An estimated 4 million people will die this year from tobacco-related
illness. Brundtland explains why tobacco control efforts have had limited
impact. More effective regulation of tobacco products, such as the new regulations
in Canada that will require prominent warning labels on cigarette packages,
is one of several necessary steps to curb this preventable epidemic.
Rates of cigarette smoking among college students may underestimate
tobacco use in this population because use of other tobacco products—cigars,
pipes, and smokeless tobacco—has not been assessed. In this analysis
of data from a 1999 cross-sectional survey of students at 119 US 4-year colleges,
Rigotti and colleagues found that almost half of respondents reported using
a tobacco product in the past year. Current prevalence of cigarette smoking
was 28.5% and of cigar use, 8.5%; a majority of tobacco users reported using
more than 1 tobacco product in the past year.
The tobacco industry has criticized the Centers for Disease Control
and Prevention (CDC) estimates of the number of deaths in the United States
attributable to smoking because the estimates are adjusted only for age and
sex and lack adjustment for socioeconomic and behavioral factors. Using data
from the same population-based study used for CDC estimates of smoking-attributable
deaths, Thun and colleagues found that after adjusting for age and controlling
for education, occupation, race, alcohol consumption, and various dietary
factors, the overall estimate of deaths attributable to smoking in the United
States decreased only by approximately 1%.
Cigarette smoking has been shown to be an independent risk factor for
the development of age-related cataracts, but whether the risk persists or
declines after smoking cessation is uncertain. In this analysis of data from
20,907 men in the Physicians' Health Study I followed up for an average of
13.6 years, Christen and colleagues found that the risk of cataract was lowest
in never smokers, intermediate in past smokers, and highest in current smokers.
Among ever smokers, the risk of cataract increased 7% for each 10-pack-year
increase in smoking, but was slightly reduced among past smokers compared
with current smokers independent of total cumulative dose.
Several strategies have been developed to reduce smoking in youth, and
interventions that target adults as well as youth might offer a new public
health approach. In an analysis of data from population-based US surveys conducted
in 1992-1993 and 1995-1996, Farkas and colleaguesArticle found that smoke-free workplaces
and homes, especially where all household members were never smokers, were
associated with significantly lower rates of adolescent smoking. In an assessment
of the Florida Pilot Program on Tobacco Control, a comprehensive youth-led
program that included a media campaign, community activities, school-based
and retailer education, and enforcement of youth access laws, Bauer and colleaguesArticle
report that tobacco use among Florida public middle school and high school
students decreased significantly 2 years after program implementation. Retailer
compliance with laws restricting the sale of cigarettes to youth could reduce
youth access to tobacco products, but in an analysis of data from 110,062
Food and Drug Administration retail compliance checks, in which minors attempt
to purchase tobacco products, Clark and colleaguesArticle found that the rate of
illegal sales was 26.6%. Illegal sales were associated with failure to request
proof of age, employment of older minors to make the purchase, attempts to
purchase smokeless tobacco, and performing checks at 5 PM or later.
Ms V has been smoking since age 9 years and currently smokes 1 to 2
packs per day. She has made several unsuccessful attempts at quitting, but
recently was able to abstain for 24 days while taking bupropion hydrochloride
and using a nicotine patch. Rigotti reviews the prevalence and health burden
of cigarette smoking and treatment of tobacco use.
Experts discuss ethical problems posed by the genetics revolution.
Rates of cigar smoking are increasing. This summary of the American
Cancer Society conference on health risks of cigar smoking points out that
cigars are not a safe alternative to cigarettes.
Global and US efforts to control tobacco use: some success, but much
Respiratory symptoms among police officers in Hong Kong who have never
smoked had a dose-response relationship with exposure to environmental tobacco
For your patients: Preventing child and adolescent tobacco use.
This Week in JAMA. JAMA. 2000;284(6):663. doi:10.1001/jama.284.6.663