January 11, 2014 marked the 50th anniversary
of the first Surgeon General’s Report on Smoking and Health. This year the office of Surgeon General has presented half a century's worth
of progress in tobacco prevention and control on their website to commemorate
the 1964 landmark report, by Dr. Luther Terry1. That report was the
first federal government document to link smoking with poor health such as lung
cancer and heart disease.
The
reputation that smoking held during the first half of the 20th century was very
different to how it is viewed today. Smoking became popular in America during
1930s. During this time, smoking was regarded as sophisticated and glamorous.
Due to its newfound popularity, research on smoking during this era often
failed to find clear evidence of serious pathology.
In 1947, Richard Doll and
A. Bradford Hill of the British Medical Research Council created a statistical
technique to evaluate the dangers of smoking. In 1950 they published an article
in the BMJ2 documenting the association
between rising rates of lung cancer and increasing numbers of smokers.
In 1950, Wynder EL, a
medical student, and Graham EA, published a landmark article in JAMA3
comparing the incidence of lung cancer in their nonsmoking and smoking
patients at Barnes Hospital in St. Louis. They concluded “cigarette smoking, over a long period, is at
least one important factor in the striking increase in bronchogenic cancer.”
Tobacco
use remains the single largest preventable cause of death and disease in the
United States according to the Centers forDisease Control and Prevention (CDC).
Cigarette smoking kills more than 480,000 Americans each year, with more than
41,000 of these deaths due to exposure to secondhand smoke. In addition,
smoking-related illness in the United States costs more than $289 billion a
year, including at least $133 billion in direct medical care for adults and
$156 billion in lost productivity.
The CDC states that smoking harms nearly every organ of the body. In
fact, smoking is the cause for one in five deaths in the United States. Smoking
can cause cancer in almost every organ (bladder, blood-acute myeloid leukemia,
cervix, colon and rectum, esophagus, kidney and ureter, larynx, liver,
oropharynx-includes parts of the throat, tongue, soft palate, and the tonsils,
pancreas, stomach, trachea, bronchus, and lung).
•
Smoking causes about 90% of all lung cancer
deaths in men and women and 80% of chronic obstructive pulmonary disease
(COPD).
•
Smoking is estimated to increase the risk for
coronary heart disease and stroke by 2 to 4 times and for lung cancer by 25
times.
Two
recent studies present risks from smoking and its prevalence in the different
countries across the globe.
Jacobs et al
research that was published in the Annals ofEpidemiology analyzed data on smoking rates
from the National Health Interview Survey, as well as data on the risks of
smoking from epidemiologic studies, to estimate the proportion of U.S. cancer
deaths caused by smoking— what the researchers called the population attributable fraction
(PAF).
The
researchers looked at deaths from the 12 cancers formally linked to smoking by
the U.S. surgeon general and they observed that the PAF was 28.7 percent.
However, after factoring in cancer deaths than may have been caused by smoking,
the PAF was 31.7 percent. These estimates don’t factor in other potential cancer deaths caused by secondhand
smoke or other kinds of smoking such as cigars, pipes or smokeless tobacco.
While there
has been a decline in smoking prevalence, the current and previous PAF
estimates may remain similar due to the addition of new cancers that may be
caused by smoking, higher rates of lung cancer deaths among female smokers, and
a greater focus on reducing deaths from cancer caused by factors other than smoking.
However, the authors noted that efforts to reduce
smoking haven’t
been futile. According to the CDC, more than 40 percent of Americans smoked in
the 1960s, but today, only 18 percent of Americans smoke.
The group by Ng et al reported In JAMA the prevalence and cigarette
consumption in 187 Countries between the years 1980-2012.
The
researchers identified nationally representative sources that measured tobacco
use (n = 2102 country-years of data) and
synthesized age-sex-country-year observations (n = 38 315) using spatial-temporal
Gaussian process regression to model prevalence estimates by age, sex, country,
and year.
Globally
modeled age-standardized prevalence of daily tobacco smoking in the population
older than 15 years decreased from 41% in 1980 to 31% in 2012 for men and from
10% to 6% for women. Despite the decline in prevalence, the number of daily
smokers increased from 721 million in 1980 to 967 million in 2012. The populous China is home to
more than 300 million smokers and 43% of the world’s cigarette production. The World Health
Organization estimates that smoking kills more than one million of the Chinese
population each year and the cost from death and complications related to
smoking would have cost China $500 billion in the decade ending in 2015. Modeled
prevalence rates exhibited substantial variation across age, sex, and
countries, with rates below 5% for women in some African countries to 57% for
men in Indonesia. The following are some
examples of prevalence of smoking in males, females and both sexes in few
countries with Greece having the most overall smokers and the United States the
fewer while Indonesia has the most male smokers and the fewer female smokers.
Countries Males Females Both sexes
Greece 41% 35% 38%
Indonesia 57% 4% 37%
US 17% 14% 16%
The authors
concluded that since 1980, large reductions in the estimated prevalence of
daily smoking were observed in both men and women, but because of population
growth, the number of smokers increased significantly.
Given the
importance of tobacco as a risk to health, monitoring the distribution and
intensity of tobacco use is critical for identifying priority areas for action
and for evaluating progress. Recent
studies in multi-country survey programs have substantially expanded the
primary data available for monitoring. The most recent cross-sectional
estimates of smoking prevalence were for 2011 and the publication of The Tobacco Atlas has greatly
facilitated the development of policies based on these data.
Since the release
of the Surgeon General report on the adverse effects of smoking, a wide range
of interventions became available, including increasing prices and bans on
advertising, promotion, sales to minors, and smoking in public places. The
adoption of the Framework Convention on Tobacco Control (FCTC) in 2003 and its
subsequent ratification by 177 countries reflects growing global efforts to
control tobacco. Despite such efforts, tobacco continues to adversely influence
global health patterns, leading to 5.7 million deaths, 6.9% of years of life
lost, and 5.5% of disability-adjusted life-years (DALYs) in 2010 requiring that
efforts towards further decrease and/or elimination of smoking across the
planet should continue.
References
1. Terry, Luther et al. Smoking and Health:
Report of the Advisory Committee to the Surgeon General of the United States.
U-23 Department of Health, Education, and Welfare. Public Health Service
Publication No. 1103. 1964 May
2. Wynder EL, Graham EA. Tobacco smoking as a possible etiologic
factor in bronchogenic carcinoma: a study of 684 proven cases. Journal of American Medical Association. 1950; 143: 329-36
3. Doll R, Hill AB. Smoking and carcinoma of the lung:
preliminary report. British Medical
Journal 1950:2 739-48
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