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the Health Conseguences of Smoking - Part 1 of 3
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- Date Loaded
- 05 Jun 1998
- UCSF Legacy ID
- ulu51e00
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The
Health Consequences
of SMOKING
U.S. DEWARTMEhllfi OF H'EALTHI, EDUCATIO1N, AN'D! WELFARE
O'
Public Health Service ~'
' ~
Hialthi$Krvices and' Mental Heal
th, Administration «D
The
Health Causequencesaf S mOkiug
hiniuary 1973
U.S. DEP'.4RVAIENT OF HEALTH,
EDUCATION, AND WELFARE
Public Healtli Service
For saI6 by the SuperintPndPntof.Documents,
U.S. Government Printiug Office, Washiii{5ton; .p.C:,?030?Prioe $1.85 domestic postpaid or $1.50 GPO
Boakstore
StockNamber 1723ToUlT)04
Preface
This report is the: seventh in a series issued by the Public Health
Seri-ice~ res-i~etiuing~ and assessing, tlie~~ scientific evidence linking ciga-
rette rette smoking to disease anrl premature death. The current report
reiterates, strengthens, and estends the fiildings in earlier reports
that cigarette smoking is a major health problem~ in the United
States,
The~ evidence has~ broadened dramaticallly~ in~ recent years: A Ptiblic
Health Service assessment of evidence available in 1959 was largely
focused on the relationsllip of cigarette smoking and lung cancer.
The~ first': formal report~ on thi:s~ subject in 1964~~ found that cigarette
smoking was not onlyy a major cause of lung cancer and chronic
bronchiti's, but was, associated wit.h~ illness and; death~ froin chronic~
bronchoplllmonary disease, cardiovascular~~ di'sease,~ and other diseases.
~
The 19T3' report confirms~ all these~ relationships and~ adds~ new
evidence in other areas as well. The evidence in the ehapter, on preg-
nancy~ strongly~~ indi:cates! . a~ causal relationship between ci:garette~
smoking dliring~~ pregnancy and'~lower infant birth~ «~eightand a strong,,
probably~~ causal''y association between ci~garette~ smoking: . and higher late~~
fetal and neonatal mortality. Also reported is the convergence of other
evidence which suggestls, that cigaretlt~e~ smoki:ng~ d'uring, pregnancy
interacts w:ith~ otller~ risk~fact~:ors to~~increase~ the~ risk of~~ an unfavorable
outcome of pregnancy for certain women more than others.~
For~ the first time~ in this~ series~ of reports, a separate~ chapter is,
d'evotedl to, pipe~ and ci~gar~ smoking and the~ heal~th hazarels involved.
Includedl is an, assessment ofi' the health impl~ications, of~ the new small
cigars which look like cigarettes.
A final chapternew to~~the~reports, concerns, cig~arette~smoking~and~~e exercise performance. A
review of a number of fitness~testls, comparing
smokers~~ to nonsmokers indicates~ that cigarette smoking~~ i~mpairs~ exer-
cise~ performance for~ many types~ of athletic, events and actin-ities~in-~
volving~~ma~xim:a1 work~capacity~.
The~~ interrelationships~ of smoking~ and health are no less~ complex
today ~ than they~ «..ere~ reported~ to be in t1le~ 1~:9641 report:~ But simce~e
that~ti;me~ we ha:ve greatly broadencdlour l.nowl~ed'ge~ and Iulderstanding~
of the prolileim : Th:e~cmrrent report s~ymtSolizes~ this progress,
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9
Table of Contents
PREFACE------------------------------------------
TAB!IGE OF CONTENTS_________________
PREPAR'ATION OF THE REPORT AND ACKNOWL-
EDMIENTS' ------------------------
Chapter 1. Cardiovascular Diseases_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Page
iii
v:
aii
Xi1T
Chapter 2. NonneopIastic Bronchopulmonary Diseases------- 33'
Chapter 3. Cancer-------------------------------------- 65
Chapter 4: Pregnancy----------------------------------- 99i
Chapter 5., Peptic U1cer Disease-------------------------- 153
Chap ter 6. Pipe and Cigar Sinoking----------------------- 167
Chapter 7. Exercise Perforrnance~-------------------------- 239'
INDEX------------------------------------------------ 251
03764280
Preparation of the Report
and Acknowledgments
"Sinoking and Health. Report of the Advisory Committee to the
Surgeon General of'the Public Health Service,"' subsequently referred
to as the "Surgeon General's Report;"' was published in 119641. The
hTlational Clearinghouse for Smoking and Healthy establ'ished in 11965,
has the responsibility for the continuous monitoring,, compilation,
and review of the world's medical literature which bears upon the
health consequences of smoking, As called f'or by Pubiic Law 89'-92, the
following three reviews of the medical literature on the health conse-
quences of'smoking, which had come to the attention of the Clearing-
house since the original "Surgeon General's Report,"' were sent to
the Congress :
1. ~"The~ H'ealth~ Consequences of ~ Smoking, A Public Health Service~~
Revie:w:1967" (submittedJuly 1967).
2. "The Health~ Consequences of Smoking; 1968 Supplement to the
1967 PHS Review" (submitted July 1968).
3. "The Health~ Consequences of Smoking, 1969: Supplement to ~ the:
1967 PHS R'eview"' ( submitted July 1969).
Public Law 91-222 was signed into law on April 1'1 1970; and called
for an 18-month interval between the 1969 supplement and the next
report. During this period, a comprehensive review of all of the medi'-
cal literature available to the Clearinghouse relating to the health,
consequences of smoking was undertaken, with an emphasis upon the
most recent additions to the literature. The product ofl this review was :
"The Health Consequences of Smoking A Report of the Surgeon.
General : 1971,"' submittedl to the Congress in January of 1971. Sub-sequently, a review of
themedh'cal literature in the field, which had
cometothe attention of the Clearinghousesincethepublication of'the
1971 report, waspublislied as,"`Il'heHealtl,il ConsequencesofSrnoking;,
A Report of the Surgeon Generall: 1972," submitted ini Januaryof'
1972..
VW
Every report published since: the originall "Surgeon G'eneral's Re-
port" has contained a review of the medical literature relevant to the
association between smoking and cardiovascular disease, nonneoplastic
bronchopulmonary disease, and cancer., Severall of' the reports in-
cluded reviews of'the rel'ationship between smoking and peptic ulcer
disease (1967,1971,1972). an& cigarett'e smoking,and pregnancy (1967,
1969, 1971, 1972') . Other topics relating to the use of' tobacco haved received special emphasis in
single reports :
1. Tobacco Amblyopia~ (1971 Report) ..
2. Allergy (1I972' R'eport ) .
3. Public Exposure to Air Pollution From Tobacco Smoke (1972:
Report ) .,
4. HarmfullConstituentsof Cigarette Smoke (1972'Report).
5. I\?oncancerousOral Disease ( 11969'Report).
The, present document, "The Health Consequences of Smoking:
1i973;'"' includes reviews of the relationships between smoking and!
card'iovasculardisea6e, bron,chopulmonarydisease cancer, and peptic
ulcer disease which are based uponi medical literature which has
become a~vailable, to the Clearinghouse since the publication ofthe1972 report.. It also inclhzdes
special rev.iews of the health consequences
of' pipe and cigar smoking, andi of' the relationship between cigarette
smoking and the outcomes of pregnancy. The material in these two
latter chapters refllects a comprehensive revieww of' the pertinent world
medical literature wliiich has come to the attention of th!eClearing-house since the publication
ofthe~ originall "Surgeon General's, Re-port,."' including materiall which has become available
since the. 1972
report. The final chapter in this year's report is a review of the: rela-
tionship between smoking and exerciseperformance; an area not
covered previously in any report.
Witht'heexception of'"`Chapter 4,Pregnaney,"each chapter is orga-
nized in a, similar fashion. The introduction to each chapter is a sum-
mary of the work reviewed in previous. reports. The summary of eachh
chapter encompasses only the work which has most recently become
a~vailabletothe Clearinghouse. The pregnancy chapter is organized
int~o~ separate sections according to several different ontcome&of preg-nancy. Each section includes
a~ brief review of previously reportedd
work and contains its own separate summ~ary;, in placeof' an overalll
summaryy for the entirechapt'er.
Viii
The~ preparation of this report~ was! accompiished~ in~ the following~
j' 1/ fashion~:
I
1! 1. The continuous monitoring and compilation of the medical liter-
11 ature on t.he health consequences of smoking was accomplished
throughseverall mechanisms.
(a) An iirformatlion science corporation is on contract to extract
articles on smoking, and health from themed'heal literature~~
of the worid.'h'Irisorganization provirlesa semimonthly ae-cessionslist with abstracts~ and copies
of t'hevariousartliclles_
Translations are called for as needed. Articles are classified
accord7ng, to subject andl filedl by ai series of' code words and
phrases.,
(b): The National Librairyof .l'bedicine; through the hledlhrssyst'em, sends the National
Clearinghousefar Srnokingand
Health a monthly listing ofl articles in the smoking and
health area. These are reviewed, and articles not identified
by the information sciencecorporatiion are orderred.(c) Staff members review current medical
literature and identify
pertinent articles.
2, The first drafts of'the individual chapters were sent to reviewers
for criticism~ and'~ comment~ with respect~ to the art!icles~ reviewed,~,
articles not included, and conclusions. The drafts were then re-
vised until they met, ~ w~i'th~ the general approval ofI the reviewers.
The final drafts:w~ere review.edl as,a.vhole by ~ the~ Directlor~of the
National C1'earingliouse~~for~S'rnolk~~ing~ and Health, the D'ir:ector~of
the National Cancer Iinst~i'tute,the Director~of~the:National Heart
and if.ung~ Iiistitute tlhe~ I)irecct~or of~ the~ National Institute of~
Environmental Health~ Sciences, the Surgeon GeneralL, and by~~
additional expert~s botlii within and outside of the Public Health.
Service.
Acknowledgments
The National Clearinghouse for Smoking,andl Health,~ Daniel Horn.
Ph. D~., Director, was responsible forr the preparation of this report.
Jledical Staff I)irector~ for the, report ~~~as~ E1'vi~n E. _1~dams;~ I~S.D'~.,~
A~ssistant~ _lledical~ Staff I)~ilrector was hl.~ Stephen «'illiams;~ M.D~~.~con-
sulting~edi'tors were~Daniel P. Asnes. A'I.I).,~David G. Cook;_:1~S.IJ.,~and1
.Iohn Il. Ilolbrooh~. M.D.
The~ professional stat}'~hEis~ hacll t'h~e~~ assistance~ and advice of a number
ofl experts iia the scientlifi~c~ancl technical fields.~both iir and outside the~
ix
Government. Their eontributiionsare gratefully ackno«ledged. Speciall
tllanksare due the f'ollowing:.
AqoeasoN, WiLLtA1r H.,, 31.D:-Chief; Pulmonary Section; School of' Medicine,
lCniver,ity of Louisville, Louisville, Ky.
:AUESBAcx; OscAta, M.D.-senior Medical Investigator, Veterans!,Administratiion
Hr~spital. East Orange, N.J.
AYxeN, STEPfIEsSL., 3f:D.--Direetor,, Cardi'opulmonarsLaboratory, S'aintVincent's Hospital and
Medical Center of New York, New York,,-N'.Y:
Bocx., FRED Gl Ph. D-Director, Orchard' Park Laboratories, Roswelli Park
Memorial Institute, Orchard I'ark, N.Y.
BoxeN, Hor.r[sGL, M:D.-Jfedicai Investigator, Veterans, Ad'niinistrationHos-pital Tampa, FlaL
BoUT1VELL,. RoSWELI:. K., '.A.D.-Professor of Oncology, McArdle'. Lahorator9' for
Cancer Re.,earcha University of'«'isconsin, Madison, Wis.
Bxoss,, Ixwt:v4 M.D.-Director of'Biostatistics, Roswell Park Memorial Inst'itute;.
Buffalo, N.Y.
Cooree,, Ti[F:oooxF;, \I.D:-Director National Heart and Lung, Institute, National
Institutes of Health, Bethesda, Mdi
EPSTE;rv, FREDERICK H., 3I.D.-Director aud Professor of Epidemiology, School'i
of Publie Health, University of Michigan, Ann Arbor, Mich.
FALK, I1:.~s L., Ph. D.-Associate Director for Program,, NationaU Institute of
EirvironuientaiHeaitlh, StiencesResearch Triangle Park, N.C.
Faa[t[tts, Be.v,ta:,[i.g G., Jr., '-\I.ID!-Professor of'~ EnvironmentaU Health and Safety,.
Schonl,of Public Health, HarvardlUniversity, Boston, Mass.
FH.tz[ER, Touu \L-?issistant Director, Harrard, Center for Community Health
andl Medical Care, Srhool of Public Health, Harvard University. Boston, Mass.
ti RdsTO:c, :lf.Ds-Associate Professor of Medicine; Head~ Division of'
Gastroentierolugy, Uni~versitsof U'tah1Tedical School, Salt Lake City,, Utah.
Go[aDsMrrHJotrs R., 3I.D: Head, Environmental Epidemiology Unit, Bureau of'.
(lucupationall Health andl Environmental Epidemiology, Cali£orniaState De-partlmentl of'I't[bli;c
Health, Berkeley, Calif.
Goas,, GIo BATTA, J1.D.-Assooiat!e Scientific Director f'or Program, Division of
Cancer Cause and Prevention, National Cancer Instfitlute,Bethesda, Md.
I'droo[sy, IAx T. T., M.D.-Professor of Epidemiology, School of' Public Health,
University of J37cliigan,,Ann Arbor, Mich.
HoFFMA:r:v,, DzaTS[axy Ph. D.-Chief'y Division of Environmental Carcinogenesis,
American Health Foundation,,NewYork:, N.Y.
KELLER, :1NuaeW Z., D:JI:Dr-Chief. Research in Geographic Epidemiology, ti'et-
eransA,dh[ihistratiouiCAntral Office, Washington, D.C.
.
IK'ass_1;Ea; JOSEPH B., 1T:D., Pi[. D!-Chief'of Staff and DeputlvDean for 3Tedical
?.ft'ailey The I"ritlzker School of'J'fedicine,, University of Chicago Hospitals and.
Clinics, (:'hi~cago, Ilh
KotBYE ALBERT C., Jr.,, M.ID. J.D.-Deputy Director, Bureau of' FoodS, Food and
Dr[igA1Luinist'mation U.S. Department of Health, Educabion,and Welfare;
i6'ashington, D.C.
I+izu.c e[oLZ, RIelnh[in A.,, 1T.D.-JIe<lical Director, I7[stituteofl Respiratory ~ Dis-easev,
Kettering Medical Center, Ietteri'ngO'hio:
LitcfNFEUU, ABRAHAM, 3I:D.-Pcofeysor and Cliai'rman, Department of Epidem-
iology, School of' Hygieneand' Public Health The Johns Hopkins University,
Baltimore, Md.
Jici:EAN, Ross. AI[D;-ProfesSorofl Medicine, Briwman Gray School of 3ledici'ne;Wal<eForest
Uhihersit,v;,A4'inst'on-SalemN.C:
