Tobacco—What it Is and What it Does - Smoking And Public Health

In the 1920s a study found that men who smoked two or more packs of cigarettes per day were twenty-two times more likely than nonsmokers to die of lung cancer. At the time, these results surprised researchers and medical authorities alike. Some forty years ago, the U.S. government first officially recognized the negative health consequences of smoking. In 1964 the Advisory Committee to the Surgeon General released a ground-breaking survey of studies on tobacco use. In Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service, the Surgeon General reported that cigarette smoking increased overall mortality in men and caused lung and laryngeal cancer, as well as chronic bronchitis. The report concluded, "Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action," but what action should be taken was left unspecified at that time.

Later surgeon generals issued additional reports on the health effects of smoking and the dangers to nonsmokers of "passive" or "secondhand" smoke. In addition to general health concerns, the reports have addressed specific health consequences and populations. Table 5.4 shows a listing of reports of the Surgeon General and the years in which they were published. The later reports concluded that smoking increased the morbidity (proportion of diseased persons in a particular population) and mortality (proportion of deaths in a particular population) of both men and women.

In 1965 Congress passed the Federal Cigarette Labeling and Advertising Act (PL 89-92), which required this health warning on all cigarette packages: "Caution: Cigarette TABLE 5.4
Twenty-eight Surgeon General's reports on smoking and health,
1964-2004
SOURCE: Adapted from "28 Surgeon General's Reports on Smoking and Health, 1964-2004," Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Tobacco Information and Prevention Source (TIPS), http://www.cdc.gov/tobacco/sgr/sgr_2004/Factsheets/11.htm (accessed March 3, 2005)

1964	Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service
1967	The Health Consequences of Smoking: A Public Health Service Review
1968	The Health Consequences of Smoking: 1968 Supplement to the 1967 Public Health Service Review
1969	The Health Consequences of Smoking: 1969 Supplement to the 1967 Public Health Service Review
1971	The Health Consequences of Smoking
1972	The Health Consequences of Smoking
1973	The Health Consequences of Smoking
1974	The Health Consequences of Smoking
1975	The Health Consequences of Smoking
1976	The Health Consequences of Smoking
1978	The Health Consequences of Smoking, 1977-1978
1979	Smoking and Health
1980	The Health Consequences of Smoking for Women
1981	The Health Consequences of Smoking—The Changing Cigarette
1982	The Health Consequences of Smoking—Cancer
1983	The Health Consequences of Smoking—Cardiovascular Disease
1984	The Health Consequences of Smoking—Chronic Obstructive Lung Disease
1985	The Health Consequences of Smoking—Cancer and Chronic Lung Disease in the Workplace
1986	The Health Consequences of Involuntary Smoking
1988	The Health Consequences of Smoking—Nicotine Addiction
1989	Reducing the Health Consequences of Smoking—25 Years of Progress
1990	The Health Benefits of Smoking Cessation
1992	Smoking and Health in the Americas
1994	Preventing Tobacco Use Among Young People
1998	Tobacco Use Among U.S. Racial/Ethnic Minority Groups
2000	Reducing Tobacco Use
2001	Women and Smoking
2004	The Health Consequences of Smoking
Note: Smoking remains the leading cause of preventable death and has negative health impacts on people at all stages of life. It harms unborn babies, infants, children, adolescents, adults, and seniors.

smoking may be hazardous to your health." The Public Health Cigarette Smoking Act of 1969 (PL 91-222; passed in 1970) strengthened the warning to read: "Warning: The Surgeon General has determined that cigarette smoking is dangerous to your health." Still later acts resulted in four different health warnings to be used in rotation.

The Morbidity and Mortality Weekly Report (April 2, 1999) included "recognition of tobacco use as a health hazard" as one of the country's ten greatest public health achievements of the twentieth century, along with vaccination, control of infectious diseases, safer and healthier food, healthier mothers and babies, family planning, safer workplaces, motor-vehicle safety, decline in deaths from coronary heart disease and stroke, and fluoridation of drinking water. These ten accomplishments were chosen based on their contributions to prevention and their impact on illness, disability, and death in the United States.

TABLE 5.5
Leading causes of death, by selected characteristics, 1980 and 2003
SOURCE: Adapted from "Table 32. Leading Causes of Death and Numbers of Deaths, according to Sex, Race, and Hispanic Origin: United States, 1980 and 2000," in Health, United States, 2002, Centers for Disease Control and Prevention, National Center for Health Statistics, September 2002, and Donna L. Hoyert, Hsiang-Ching Kung, and Betty L. Smith, "Table 7. Deaths and Death Rates for the 10 Leading Causes of Death in Specified Age Groups: United States, Preliminary 2003," in "Deaths: Preliminary Data for 2003," National Vital Statistics Reports, vol. 53, no. 15, February 28, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_15.pdf (accessed March 3, 2005)

Rank order	1980		2003
	Cause of death		Cause of death
	All causes		All causes
1	Diseases of heart	1	Diseases of heart
2	Malignant neoplasmas	2	Malignant neoplasmas
3	Cerebrovascular diseases	3	Cerebrovascular diseases
4	Unintentional injuries	4	Chronic lower respiratory diseases
5	Chronic obstructive pulmonary diseases	5	Accidents (unintentional injuries)
6	Pneumonia and influenza	6	Diabetes mellitus
6	Diabetes mellitus	7	Influenza and pneumonia
8	Chronic liver disease and cirrhosis	8	Alzheimer's disease
9	Atherosclerosis	9	Nephritis, nephrotic syndrome and nephrosis
10	Suicide	10	Septicemia