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than non-smokers; they have about half the risk. Morens et al. (1995) reviewed 35 studies (cohort and case–control) and all showed a decreased risk. Table 34.7 shows the results from the cohort studies some of which, for example Hirayama (1985), Doll et al. (1994), and Hernan et al. (2001), reported that risk decreased with increasing number of cigarettes smoked. Gorell et al. (1999) also showed a clear relationship in ex-smokers, in which those who gave up relatively recently (1–20 years) had a much lower risk compared to never-smokers than those who had given up for a longer time (>20 years); relative risk 0.4 versus 0.9. Several mechanisms have been proposed to explain the association; nicotine stimulates an increase in dopamine, the anti-oxidant effect of carbon monoxide in cigarette smoke is protective and smoking offers some protection against neuronal damage. There have been several reviews including Marmot (1990), Morens et al. (1995), and Fratiglioni and Wang (2000). Alzheimer’s disease Because Alzheimer’s disease accounts for most cases of dementia in the elderly, there was interest in the early studies that, like Parkinson’s disease, suggested a decreased risk in smokers. In an early meta-analysis (Lee 1994), the estimated risk in ever smokers was almost half that in never smokers (relative risk 0.64, 95% CI 0.54–0.76). However, unlike Parkinson’s disease, the evidence was not so consistent between studies. Many were relatively small case–control studies that relied on information from surrogates and suffered from several limitations (see Doll et al. 2000 for a discussion). A recent comprehensive meta-analysis of both case–control and cohort studies showed conflicting results according to study type (Almeida et al. 2002). In 21 case–control studies (based on a total of 1143 affected subjects) the pooled relative risk was 0.74 (95% CI 0.66–0.84). The pooled estimate from eight cohort studies (1156 affected individuals) was 1.10 (95% CI 0.94–1.29); the results from these studies are shown in Table 34.8. Smoking does not seem to be protective against this disorder; previous results showing a benefit are likely to be artefactual. On the contrary, there is evidence that it in fact increases risk (Doll et al. 2000; Almeida et al. 2002), though this is yet to be established. Eyes ALLAN HACKSHAW 601 Studies have suggested that smoking may be a risk factor for several diseases of the eye, some of which can lead to irreversible blindness. However, the evidence for many has not been strong, for example glaucoma and diabetic retinopathy. It is likely that smoking has some direct effects on the lens and retina because of its well-known thrombotic and atherosclerotic effects. Reviews of this subject can be found in Solberg et al. (1998), Cheng et al. (2000), and Evans (2001). Cataracts Cataracts are a major cause of blindness and visual impairment in developed countries and their removal is the most common reason for eye surgery. Table 34.9 shows the
Table 34.7 Cohort studies that reported results on Parkinson’s disease and smoking* Study Country Number Total number of subjects Gender Relative risk in current smokers of subjects with Parkinson’s disease compared to never-smokers (95% CI) Kahn 1959 USA ~250 000 40 Men 0.23 (not reported) Hammond 1966 USA ~1 million 123 Men and women 0.76 (age 45–64) and 0.80 (age 65–79) Hiryama 1985 Japan – – Men and women 0.57 Doll et al. 1994 UK 34 439 152 Men 0.75 (not reported) Morens 1966 USA (Hawaii) 8006 92 Men 0.40 (0.26–0.61) Hernan et al. 2001 USA 51 529 92 Men 0.3 (0.1–0.8) 121 700 102 Women 0.4 (0.2–0.7) *Adapted from Fratiglioni and Wang (2000), except Hernan (2001) (from which the results were obtained directly).
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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,
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Table 31.7 Studies of cigarette smo
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of the association between cigarett
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Jensen, J., Christiansen, C., and R
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PAUL D. TERRY ET AL. 545 Weiderpass
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Part 7 Tobacco and heart disease
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Introduction Chapter 32 Tobacco and
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Page 586 and 587: KONRAD JAMROZIK 553 because the dat
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Page 592 and 593: Table 32.5 Cohort studies of active
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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 622 and 623: DAVID M. BURNS Higgins, M. W., Enri
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 636 and 637: Table 34.8 Cohort studies that repo
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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
Page 672 and 673: MICHAEL MURPHY ET AL. Lichtenstein,
Page 674 and 675: Part 11 Tobacco and alcohol
Page 676 and 677: Introduction Chapter 36 Tobacco and
Page 678 and 679: Table 36.1 Comparison of alcohol an
Page 680 and 681: Although gene therapy has rarely be
Page 682 and 683: 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
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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
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RON BORLAND AND CLAIRE DAVEY 715 ro
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you are subject, but this does not
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RON BORLAND AND CLAIRE DAVEY 719 to
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RON BORLAND AND CLAIRE DAVEY 721 fo
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RON BORLAND AND CLAIRE DAVEY 723 (E
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RON BORLAND AND CLAIRE DAVEY 725 th
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advanced. Although in countries lik
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RON BORLAND AND CLAIRE DAVEY 729 Da
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RON BORLAND AND CLAIRE DAVEY 731 Pr
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Introduction Chapter 42 Effective i
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PRABHAT JHA ET AL. 735 India (Gupta
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Average price or tax per pack (US$)
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PRABHAT JHA ET AL. 739 Bans on adve
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PRABHAT JHA ET AL. 741 Table 42.2 T
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PRABHAT JHA ET AL. 743 antismugglin
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Farrelly, M. C., Pechacek, T. F., a
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PRABHAT JHA ET AL. 747 Raw, M., Mc
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Part 13 Treatment of dependence
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Introduction Chapter 43 Treatment o
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Nocturnal sleep-disturbing nicotine
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MICHAEL KUNZE AND E. GROMAN 755 tob
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Fifteen different products were ide
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In summary, tobacco dependence amon
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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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