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 Fifty years later, smoking rates have been cut by about half, and
a new study estimates that 8 million Americans have been saved from
premature smoking-related deaths.
"You look back in history to 1964, and in reality the world was a
very different place when it came to tobacco use and smoking," said
Rear Admiral Boris Lushniak, the acting U.S. Surgeon General.
A collection of reports released online on Tuesday in the Journal of
the American Medical Association (JAMA) highlights how public-health
efforts, from cigarette taxes to advertising limits, have helped
curtail smoking rates. The reports also identify new trouble spots,
including communities whose members have not been able to quit in
significant numbers.
Lushniak believes the next step should be a resolve to introduce an
endgame within the next 50 years. That concept will be part of an
upcoming Surgeon General's report on January 16 celebrating the
anniversary of the original, he said.
"The next stage really needs to be a resolution to move ahead to
this smoke-free generation concept," Lushniak said.
One paper estimates that about 17.7 million deaths from 1964 to 2012
were related to smoking. Without any of the tobacco control measures
introduced in that period, an additional 8 million people would have
died, according to Theodore Holford of the Yale School of Public
Health in New Haven, Connecticut, and colleagues.
The average American lifespan is also more than two years longer
because those deaths have been averted, the researchers suggest.
"TREMENDOUS ACCELERATION"
Although Terry's 1964 report was not the first scientific review to
connect cigarettes and health issues, it is widely considered a
turning point in the battle against smoking.
"The announcement gave tremendous acceleration to the study of
cigarettes and health," Dr. Otis Brawley, chief medical officer of
the American Cancer Society in Atlanta, told Reuters Health.
Terry gathered 10 doctors, pathologists, chemists, statisticians and
other experts to review the available evidence.
Because the tobacco industry in those days was so important to the
U.S. economy, Brawley said, the announcement was made on a Saturday
to lessen any impact on the stock market.
The committee's conclusion was that smoking causes lung cancer in
men and that men who smoke are more likely to die of heart disease
than those who don't.
Based on research since then, the U.S. Centers for Disease Control
and Prevention (CDC) estimates there is a two- to four-fold increase
in the risk of heart disease and stroke for smokers. The CDC also
estimates that smoking increases the risk of lung cancer 13 times
among women and 23 times among men.
The U.S. is not alone in lowering smoking rates over the past few
decades, another new study found.
Researchers from the University of Washington found that Canada,
Mexico, Iceland and Norway cut the proportion of their populations
that smoke by more than half from 1980 to 2012.
Worldwide, however, the slowdown is weaker, said Dr. Christopher
Murray, one of the study's authors.
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Data from 187 countries shows that about 41 percent of men and 11
percent of women worldwide smoked in 1980, and those rates have
since declined to about 31 percent for men and 6 percent for women
in 2012.
The actual number of smokers, however, rose from an estimated 721
million in 1980 to 967 million in 2012 as the world's population
grew.
TROUBLE SPOTS
One approach to cutting the smoking rate involves targeting groups
that are more likely to use tobacco.
People with mental illnesses, for example — including depression and
anxiety disorders — had a slower decline in smoking rates, another
report says.
Benjamin Cook, the report's lead author and a senior scientist at
the Center for Multicultural Mental Health Research at the Cambridge
Health Alliance in Massachusetts, and colleagues write that people
with mental illness historically smoke at twice the rate of people
without mental illnesses.
"If you were able to decrease those rates of smoking among people
with mental illness, then you can really make a dent in national
rates," he said.
The JAMA reports did not pinpoint what have been the most effective
measures to induce people to quit smoking. But public health
advocates say the combination of tobacco taxes, smoke-free air laws,
youth education campaigns and adequately funding state tobacco and
anti-smoking programs has made a difference over time.
"I think we know what prevents people from continuing to smoke or
not smoke at all," said Dr. Mariell Jessup, president of the
American Heart Association.
Persistent efforts to keep children from smoking are also key,
Brawley added.
"Very few smokers — less than 10 percent — start smoking as adults,"
he said. "We really need to focus on keeping kids from smoking."
Brawley and Jessup said attention needs to be paid to electronic
cigarettes — also known as e-cigarettes — which are electronic
devices that deliver nicotine through vapor instead of tobacco
smoke.
Previous studies have suggested that people can use the devices as
smoking cessation tools, but some public health advocates worry that
e-cigarettes may introduce more people to nicotine, the addicting
chemical found in tobacco.
"E-cigarettes can be a very bad thing, can be a very good thing, and
it can actually be both," Brawley said. "We need to figure that
out."
(Editing by Nancy Lapid, Michele Gershberg and Douglas Royalty)
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