Tobacco and Public Health - TCSC Indonesia

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THE GREAT STUDIES OF SMOKING AND DISEASE IN THE TWENTIETH CENTURY
British Doctors Study
In 1951, a questionnaire on smoking habits was sent to all British doctors included in
the Medical Register. Of the 41 024 replies received, 40 701 were sufficiently complete to
be utilized (Doll and Hill 1954). The 34 494 men and 6207 women included in the
follow-up comprised 69 per cent and 60 per cent of the men and women, respectively, in
the registry. Further questionnaires about changes in smoking habits were sent in 1957
to men, in 1960 to women, and in 1966 and 1972 to all participants. On each occasion,
approximately 97 per cent of the doctors responded. The analyses defined lifelong nonsmoking
as never having smoked as much as one cigarette per day, or 1 /4 ounce of other
forms of tobacco, for as much as 1 year. A preliminary report was published by Doll
and Hill (1954), and a second report in 1956 (Doll and Hill 1956). Results from the
10-year follow-up of male doctors were published in 1964 (Doll and Hill 1964), the
20-year follow-up (through October 1971) for men in 1976 (Doll and Peto 1976), and
the 22-year follow-up for women in 1980 (Doll et al. 1980). Results from the 40-year
follow-up were published in 1994 (Doll et al. 1994), and the final report of the 50-year
follow-up is now being prepared (personal communication, Sir Richard Doll).
Hammond Horn (the nine-state) study
The Hammond Horn study began in October 1952, when over 22 000 ACS volunteers distributed
a questionnaire to 10 white men, aged 50–69 years, whom he or she knew well
(Hammond 1954). A total of 204 547 men in nine states participated. Patterns of cigarette,
cigar, and pipe smoking were similar in the Hammond Horn cohort to those found in a
representative survey of American males in 1955 (Haenszel et al. 1956). Study participants
were enrolled from among the friends, neighbors, and acquaintances of local volunteers,
and thus resembled the socio-demographic characteristics of the volunteers. A higher
percentage were graduates of high school or college, and were more affluent, than in the
general United States population. After exclusions, a cohort of 187 783 men was followed
from 1952 through 1955. A total of 11 783 deaths (6.2 per cent) occurred during an average
of 44 months of follow-up, with 1.1 per cent of the cohort being lost to follow-up.
Death certificates were collected for all reported deaths and further information was
collected from the physician, hospital, or tumor registry whenever cancer was mentioned
(Hammond and Horn 1958a). Preliminary results from the first 20 months of follow-up
were published in 1954 (Hammond 1954). Final results were published in 1958 for total
mortality (Hammond and Horn 1958a), and for specific causes of death (Hammond and
Horn 1958b). The Hammond Horn study was terminated after 44 months of follow-up.
Early findings from the British Doctors and
Hammond Horn Studies
Preliminary results from both the British Doctors and the Hammond Horn studies
were published in 1954. The British cohort demonstrated a statistically significant and