Tobacco and Public Health - TCSC Indonesia

cigarette smoking in deaths from coronary disease is not proven, the Committee considers it
more prudent from the public health viewpoint to assume that the established association has
causative meaning than to suspend judgment until no uncertainty remains.
(US Public Health Service 1964)
After 1964 there was no serious scientific controversy about whether smoking caused
lung cancer. The official skepticism of the tobacco industry was maintained as a legal
and political strategy, rather than a consequence of any genuine scientific debate, as
was revealed later through the disclosure of internal documents (Glantz et al. 1996).
However, many important scientific questions remained concerning other deleterious
effects of tobacco use, the magnitude of the problem, and the potential benefits of
cessation and other possible interventions.
Additional cohort studies
MICHAEL J. THUN AND JANE HENLEY 25
Among the seven cohort studies considered by the 1964 Report to the Surgeon General
(US Public Health Service 1964) were two that, like the British Doctors Study, were of
sufficient size and duration to qualify as ‘Great Studies’. These were the US Veterans
Study, begun by the National Institutes of Health and the US Veterans’ Administration
in 1954, and Cancer Prevention Study I, a second large cohort study initiated by the
American Cancer Society, in 1959 (Auerbach et al. 1961).
The US Veterans (Dorn) Study
In September 1954, the US Veterans’ Administration contacted 293 958 men who had
served in the armed forces at any time between 1917 and 1940, and who held US government
life insurance policies (Kahn 1966). Subjects were mainly white men of the
middle and upper social classes. A total of 248 195 men (response rate 85 per cent after
two mailings) returned a questionnaire on their smoking habits. The vital status of
these veterans was followed until death by tracking life insurance claims to the Veterans
Administration, or termination of the policy for other reasons. Supplemental information
was obtained on deceased persons from certifying physicians or hospitals. Results
from the Veterans Study were published in 1958 (Dorn 1958), 1959 (Dorn 1959), 1966
(Kahn 1966), 1990 (Hsing et al. 1990), and 1995 (Chow et al. 1995). A total of 192 756
deaths occurred during the 26-year follow-up from 1954 to 1980.
Cancer Prevention Study I (CPS-I)
Between October 1959 and February 1960, volunteers for the American Cancer Society
in 25 states recruited more than 1 million subjects, from among their friends, neighbors,
and acquaintances, to complete a four-page questionnaire (Hammond 1964,
1966). Known as Cancer Prevention Study I (CPS-I) or the 25 State Study, the
cohort was substantially larger than the Hammond Horn study, and included women
as well as men (Hammond 1964; Garfinkel 1985). Enrollment was by family; all family