The Cigarette Century Pdf

[Dunstan Jomphe]

anythanks for visiting the official website of my new book, The Cigarette Century. I very much hope that this site will serve to generate a vigorous debate about issues concerning the history, culture, and politics of cigarette use in the United States and around the globe.

The court pointed to an earlier ruling in the case of a company that was licensed to operate cigarette vending machines in Provincetown. The group argued that a state law only banning vending machine sales of cigarettes to minors preempted a local ordinance banning all vending machine cigarette sales.

Allan M. Brandt is the Amalie Moses Kass Professor of the History of Medicine and Professor of the History of Science. He holds a joint appointment between the Faculty of Arts and Sciences and Harvard Medical School. Brandt served as Dean of the Graduate School of Arts and Sciences from 2008 to 2012. He earned his undergraduate degree at Brandeis University and a Ph.D. in American History from Columbia University. His work focuses on social and ethical aspects of health, disease, medical practices, and global health in the twentieth century. Brandt is the author of No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (1987); and co-editor of Morality and Health (1997). He has written on the social history of epidemic disease; the history of public health and health policy; and the history of human experimentation among other topics. His book on the social and cultural history of cigarette smoking in the U.S., The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America, was published by Basic Books in 2007 (paperback, 2009). The book received the Bancroft Prize from Columbia University in 2008 and the Welch Medal from the American Association for the History of Medicine in 2011. Brandt has been elected to the Institute of Medicine of the National Academy of Sciences and the American Academy of Arts and Sciences. He is currently writing about the impact stigma has on patients and health outcomes.

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Objectives: A four-stage model of the cigarette epidemic was proposed in 1994 to communicate the long delay between the widespread uptake of cigarette smoking and its full effects on mortality, as had been experienced in economically developed countries where cigarette smoking became entrenched decades earlier in men than in women. In the present work, the question of whether qualitative predictions from the model have matched recent trends in smoking and deaths from smoking in countries at various levels of economic development is assessed, and possible projections to the year 2025 are considered.

Methods: The proportion of all deaths attributed to tobacco was estimated indirectly for 41 high-resource and medium-resource countries from 1950 to the most recent year for which data were available, generally about 2005-2009. The trends in tobacco-attributed mortality in later middle age were then projected forward to 2025, based on recent trends in tobacco-attributed mortality in early middle age.

Results: In developed countries the prevalence of smoking has continued to decrease in both sexes, although the rate of decrease has slowed and is less than that predicted by the original version of the model. Over the past 20 years the proportionate contribution of smoking to all deaths has decreased in men while continuing to increase or plateau among women. Although the proportion of all deaths at ages 35-69 that are attributed to smoking is still generally greater in men than in women, the male and female proportions are converging and will probably cross over in some high resource countries. Projections through to 2025 suggest that male and female smoking prevalence and smoking-attributed mortality will decrease in parallel in most developed countries towards lower limits that are not yet defined. In developing countries the model seems generally applicable to men but cannot predict whether or when women will begin smoking in large numbers. Modified criteria that describe the stages of the epidemic separately for men and women would be more generalisable to developing countries.

Conclusions: The four-stage model of the cigarette epidemic still provides a reasonably useful description in many developed countries. Its relevance to developing countries could be improved by describing the stages of the epidemic separately for men and women.

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Smoking--once a socially accepted behavior--is the leading preventable cause of death and disability in the United States. During the first decades of the 20th century, lung cancer was rare; however, as cigarette smoking became increasingly popular, first among men and later among women, the incidence of lung cancer became epidemic (Figure 1). In 1930, the lung cancer death rate for men was 4.9 per 100,000; in 1990, the rate had increased to 75.6 per 100,000 (1). Other diseases and conditions now known to be caused by tobacco use include heart disease, atherosclerotic peripheral vascular disease, laryngeal cancer, oral cancer, esophageal cancer, chronic obstructive pulmonary disease, intrauterine growth retardation, and low birthweight. During the latter part of the 20th century, the adverse health effects from exposure to environmental tobacco smoke also were documented. These include lung cancer, asthma, respiratory infections, and decreased pulmonary function (2).

Large epidemiologic studies conducted by Ernst Wynder (see box) and others in the 1940s and 1950s linked cigarette smoking and lung cancer. In 1964, on the basis of approximately 7000 articles relating to smoking and disease, the Advisory Committee to the U.S. Surgeon General concluded that cigarette smoking is a cause of lung and laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of chronic bronchitis in both sexes (3). The committee stated that "Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action." Substantial public health efforts to reduce the prevalence of tobacco use began shortly after the risk was described in 1964. With the subsequent decline in smoking, the incidence of smoking-related cancers (including cancers of the lung, oral cavity, and pharynx) have also declined (with the exception of lung cancer among women) (4). In addition, age-adjusted death rates per 100,000 persons (standardized to the 1940 population) for heart disease (i.e., coronary heart disease) have decreased from 307.4 in 1950 to 134.6 in 1996 (4). During 1964-1992, approximately 1.6 million deaths caused by smoking were prevented (5).

Early in the 20th century, several events coincided that contributed to increases in annual per capita consumption, including the introduction of blends and curing processes that allowed the inhalation of tobacco, the invention of the safety match, improvements in mass production, transportation that permitted widespread distribution of cigarettes, and use of mass media advertising to promote cigarettes (6,7). Cigarette smoking among women began to increase in the 1920s when targeted industry marketing and social changes reflecting the liberalization of women's roles and behavior led to the increasing acceptability of smoking among women (8,9). Annual per capita cigarette consumption increased from 54 cigarettes in 1900 to 4345 cigarettes in 1963 and then decreased to 2261 in 1998 (10,11). Some decreases correlate with events, such as the first research suggesting a link between smoking and cancer in the 1950s, the 1964 Surgeon General's report, the 1968 Fairness Doctrine, and increased tobacco taxation and industry price increases during the 1980s (Figure 1).

An important accomplishment of the second half of the 20th century has been the reduction of smoking prevalence among persons aged greater than or equal to 18 years from 42.4% in 1965 to 24.7% in 1997, with the rate for men (27.6%) higher than for women (22.1%) (Figure 2). The percentage of adults who never smoked increased from 44% in the mid-1960s to 55% in 1997. In 1998, tobacco use varied within and among racial/ethnic groups. The prevalence of smoking was highest among American Indians/Alaska Natives, and second highest among black and Southeast Asian men. The prevalence was lowest among Asian American and Hispanic women (12). Smokeless tobacco use has changed little since 1970, with a 5% prevalence in 1970 and a 6% prevalence in 1991 among men, and 2% and 1%, respectively, for women. The prevalence of smokeless tobacco use is highest among high school males, with prevalence being 20% among white males, 6% among Hispanics males, and 4% among blacks males. Prevalence of use tends to be lower in the northeastern region and higher in the southern region of the United States. Total consumption of cigars decreased from 8 million in 1970 to 2 million in 1993 but increased 68% to 3.6 million in 1997 (13).

Reductions in smoking result from many factors, including scientific evidence of the relation among disease, tobacco use, and environmental exposure to tobacco; dissemination of this information to the public; surveillance and evaluation of prevention and cessation programs; campaigns by advocates for nonsmokers' rights; restrictions on cigarette advertising; counteradvertising; policy changes (i.e., enforcement of minors' access laws, legislation restricting smoking in public places, and increased taxation); improvements in treatment and prevention programs; and an increased understanding of the economic costs of tobacco.

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