`i IN'rcrut Ihink th:rt it is a had bahit. Iti(: IlrTl1. p. 17-R1 I )eri.cions ill vicw of this, tlN• U.S. Puhlic llt:{11h St•rvicY•. suµests: "it is futilt• to crrnlintte ill tt-11 it•t'naFt'rs that snwkinK i.c Irarmful.... The uiost effective thiu}; that wt• ran tla is lo help thrm to tmder- s1arN1 1hr• IN'u4•til. 401 suNd ing az rti.uqr.irrd wilb /Fr4• tYxas :rnil tlarr- F;t'rs st{ 11{at Iht•%' will havt• lllt• f:{rl. Ilhal llu'y n(YYl In ntakr a t6ou};htful .li•cisiou as lo wlholht•r lu smoke or not to s{uukte " INatioual Institutes of llcalth. "1't•t•ual;c Smoking National Pat- tcrus of Cigarette Swoking, ages 12 throuKh 18 in 1972 and 1974 U.S. Dt'partnNrut of I lccrlth, Educttitur, a{ul Welfare, Public licalth Service, National Institutes of Ilcalth, DIIEW publication, No. ( N I I I) 7(3-931,197(3,125 pp J "Perhaps Iht- rcal yucstion to be answered is: why do we TII[: SI,/(>KIN(: IlAtil'1': 58 PSYCIK)t.(X:Y ANI) P/IAItAtACOI.(X:Y r 1 59 50332 8756 krn{wingly t'INNrxt• lo cnl;a/;#• ill srlf tlt•slnN'livr IN'I{:rvior wht'n so urucb of uur r{N-rKy is dinratYl lua•ard INt'st•rviuy; tNrr IiveK?" IS(' 1979, p.17-25J ~ 1's yr'h n cortal 1 n/f r~ ru ~cs Ycrsrmrality Traits o/ Adult Sruokcrs Many studics have attempted to correlate the smoking habit with various personality traits. A large British strrdy fnannl that srrokcrs are greater risk-takers, nurrc ilnls{Ilsive, more prrMra to divorc.r. arKl job changing, nrrxR inlarestr-tl irr sex arul rrarrr•e likaly to (kirrk tca, coQec and alcohol. j( aurry, N., Kiernan, K. Pe"oral- ity scores and smoking behavior. A longitudinal study. British Journsd of Preventive and Social Medicine 30(2): 123-131, June 1978.) In general, smokers scem to tend toward extroversion-crav- &{g ex(itcrrtaW, willing to take risks, liking partics; they are so(iabk, carefree and easy Kning, antl may he aggressive. Non- smokers Icnd to be irrlrnvt'ris-_iutrr~clw~rtivc, retiring, IMNrkish, prrnlrnt, t•nkoltirNrally etNtlrolltYl. p:rssive, arul reliable. lalrrrurl-r: xterpal Cnatral M'tHUr of gvc strKlics slwrwtYl snxrkt•n to Irn rrwN•a cxtenrally c:ontulkvl (han nonsmokers. Intcnraliunl-cwrtrollcd irulividrrals tend to believe that they are u{asters of what happens to them; extcnuilly corrtrolled pcrsorrs terrd to kink to fate, luck or things beyond their control to bring lhem their rewards. (SC 1979, pp. 1&ti, 91 l )rug '/'akink QN six persnnality factors in drol; takiu}„ two nur.ct liukal with snwking were 1) general tcndcncy to use drugs ark12) "fear of personal reaction to dnrgs." Snuskcrs of tobacco (Yx{srmrc nr(xe marijuana, more psyclrotropic rlrua.s, arxl nxrrn aspirin than do rNN{snN{kcrs of tolraccYr. IS(: 1!17!), p. 111•101 F..r•Suullrrs Pcru.ualily . IFornrer smokers expn :ss aggression rruxa oprnly than eitlrcr nonsmokers or smokers who never tri-1 to stop; they also have a stronger need for achievement thau any ,dhcr group, a lesser need for close tics with peers, awl more behavioral stability than the other groups. Ncuroticism an<l extroversion are associated with the ability to abstain from smoking. Such individuals arc high In ex- TIIR SMOKIN(: IIAIi1T: PSY(:11Ol.(1(:Y ANI)1'l1AttAlACOIA)(:Y 59

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