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DAVID M. BURNS Higgins, M. W., Enright, P. L., Kronmal, R. A., Schenker, M. B., Anton-Culver, H., and Lyles, M. (1993). Smoking and lung function in elderly men and women: the Cardiovascular Health Study. Journal of the American Medical Association, 269, 2741–8. Hogg, J. C., Macklem, P. T., and Thurlbeck, W. M. (1968). Site and nature of airway obstruction in chronic lung disease. New England Journal of Medicine, 278, 1355–60. International Agency for Research on Cancer (1986). IARC Monographs on the carcinogenic risk of chemicals to humans: tobacco smoking.Vol. 38. IARC, Lyon, France. Lebowitz, M. D. and Burrows, B. (1977). Quantitative relationships between cigarette smoking and chronic productive cough. International Journal of Epidemiology, 6, 107–13. National Cancer Institute. Smoking and Tobacco Control Monograph # 8: Changes in cigaretterelated disease risks and their implications for prevention and control (ed. D. Burns, L. Garfinkel, and J Samet), U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute. NIH Publication No. 97-4213, 1997. National Cancer Institute. Smoking and Tobacco Control Monograph No.13. Risks associated with smoking cigarettes with low machine yields of tar and nicotine.U.S. Department of Health and Human Services, Bethesda. NCI, October 2001. Pollay,R.W.and Dewhirst, T. (2002). The dark side of marketing seemingly ‘light’ cigarettes: successful images and failed fact. Tobacco Control, 11(Suppl 1), 118–31. Scanlon, P. D., Connett, J. E., Waller, L. A., Altose, M. D., Bailey, W. C., Buist, A. S., and Tashkin, D. P. (2000). Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease: the Lung Health Study. American Journal of Respiratory and Critical Care Medicine, 161, 381–90. Shanks, T. and Burns, D. (1998). Disease consequences of cigar smoking. In: Cigar smoking in the United States: Health effects and trends. Smoking and Tobacco Control Monograph No. 9 (ed. D. Burns, K.M. Cummings, and D. Hoffman), USDHHS NIH NCI, Chapter 4. Sherrill, D. L., Holberg, C. J., Enright, P. L., Lebowitz, M. D., and Burrows, B. (1994). Longitudinal analysis of the effects of smoking onset and cessation on pulmonary function. American Journal of Respiratory and Critical Care Medicine, 149, 591–7. Shiffman, S., Pillitteri, J. L., Burton, S. L., Rohay, J. M., and Gitchell, J. G. (2001). Smokers beliefs about ‘light’ and ‘ultra light’ cigarettes. Tobacco Control, 10(Suppl I), i17–i23. Speizer, F. E. and Tager, I. B. (1979). Epidemiology of chronic mucus hypersecretion and obstructive airways disease. Epidemiology Reviews, 1, 124–42. Stratton, K., Shetty, P., Wallace, R., and Bondurant, S., eds. (2001). Clearing the smoke. Assessing the science base for tobacco harm reduction.National Academy Press, Washington DC. Sutinen, S., Vaajalahti, P., and Paakko, P. (1978). Prevalence, severity, and types of pulmonary emphysema in a population of deaths in a Finnish city. Correlation with age, sex and smoking. Scandinavian Journal of Respiratory Disease, 59, 101–15. Tager, I. B., Segal, M. R., Speizer, F. E., and Weiss, S. T. (1988). The natural history of forced expiratory volumes: effect of cigarette smoking and respiratory symptoms. American Review of Respiratory Disease, 138, 837–49. Thun, M., Myers, D., Day-Lally, C., Namboodiri, M., Calle, E., Flanders, W. D., et al. (1997). Age and the exposure-response relationships between cigarette smoking and premature death in Cancer Prevention study II, Chapter 5. In: Changes in cigarette-related disease risks and their implications for prevention and control: smoking and tobacco control monograph # 8.(ed.D.Burns, L. Garfinkel, and J. Samet). U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, NIH Publication No. 97-4213, pp. 383–476. 589
590 CHRONIC OBSTRUCTIVE PULMONARY DISEASE U.S. Department of Health and Human Services (1984). The health consequences of smoking: chronic obstructive lung disease. A report of the surgeon general. U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health, DHHS Publication No. (PHS) 84-50205. U.S. Department of Health and Human Services (1990). The health benefits of smoking cessation. U.S. Dept of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, DHHS Publication No. (CDC) 90-8416. U.S. Department of Health and Human Services (1994). Preventing tobacco use among young people: A report of the surgeon general.U.S. DHHS, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta G. U.S. Department of Health and Human Services (2001). Women and smoking: a report of the surgeon general.Atlanta, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Georgia. U.S. Department of Health and Human Services (in press) The health consequences of tobacco use: A report of the surgeon general.U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, Georgia.
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Tobacco and Public Health: Science
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Tobacco and Public Health: Science
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Preface Tobacco: The public health
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PREFACE vii The cigarette companies
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dramatically. Once more, I am not s
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it impairs quality of life for year
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documents and through litigation by
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PREFACE xv it will not succeed. Now
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Stratton, K., Shetty, P., Wallace,
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Contents Preface v C. Everett Koop
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27 Tobacco and pancreas cancer 479
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Contributors Amanda Amos Reader in
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Stephen S. Hecht University of Minn
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Cecily S. Ray Project Assistant Epi
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Abbreviations AAA Abdominal aortic
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Introduction The publication of thi
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Part 1 Tobacco: History
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Introduction Chapter 1 Evolution of
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RICHARD DOLL 5 However, little atte
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RICHARD DOLL 7 lung’ (Doll and Hi
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Table 1.1 Principal diseases caused
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Table 1.4 Manufactured cigarette co
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in 1995 was approaching the maximum
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References Adler, I. (1912). Primar
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Introduction Chapter 2 The great st
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MICHAEL J. THUN AND JANE HENLEY 19
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it seems likely that some of this v
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steady increase in lung cancer occu
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cigarette smoking in deaths from co
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the effects of smoking and smoking
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Lung cancer death rate (per 100,000
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Lickint, F. (1929). Zeitschrift fur
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Chapter 3 Dealing with health fears
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LYNN T. KOZLOWSKI AND RICHARD J. O
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Table 3.3 Selected cigarette advert
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Part 2 Tobacco: Composition
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Introduction Chapter 4 The changing
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ILSE HOFFMANN AND DIETRICH HOFFMANN
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Table 4.4 (continued) Carcinogens i
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Table 4.5 Standard conditions for m
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Table 4.7 Comparison of experimenta
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the lung in rats treated with NNK (
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serve as the scientific basis in su
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Senkus, M. (ed.) (1976). Leaf compo
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Introduction Chapter 5 Tobacco smok
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STEPHEN S. HECHT 95 Established pul
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STEPHEN S. HECHT 97 magnitude lower
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STEPHEN S. HECHT 99 generally great
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Table 5.1 1-Hydroxypyrene in the ur
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Table 5.2 NNAL and its glucuronides
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STEPHEN S. HECHT 105 Table 5.2 (con
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Table 5.3 Representative DNA adduct
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G No (Wang et al. 2001a) N 2 CHCH 2
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STEPHEN S. HECHT 111 N-Nitrosopyrro
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(Kozack et al. 2000; Seo et al. 200
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the DNA adducts resulting from toba
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Culp, S. J., Gaylor, D. W., Sheldon
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STEPHEN S. HECHT 119 International
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STEPHEN S. HECHT 121 Melchior, W. B
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STEPHEN S. HECHT 123 Rivenso, A., H
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Wang, M., McIntee, E. J., Cheng, G.
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Part 3 Nicotine and addiction
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Chapter 6 Pharmacology of nicotine
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JACK E. HENNINGFIELD AND NEAL L. BE
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Pickworth et al. 1995; Shiffman et
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American Caucasians and Hispanics (
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(US DHHS 2001). At doses delivered
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References JACK E. HENNINGFIELD AND
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Introduction Chapter 7 Behavioral p
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BRIDGETTE E. GARRETT ET AL. 151 How
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(Fischman and Foltin 1991). Another
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following repeated, infrequent and
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BRIDGETTE E. GARRETT ET AL. 157 oth
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BRIDGETTE E. GARRETT ET AL. 159 cli
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to tobacco product ingredients and
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BRIDGETTE E. GARRETT ET AL. 163 Gom
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BRIDGETTE E. GARRETT ET AL. 165 Ris
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Introduction Chapter 8 Cigarette sc
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JEFF FOWLES AND DENNIS SHUSTERMAN 1
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◆ The pressure drop of the filter
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Nitrosamines Nitrosamines are biolo
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Physical design features of cigaret
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Introduction Chapter 9 Nicotine dos
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world tobacco burden (World Health
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Table 9.2 The ranges of nicotine, n
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MIRJANA V. DJORDJEVIC 187 turing a
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Poland 19 1.4 n.a. n.a. 68−347 36
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MIRJANA V. DJORDJEVIC 191 cigarette
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MIRJANA V. DJORDJEVIC 193 Table 9.5
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MIRJANA V. DJORDJEVIC 195 MS wherea
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MIRJANA V. DJORDJEVIC 197 In recent
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MIRJANA V. DJORDJEVIC 199 Table 9.8
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MIRJANA V. DJORDJEVIC 201 Burns, D.
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International Agency for Research o
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Part 4 Tobacco use: Prevalence, tre
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Chapter 10 Tobacco in Great Britain
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Adult smoking PATTI WHITE 209 Since
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oys who were regular smokers report
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PATTI WHITE 213 cancer, and bringin
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Introduction Chapter 11 The epidemi
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since the late 1980s. In 2001, Phil
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YANG HONGHUAN 219 ◆ Among males,
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Table 11.1 Smoking among adolescent
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(57%) was higher than in males (45%
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20 cigarettes a day had double the
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Chapter 12 Patterns of smoking in R
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DAVID ZARIDZE 229 Ignatova et al. (
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DAVID ZARIDZE 231 Tyumen, respectiv
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References DAVID ZARIDZE 233 Alexee
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Chapter 13 Tobacco smoking in centr
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WITOLD ZATOŃSKI 237 The developmen
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especially post-Soviet countries, w
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No. of Cigarettes 3000 2500 2000 15
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WITOLD ZATOŃSKI 243 young men and
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DEATHS / 100,000 DEATHS / 100,000 7
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WITOLD ZATOŃSKI 247 According to d
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Unfortunately, available data on th
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Kaczmarczyk-Chalas, K., Gdulewicz,
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Chapter 14 The epidemic in India Pr
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aniseed, and musk, also available a
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PRAKASH C. GUPTA AND CECILY S. RAY
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Prevalence among youth PRAKASH C. G
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treatment and premature death were
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Although tobacco control legislatio
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PRAKASH C. GUPTA AND CECILY S. RAY
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Chapter 15 Tobacco in Africa: More
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In assessing tobacco use in Africa
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YUSSUF SALOOJEE 271 plug the gap th
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Table 15.2 Cigarette taxes as perce
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YUSSUF SALOOJEE 275 In recent years
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World Bank (2001). Economics of Tob
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Part 5 Tobacco and health. Global b
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Chapter 16 The future worldwide hea
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RICHARD PETO AND ALAN D LOPEZ 283 a
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UK male death rate at ages 35-69 ha
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Overview Chapter 17 Passive smoking
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evidence have proved to be effectiv
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JONATHAN M. SAMET 291 a thousand de
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Table 17.2 Occupational ETS exposur
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Table 17.3 Nicotine concentrations
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portable piezobalance to sample aer
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JONATHAN M. SAMET 299 Fetal effects
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JONATHAN M. SAMET 301 Investigation
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Table 17.4 Summary of pooled random
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JONATHAN M. SAMET 305 also reported
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and involuntary exposure to tobacco
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Glantz, S. A. and Parmley, W. W. (1
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JONATHAN M. SAMET 311 O’Connor, G
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JONATHAN M. SAMET 313 US Department
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Introduction Chapter 18 Adolescent
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JOHN P. PIERCE ET AL. 317 would be
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JOHN P. PIERCE ET AL. 319 Indeed, t
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JOHN P. PIERCE ET AL. 321 reached i
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subsequent consumption. Most studie
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Burns, D., Garfinkel, L., and Samet
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JOHN P. PIERCE ET AL. 327 US Depart
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The epidemic Chapter 19 Tobacco and
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AMANDA AMOS AND JUDITH MACKAY 331 w
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AMANDA AMOS AND JUDITH MACKAY 333 T
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AMANDA AMOS AND JUDITH MACKAY 335 w
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AMANDA AMOS AND JUDITH MACKAY 337 p
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AMANDA AMOS AND JUDITH MACKAY 339 T
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AMANDA AMOS AND JUDITH MACKAY 341 o
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AMANDA AMOS AND JUDITH MACKAY 343 M
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such as Jewel and Madonna, who woul
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AMANDA AMOS AND JUDITH MACKAY 347 t
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particularly in developing countrie
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AMANDA AMOS AND JUDITH MACKAY 351 L
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Part 6 Tobacco and cancer
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Chapter 20 Cancer of the prostate F
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Table 20.1 Summary of results of ca
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Andersson et al. 1996 Sweden 256 ca
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Table 20.2 Summary of results of co
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cancer in younger or elderly men, w
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FABIO LEVI AND CARLO LA VECCHIA 365
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Summary Chapter 21 Laryngeal cancer
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12-year follow-up of the American C
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Hedberg et al. USA, 235, 81% P, 547
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cigarettes as compared to blond-tob
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of 3.78 and 11.47. An interpretatio
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Effect on survival In two studies f
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Cattaruzza, M. S., Maisonneuve, P.,
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USDHEW (1964). Laryngeal cancer. In
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Chapter 22 Smoking and cancer of th
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Table 22.1 Results from selected ca
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Asia Gao et al. 1994— Population
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EVA NEGRI 389 Ille-et-Vilaine, Fran
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Odds Ratio 2.5 2 1.5 1 0.5 0 0.30 2
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Garidou et al. 1996— Hospital ≤
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De Stefani, E., Barrios, E., and Fi
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Wynder, E. L. and Bross, I. J. (196
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Introduction Chapter 23 Tobacco use
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Table 23.1 Tobacco use and risk of
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Franceschi et al. Oral cavity, Oral
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Muscat et al. Oral cavity OR = 2.1
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Population-based case-control studi
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Lewin et al. Oral cavity, RR = 6.5
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TONGZHANG ZHENG ET AL. 411 the cont
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TONGZHANG ZHENG ET AL. 413 For smok
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TONGZHANG ZHENG ET AL. 415 per day
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TONGZHANG ZHENG ET AL. 417 than tha
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TONGZHANG ZHENG ET AL. 419 For exam
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TONGZHANG ZHENG ET AL. 421 decline
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Studies in India: Oral cancer is th
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carcinoma compared with other combi
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studies have demonstrated a positiv
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TONGZHANG ZHENG ET AL. 429 Garrote,
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TONGZHANG ZHENG ET AL. 431 Notani,
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Chapter 24 Smoking and stomach canc
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DAVID ZARIDZE 435 such as sex, age,
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DAVID ZARIDZE 437 (Kato et al. 1990
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DAVID ZARIDZE 439 respectively. The
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Gajalakshmi, C. K. and Shanta, V. (
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Pisani, P., Parkin, D. M., Bray, F.
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Introduction Chapter 25 Cigarette s
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attenuated in every study after con
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EDWARD GIOVANNUCCI 449 with a gener
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(Baron et al. 1994) of 352 colon ca
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(U.S. Dept. of Health Education and
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References EDWARD GIOVANNUCCI 455 A
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EDWARD GIOVANNUCCI 457 Kono, S., Ik
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Chapter 26 Smoking and cervical neo
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Tokuhata 1967* Williams 1977* Wigle
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Clarke 1985* Hellberg 1986* La Vecc
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ANNE SZAREWSKI AND JACK CUZICK 465
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case-control study nested in a scre
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five-fold risk of cervical cancer f
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(typically around two-fold), but be
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Introduction Chapter 27 Tobacco and
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Cigar, pipe, and chewing tobacco Wh
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Conclusion Overall, tobacco smoking
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Summary Chapter 28 Smoking and lung
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GRAHAM G. GILES AND PETER BOYLE 487
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quit for 20 years or more (Rogot an
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cancer and others where there is st
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Peto, R. (1986) Influence of dose a
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Chapter 29 Tobacco smoking and canc
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He further noted that case-control
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coefficients from the data in Table
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DIMITRIOS TRICHOPOULOS AND ARETI LA
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Epidemiology Chapter 30 Smoking and
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CRYSTAL N. HOLICK AND HARVEY A. RIS
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and at least the enteric variety of
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Chapter 31 Endometrial cancer Paul
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Table 31.1 Epidemiological studies
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studies (Terry et al. 1999, 2002a),
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Newcomer Population 740/2372 40-79
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PAUL D. TERRY ET AL. 531 levels, an
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Relative body weight Obesity is an
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Key et al. 1991 147 pre- and postme
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lood levels among current smokers,
Page 572 and 573: Table 31.7 Studies of cigarette smo
Page 574 and 575: of the association between cigarett
Page 576 and 577: Jensen, J., Christiansen, C., and R
Page 578 and 579: PAUL D. TERRY ET AL. 545 Weiderpass
Page 580 and 581: Part 7 Tobacco and heart disease
Page 582 and 583: Introduction Chapter 32 Tobacco and
Page 584 and 585: citations of some of the best-known
Page 586 and 587: KONRAD JAMROZIK 553 because the dat
Page 588 and 589: KONRAD JAMROZIK 555 Fig. 32.2 Trend
Page 590 and 591: Table 32.3 Case-control studies of
Page 592 and 593: Table 32.5 Cohort studies of active
Page 594 and 595: Table 32.6 Effect of exclusion of p
Page 596 and 597: eadily addressed by cohort studies
Page 598 and 599: Specificity The entries in Table 32
Page 600 and 601: Table 32.8 Application of Bradford
Page 602 and 603: KONRAD JAMROZIK 569 arterial CVD re
Page 604 and 605: elationship goes beyond statistical
Page 606 and 607: Garland, C., Barrett-Connor, E., Su
Page 608 and 609: National Health and Medical Researc
Page 610 and 611: Part 8 Tobacco and respiratory dise
Page 612 and 613: Introduction Chapter 33 Chronic obs
Page 614 and 615: Many of the constituents in both th
Page 616 and 617: DAVID M. BURNS rate of growth in lu
Page 618 and 619: Death rates from COPD in smokers an
Page 620 and 621: Fraction of Excess Risk 1.20 1.00 0
Page 624 and 625: Part 9 Tobacco and other diseases
Page 626 and 627: Introduction Chapter 34 Smoking and
Page 628 and 629: ALLAN HACKSHAW 595 several mechanis
Page 630 and 631: Table 34.4 Studies that reported re
Page 632 and 633: Table 34.5 Cohort studies that repo
Page 634 and 635: than non-smokers; they have about h
Page 636 and 637: Table 34.8 Cohort studies that repo
Page 638 and 639: esults from cohort studies. There i
Page 640 and 641: ALLAN HACKSHAW 607 (DiFranza and Le
Page 642 and 643: Table 34.12 Cohort studies that rep
Page 644 and 645: Caries and tooth loss Because perio
Page 646 and 647: Table 34.16 Summary of disorders in
Page 648 and 649: References ALLAN HACKSHAW 615 Allar
Page 650 and 651: Johnsen, R., Forde, O. H., Straume,
Page 652 and 653: Seddon, J. M., Willett, W. C., Spei
Page 654 and 655: Part 10 Genetics, nicotine addictio
Page 656 and 657: Chapter 35 Genes, nicotine addictio
Page 658 and 659: Cotinine (ng/ml) 750 500 250 OXCHEC
Page 660 and 661: MICHAEL MURPHY ET AL. 627 of those
Page 662 and 663: MICHAEL MURPHY ET AL. risk associat
Page 664 and 665: Table 35.2 (continued) Gene map Chr
Page 666 and 667: MICHAEL MURPHY ET AL. pre-clinical
Page 668 and 669: Steps to carcinogenesis Exposure to
Page 670 and 671: DNA repair As previously alluded to
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MICHAEL MURPHY ET AL. Lichtenstein,
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Part 11 Tobacco and alcohol
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Introduction Chapter 36 Tobacco and
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Table 36.1 Comparison of alcohol an
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Although gene therapy has rarely be
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20+ TABAC 5.1 10-19 0-9 3.4 12.3 0-
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Heavy drinking is known to cause ga
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Treatment issues and co-dependence
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ALBERT B. LOWENFELS AND PATRICK MAI
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Part 12 Tobacco control: Successes
Page 692 and 693:
Introduction Chapter 37 Global toba
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NIGEL GRAY (sometimes at state leve
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NIGEL GRAY The first attempt to red
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per litre of smoke. Reduction of th
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Borland, R., Cappiello, M. and Owen
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Chapter 38 Lessons in tobacco contr
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entangling relationships with negot
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successful country advocates deeply
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Thus, when the opportunity arose, t
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Chapter 39 A brief history of legis
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Committee, mentioned above, little
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4. Tobacco and its related processi
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RUTH ROEMER 683 advertising and adv
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or shows, and distribution of free
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RUTH ROEMER 687 threat to the peopl
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RUTH ROEMER 689 The case was settle
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Another study by Harvard researcher
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At the end of 2003, 83 countries ha
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Chapter 40 Roles of tobacco litigat
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NGOs obtained sanctions against tob
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RICHARD A. DAYNARD 699 In a 1980s c
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RICHARD A. DAYNARD 701 Fourth, the
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even impossible. Such a statute pre
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RICHARD A. DAYNARD 705 Daynard, R.
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Introduction Chapter 41 Impact of s
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in this chapter, is evidence that s
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RON BORLAND AND CLAIRE DAVEY 711 Wh
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RON BORLAND AND CLAIRE DAVEY 713 On
Page 748 and 749:
RON BORLAND AND CLAIRE DAVEY 715 ro
Page 750 and 751:
you are subject, but this does not
Page 752 and 753:
RON BORLAND AND CLAIRE DAVEY 719 to
Page 754 and 755:
RON BORLAND AND CLAIRE DAVEY 721 fo
Page 756 and 757:
RON BORLAND AND CLAIRE DAVEY 723 (E
Page 758 and 759:
RON BORLAND AND CLAIRE DAVEY 725 th
Page 760 and 761:
advanced. Although in countries lik
Page 762 and 763:
RON BORLAND AND CLAIRE DAVEY 729 Da
Page 764 and 765:
RON BORLAND AND CLAIRE DAVEY 731 Pr
Page 766 and 767:
Introduction Chapter 42 Effective i
Page 768 and 769:
PRABHAT JHA ET AL. 735 India (Gupta
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Average price or tax per pack (US$)
Page 772 and 773:
PRABHAT JHA ET AL. 739 Bans on adve
Page 774 and 775:
PRABHAT JHA ET AL. 741 Table 42.2 T
Page 776 and 777:
PRABHAT JHA ET AL. 743 antismugglin
Page 778 and 779:
Farrelly, M. C., Pechacek, T. F., a
Page 780 and 781:
PRABHAT JHA ET AL. 747 Raw, M., Mc
Page 782 and 783:
Part 13 Treatment of dependence
Page 784 and 785:
Introduction Chapter 43 Treatment o
Page 786 and 787:
Nocturnal sleep-disturbing nicotine
Page 788 and 789:
MICHAEL KUNZE AND E. GROMAN 755 tob
Page 790 and 791:
Fifteen different products were ide
Page 792 and 793:
In summary, tobacco dependence amon
Page 794 and 795:
medications for OTC sale in 1996, t
Page 796 and 797:
MICHAEL KUNZE AND E. GROMAN 763 US
Page 798 and 799:
Chapter 44 Regulation of the cigare
Page 800 and 801:
as these correlate quite well with
Page 802 and 803:
NIGEL GRAY 769 within three major g
Page 804 and 805:
of carcinogens and toxins in its wa
Page 806 and 807:
Index abdominal aortic aneurysm see
Page 808 and 809:
aromatic amines 58, 60, 98 DNA addu
Page 810 and 811:
central and eastern Europe (CEE) (C
Page 812 and 813:
coronary thrombosis 5 see also myoc
Page 814 and 815:
epinephrine 169 epoxide hydrolase g
Page 816 and 817:
health professionals advice on smok
Page 818 and 819:
laryngeal cancer (Continued) animal
Page 820 and 821:
Morris, Philip 207 see also Philip
Page 822 and 823:
nursing home residents 718 nutritio
Page 824 and 825:
Polish Central Statistical Office (
Page 826 and 827:
smoke, tobacco (including cigarette
Page 828 and 829:
Sweden female smoking rates 330-1 l
Page 830 and 831:
United Nations agencies 680-1 Unite
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Tobacco and Public Health - TCSC Indonesia

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