The First Surgeon General’s Report on Smoking and Health
The First Surgeon General’s Report on Smoking and Health
The best efforts of the industry notwithstanding, the collective tobacco control interventions of government and the voluntary and private sectors have averted millions of premature smokingproduced deaths among Americans— including 800 000 lung cancer deaths alone during the period 1975 to 2000—with each beneficiary gaining on average fully 20 years in additional life. This extraordinary achievement is likely unmatched by any other public health endeavor in our nation in the past half century. The achievement has not been shared equally by all members of our society, however. Smoking prevalence is today highly inversely correlated with education, far more so than it was at the time of the 1964 report. In 1966, adults with 9 to 11 years of education had a smoking prevalence (45.5%) only 12 percentage points above that of college graduates (33.5%). In 2011 the gap had grown to 29.2 percentage points: the era of tobacco control has witnessed smoking among college graduates plummet by more than three quarters, to 7.5%, while for those with 9 to 11 years of education, the decrease has been less than one fifth, to 36.7% (K. Asman, Office on Smoking and Health, CDC, written communication, September 23, 2013). As would be expected, given the correlation between education and income, smoking today has a strong inverse relationship with economic status as well.
Among racial/ethnic groups, smoking prevalence varies from a high of 31.5% for American Indians and Alaska Natives to a low of 9.9% among Asian Americans. Whites and Blacks smoke at about the same rate (20.6% and 19.4%, respectively), while Hispanics are much lower (12.9%, reflecting the low rate of smoking among Hispanic women).
Of growing concern is the increasing concentration of smoking among people with mental illness. A CDC study examining data from 2009 to 2011 found that 36% of people with a diagnosable mental illness in the past 12 months were smokers, compared with 21% of individuals not suffering from mental illness. We in tobacco control all too often observe this important characteristic of today's smoking population and then forget about it as we go about our work.
Another source of tobaccorelated disparities is the difference in tobacco control efforts and successes between the developed nations, many of which have matched or exceeded the achievements of the United States, and low- and middle-income countries (LMICs). The major multinational tobacco companies have preyed on LMICs in the past few decades, where the combination of less understanding of the hazards of smoking, growing affluence, and greater governmental susceptibility to corruption makes LMICs the industry's market of the future. The World Health Organization projects that by 2030, more than 80% of the then-expected eight million annual tobacco-produced deaths will occur in LMICs.
As bleak as this situation may sound, recently a large number of LMICs have adopted strong tobacco control policies, motivated in part by the Framework Convention on Tobacco Control (FCTC), the world's first international health treaty, ratified by 177 countries representing 88% of the world's population. Only 19 eligible countries have failed to ratify the treaty, most conspicuously the United States, an irony, disappointment, and indeed embarrassment because in the past our country provided so much global leadership in tobacco control and produced so much of the research that underpins the action requirements of the treaty.
Growing Disparities in Smoking
The best efforts of the industry notwithstanding, the collective tobacco control interventions of government and the voluntary and private sectors have averted millions of premature smokingproduced deaths among Americans— including 800 000 lung cancer deaths alone during the period 1975 to 2000—with each beneficiary gaining on average fully 20 years in additional life. This extraordinary achievement is likely unmatched by any other public health endeavor in our nation in the past half century. The achievement has not been shared equally by all members of our society, however. Smoking prevalence is today highly inversely correlated with education, far more so than it was at the time of the 1964 report. In 1966, adults with 9 to 11 years of education had a smoking prevalence (45.5%) only 12 percentage points above that of college graduates (33.5%). In 2011 the gap had grown to 29.2 percentage points: the era of tobacco control has witnessed smoking among college graduates plummet by more than three quarters, to 7.5%, while for those with 9 to 11 years of education, the decrease has been less than one fifth, to 36.7% (K. Asman, Office on Smoking and Health, CDC, written communication, September 23, 2013). As would be expected, given the correlation between education and income, smoking today has a strong inverse relationship with economic status as well.
Among racial/ethnic groups, smoking prevalence varies from a high of 31.5% for American Indians and Alaska Natives to a low of 9.9% among Asian Americans. Whites and Blacks smoke at about the same rate (20.6% and 19.4%, respectively), while Hispanics are much lower (12.9%, reflecting the low rate of smoking among Hispanic women).
Of growing concern is the increasing concentration of smoking among people with mental illness. A CDC study examining data from 2009 to 2011 found that 36% of people with a diagnosable mental illness in the past 12 months were smokers, compared with 21% of individuals not suffering from mental illness. We in tobacco control all too often observe this important characteristic of today's smoking population and then forget about it as we go about our work.
Another source of tobaccorelated disparities is the difference in tobacco control efforts and successes between the developed nations, many of which have matched or exceeded the achievements of the United States, and low- and middle-income countries (LMICs). The major multinational tobacco companies have preyed on LMICs in the past few decades, where the combination of less understanding of the hazards of smoking, growing affluence, and greater governmental susceptibility to corruption makes LMICs the industry's market of the future. The World Health Organization projects that by 2030, more than 80% of the then-expected eight million annual tobacco-produced deaths will occur in LMICs.
As bleak as this situation may sound, recently a large number of LMICs have adopted strong tobacco control policies, motivated in part by the Framework Convention on Tobacco Control (FCTC), the world's first international health treaty, ratified by 177 countries representing 88% of the world's population. Only 19 eligible countries have failed to ratify the treaty, most conspicuously the United States, an irony, disappointment, and indeed embarrassment because in the past our country provided so much global leadership in tobacco control and produced so much of the research that underpins the action requirements of the treaty.
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