Tobacco and Public Health - TCSC Indonesia

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THE GREAT STUDIES OF SMOKING AND DISEASE IN THE TWENTIETH CENTURY
age, sex, and smoking status. The highest risk is seen in men and women who actively
smoked cigarettes at the time of enrollment into the study in 1982. The cumulative risk
in men and women older than 85 equals 24 per cent and 11 per cent, respectively. The
lowest risk of lung cancer is seen in men and women who have never smoked regularly.
The risk is intermediate among men and women who have quit smoking at various
ages, prior to enrollment in the study, and decreases most the earlier the age of quitting.
Persons who stop smoking avoid much of the dramatic further increase in risk
incurred by those who continue.
Continuing need for cohort studies
It is important to note that there is a continuing need for cohort studies to monitor
the course of the pandemic in other countries and to improve strategies for ending
tobacco dependence. Not all of the important questions have been answered. There is
still much to learn about the nature and treatment of addiction, the phenomenon that
obligates continued smoking for most adults. This is very important for the 46.5 million
Americans (CDC 2002) and over 1.2 billion people worldwide (Corrao et al. 2000)
who are addicted to tobacco use. Most of the attention of cohort studies in the past has
been directed at understanding the disease burden caused by smoking, not at developing
or testing interventions.
Furthermore, the diseases that tobacco use causes differ somewhat in different countries,
depending on the background risks of contracting diseases that either compete
with, or interact with, smoking. For example, much of the disease burden caused by
tobacco in the United States and other Western countries involves cardiovascular diseases,
because of the high background rate of these conditions. The same is not true in
China, where a much higher proportion of the burden involves chronic obstructive
pulmonary disease (Liu et al. 1998), or in India, where tuberculosis is the most
common disease by which smoking causes premature death.
Summary and conclusions
Since the early 1950s, large cohort studies have played a major role in helping to identify
the multitude of adverse health effects caused by tobacco use, particularly in manufactured
cigarettes. They demonstrated that the harmful effects applied to women as
well as men, and that the burden of disease caused by smoking increased over time, as
smokers initiated regular cigarette smoking at progressively earlier ages. Large cohort
studies will continue to be important for monitoring the course of the epidemic as it
evolves in different cultures, and for sustaining the political resolve to end it.
References
Adler, I. (1912). Primary malignant growths of the lung and bronchi.Longmans Green, London.
Akiba, S. and Hirayama, T. (1990). Environmental Health Perspectives, 87, 19–26.