Smoking and Health: Report of the Advisory Committee to the Surgeon General of the United States

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Cover page of the report Smokingandhealthcover.jpg
Cover page of the report

Smoking and Health: Report of the Advisory Committee to the Surgeon General of the United States was a landmark report published on January 11, 1964 [1] , by the Surgeon General's Advisory Committee on Smoking and Health, chaired by the then Surgeon General of the United States, Dr. Luther Leonidas Terry, M.D., regarding the negative health effects of tobacco smoking. [2] Although it was not the first such declarationor even the first declaration by an official of the United States of America it is notable for being arguably the most famous such declaration and has had lasting and widespread effects both on the tobacco industry and on the worldwide perception of smoking.

Surgeon General of the United States Head of the U.S. Public Health Service Commissioned Corps

The Surgeon General of the United States is the operational head of the U.S. Public Health Service Commissioned Corps (PHSCC) and thus the leading spokesperson on matters of public health in the federal government of the United States. The Surgeon General's office and staff are known as the Office of the Surgeon General (OSG) which is housed within the Office of the Assistant Secretary for Health.

Luther Terry 20th-century Surgeon General of the United States

Luther Leonidas Terry was an American physician and public health official. He was appointed the ninth Surgeon General of the United States from 1961 to 1965, and is best known for his warnings against the dangers and the impact of tobacco use on health.

Tobacco smoking practice of burning tobacco and inhaling the resulting smoke

Tobacco smoking is the practice of smoking tobacco and inhaling tobacco smoke. The practice is believed to have begun as early as 5000–3000 BC in Mesoamerica and South America. Tobacco was introduced to Eurasia in the late 17th century by European colonists, where it followed common trade routes. The practice encountered criticism from its first import into the Western world onwards but embedded itself in certain strata of a number of societies before becoming widespread upon the introduction of automated cigarette-rolling apparatus.

Contents

Background

The health effects of tobacco had been debated by users, medical experts, and governments alike since its introduction to European culture. [1] Hard evidence for the ill effects of smoking became apparent with the results of several long-term studies conducted in the early to middle twentieth century, such as the epidemiology studies of Richard Doll and pathology studies of Oscar Auerbach. On June 12, 1957, then-Surgeon General Leroy Burney "declared it the official position of the U.S. Public Health Service that the evidence pointed to a causal relationship between smoking and lung cancer". [1] A committee of the United Kingdom's Royal College of Physicians issued a report on March 7, 1962, [3] which "clearly indicted cigarette smoking as a cause of lung cancer and bronchitis" and argued that "it probably contributed to cardiovascular disease as well." [4] After pressure from the American Cancer Society, the American Heart Association, the National Tuberculosis Association, and the American Public Health Association, President John F. Kennedy authorized Surgeon General Terry's creation of the Advisory Committee. The committee met from November 1962 to January 1964 and analyzed over 7,000 scientific articles and papers.

Health effects of tobacco circumstances, mechanisms, and factors of tobacco consumption on human health

Tobacco use has predominantly negative effects on human health and concern about health effects of tobacco has a long history. Research has focused primarily on cigarette tobacco smoking.

Richard Doll British physiologist

Sir William Richard Shaboe Doll was a British physician who became an epidemiologist in the mid-20th century and made important contributions to that discipline. He was a pioneer in research linking smoking to health problems. With Ernst Wynder, Bradford Hill and Evarts Graham, he was credited with being the first to prove that smoking caused lung cancer and increased the risk of heart disease. He also carried out pioneering work on the relationship between radiation and leukemia as well as that between asbestos and lung cancer, and alcohol and breast cancer. On 28 June 2012 he was the subject of a series on Radio Four called The New Elizabethans, a programme broadcast to mark the Diamond Jubilee of Queen Elizabeth II, dealing with 60 public figures from her reign.

Oscar Auerbach was an American pathologist and medical educator who significantly helped tie cigarette smoking to cancer.

Committee members

The Surgeon General's Advisory Committee on Smoking and Health: [5]

William Gemmell Cochran was a prominent statistician. He was born in Scotland but spent most of his life in the United States.

Findings

The report's conclusions were almost entirely focused on the negative health effects of cigarette smoking. It found:

In addition, it reported:

Smoking and pregnancy specific developmental disorder that is characterized by physical, behavioral and learning birth defects resulting from maternal ingestion of nicotine during pregnancy

Tobacco smoking and pregnancy is related to many effects on health and reproduction, in addition to the general health effects of tobacco. A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers, and that it contributes to a number of other threats to the health of the fetus.

As did the World Health Organization during this period, but possibly influenced by the fact that they were all smokers themselves, [6] the Committee defined cigarette smoking as a "habituation" rather than an overpowering "addiction". [6] Committee members agreed with most Americans that this habit (though often strong) was possible for individuals to break.

World Health Organization Specialised agency of the United Nations

The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organisation, was an agency of the League of Nations.

Habituation is a form of non-associative learning in which an innate (non-reinforced) response to a stimulus decreases after repeated or prolonged presentations of that stimulus. Responses that habituate include those that involve the intact organism or those that involve only components of the organism. The response-system learns to stop responding to a stimulus which is no longer biologically relevant. For example, organisms may habituate to repeated sudden loud noises when they learn these have no consequences. Habituation usually refers to a reduction in innate behaviours, rather than behaviours acquired during conditioning. A progressive decline of a behavior in a habituation procedure may also reflect nonspecific effects such as fatigue, which must be ruled out when the interest is in habituation as a learning process.

Addiction state characterized by compulsive engagement in rewarding stimuli despite adverse consequences

Addiction is a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences. Despite the involvement of a number of psychosocial factors, a biological process – one which is induced by repeated exposure to an addictive stimulus – is the core pathology that drives the development and maintenance of an addiction. The two properties that characterize all addictive stimuli are that they are reinforcing and intrinsically rewarding.

In the years that followed the Surgeon General's report, millions of Americans successfully chose to quit smoking, with two-thirds to three-quarters of ex-smokers quitting unaided by nicotine replacement methods. In addition, the "cold turkey," or sudden-and-rapid-cessation, method has been found to be the most successful in terms of stopping smoking over long periods of time. [7] However, in a controversial move in 1989, a later Surgeon General, Dr. C. Everett Koop, M.D., shifted course and redefined cigarette smoking as "an addiction" rather than a habit. [8]

Effects

The report's publication had wide effects across the United States and the world. It was deliberately published on a Saturday to minimize the negative effect on the American stock markets, while maximizing the coverage in Sunday newspapers. [1] The release of the report was one of the top news stories of 1964. It led to policy and public opinion changes such as the Federal Cigarette Labeling and Advertising Act of 1965 and the Public Health Cigarette Smoking Act of 1969, which mandated warning labels on cigarettes and instituted a ban on the broadcasting of cigarette advertisements on radio and/or television. [9]

See also

Related Research Articles

Cigarette small roll of cut tobacco designed to be smoked

A cigarette, also known colloquially as a fag in British English, is a narrow cylinder containing psychoactive material, usually tobacco, that is rolled into thin paper for smoking. Most cigarettes contain a "reconstituted tobacco" product known as "sheet", which consists of "recycled [tobacco] stems, stalks, scraps, collected dust, and floor sweepings", to which are added glue, chemicals and fillers; the product is then sprayed with nicotine that was extracted from the tobacco scraps, and shaped into curls. The cigarette is ignited at one end, causing it to smolder and allowing smoke to be inhaled from the other end, which is held in or to the mouth. Most modern cigarettes are filtered, although this does not make them safer. Cigarette manufacturers have described cigarettes as a drug administration system for the delivery of nicotine in acceptable and attractive form. Cigarettes are addictive and cause cancer, chronic obstructive pulmonary disease, heart disease, and other health problems.

Smoking ban public policies, including criminal laws and occupational safety and health regulations, that prohibit tobacco smoking in workplaces and other public spaces

Smoking bans, or smoke-free laws, are public policies, including criminal laws and occupational safety and health regulations, that prohibit tobacco smoking in workplaces and other public spaces. Legislation may also define smoking as more generally being the carrying or possessing of any lit tobacco product.

Passive smoking inhalation of smoke by persons other than the intended active smoker

Passive smoking is the inhalation of smoke, called second-hand smoke (SHS), or environmental tobacco smoke (ETS), by persons other than the intended "active" smoker. It occurs when tobacco smoke permeates any environment, causing its inhalation by people within that environment. Exposure to second-hand tobacco smoke causes disease, disability, and death. The health risks of second-hand smoke are a matter of scientific consensus. These risks have been a major motivation for smoke-free laws in workplaces and indoor public places, including restaurants, bars and night clubs, as well as some open public spaces.

Nicotine replacement therapy

Nicotine replacement therapy (NRT) is a medically-approved way to take nicotine by means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the chance of quitting smoking by about 50% to 70%. Often it is used along with other behavioral techniques. NRT has also been used to treat ulcerative colitis. Types of NRT include the adhesive patch, chewing gum, lozenges, nose spray, and inhaler. The use of more than one type of NRT at a time may increase effectiveness.

Public Health Cigarette Smoking Act

The Public Health Cigarette Smoking Act is a 1970 federal law in the United States designed to limit the practice of smoking. As approved by the United States Congress, the act required a stronger health warning on cigarette packages, saying "Warning: The Surgeon General Has Determined that Cigarette Smoking Is Dangerous to Your Health". It also banned cigarette advertisements on American radio and television.

Comprehensive Smoking Education Act

The Comprehensive Smoking Education Act of 1984 is an act of the Congress of the United States. A national program established in order to improve the availability of information on health risks related to smoking, to amend the Federal Cigarette Labeling and Advertising Act so that cigarette warning labels would be different, and for other reasons, the Comprehensive Smoking Education Act was enacted with a purpose to, as stated in Section 1 of the Act, "provide a new strategy for making Americans more aware of any adverse health effects of smoking, to assure the timely and widespread dissemination of research findings and to enable individuals to make informed decisions about smoking". Adopted by Congress in 1984 and effective October 12, 1984, the Comprehensive Smoking Education Act created a rotational warning system that required all cigarette packages and advertisements to rotate the following four warnings every three months:

Tobacco harm reduction (THR) is a public health strategy to lower the health risks to individuals and wider society associated with using tobacco products. It is an example of the concept of harm reduction, a strategy for dealing with the abuse of other drugs. Tobacco smoking is widely acknowledged as a leading cause of illness and death, and preventing smoking is vital to public health.

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A Frank Statement

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Tobacco control field of public health addressing tobacco use

Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use and thereby reducing the morbidity and mortality it causes. Tobacco control is a priority area for the World Health Organization (WHO), through the Framework Convention on Tobacco Control. References to a tobacco control movement may have either positive or negative connotations, both briefly covered here.

Women and smoking

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Youth smoking

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Jeffrey E. Harris, an economist and physician, has been on the faculty of the Economics Department of the Massachusetts Institute of Technology since 1977. He received an AB from Harvard University, as well as an MD (1974) and PhD in Economics (1975) from the University of Pennsylvania. Having trained in internal medicine at the Massachusetts General Hospital (1974-1977), he maintained a medical practice at that institution until 2006. Since then, he has continued to practice as an internist at federally sponsored community health centers in Rhode Island, where the majority of his patients have poverty-level incomes and are not fluent in English.

The scientific community in United States and Europe are primarily concerned with the possible effect of electronic cigarette use on public health. There is concern among public health experts that e-cigarettes could renormalize smoking, weaken measures to control tobacco, and serve as a gateway for smoking among youth. The public health community is divided over whether to support e-cigarettes, because their safety and efficacy for quitting smoking is unclear. Many in the public health community acknowledge the potential for their quitting smoking and decreasing harm benefits, but there remains a concern over their long-term safety and potential for a new era of users to get addicted to nicotine and then tobacco. There is concern among tobacco control academics and advocates that prevalent universal vaping "will bring its own distinct but as yet unknown health risks in the same way tobacco smoking did, as a result of chronic exposure", among other things.

The 1950 Wynder and Graham Study was conducted by Ernest Wynder and Evarts Graham and was entitled "Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of Six Hundred and Eighty-Four Proved Cases". It was published on May 27, 1950. It was a case-control study to determine the relationship between various external factors and the development of bronchogenic carcinoma. The study concluded that long-term tobacco usage contributes to the onset of lung cancer, as an overwhelming majority (96.5%) of the men with the disease were classified as moderate to heavy smokers for an extended period of time, compared to a lower percentage of the general hospital population control group.

References

  1. 1 2 3 4 5 "The Reports of the Surgeon General".
  2. 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 be downloaded from: https://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBMQ
  3. "Smoking and health 50 years on from landmark report". BBC News. March 6, 2012.
  4. "Luther Leonidas Terry (1961–1965)". Archived from the original on September 16, 2008.
  5. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service (PDF), U.S. Department of Health, Education, and Welfare, 1964, pp. report, retrieved January 5, 2016
  6. 1 2 Joel Spitzer. The Surgeon General says ... WhyQuit.com. Retrieved May 22, 2010.
  7. Chapman, Simon; MacKenzie, Ross (February 9, 2010). "The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences". PLoS Medicine. Public Library of Science. 7 (2): e1000216. doi:10.1371/journal.pmed.1000216. PMC   2817714 . PMID   20161722.
  8. Sullum, Jacob (1998). For Your Own Good: The Anti-Cigarette Crusade and the Tyranny of Public Health (First ed.). Urbana: The Free Press. pp. 234–235. ISBN   978-0-684-82736-0.
  9. https://www.cdc.gov/tobacco/data_statistics/sgr/history/