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2011 Johns Hopkins Bloomberg School of Public Health
Jonathan M. Samet, MD, MSDirector, USC Institute for Global Health Professor and Flora L. Thornton Chair, Department of Preventive Medicine Keck School of Medicine
Smoking and Health: An UpdateSmoking and Health: An Update
2011 Johns Hopkins Bloomberg School of Public Health
Global Tobacco EpidemicGlobal Tobacco Epidemic
State of the global tobacco epidemic and an update on the health effects of smoking
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2011 Johns Hopkins Bloomberg School of Public Health
Prevalence of Current Cigarette Smoking
*GATS = Global Adult Tobacco Survey
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2011 Johns Hopkins Bloomberg School of Public Health
The 2010 Report of the U.S. Surgeon General
Reviews mechanisms by which smoking causes disease
Includes findings from human, animal, and laboratory studies
Evidence important for causation, prevention, diagnosis, and treatment
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Text and image source: USDHHS. (2010).
2011 Johns Hopkins Bloomberg School of Public Health
SGR 2010: Major Conclusions
Source: USDHHS. (2010).
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2011 Johns Hopkins Bloomberg School of Public Health
SGR 2010: Summary on Genetics of Nicotine Addiction
Source: USDHHS. (2010).
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2011 Johns Hopkins Bloomberg School of Public Health
Emerging Information on the Health Effects of Smoking
Tuberculosis
Breast cancer
Diabetes mellitus
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2011 Johns Hopkins Bloomberg School of Public Health
Smoking and Tuberculosis
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2011 Johns Hopkins Bloomberg School of Public Health
Smoking and Tuberculosis
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2011 Johns Hopkins Bloomberg School of Public Health
Risk of Latent TB Infection for Smoking vs. Nonsmoking
Image source: (2007). PLoS Med, 4:e20
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2011 Johns Hopkins Bloomberg School of Public Health
Risk of Clinical TB for Current Smoking vs. Nonsmoking
Image source: (2007). PLoS Med, 4:e20
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2011 Johns Hopkins Bloomberg School of Public Health
Risk of TB Mortality for Smoking vs. Nonsmoking
Image source: (2007). PLoS Med, 4:e20
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2011 Johns Hopkins Bloomberg School of Public Health
Smoking and Tuberculosis
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2011 Johns Hopkins Bloomberg School of Public Health
Smoking and Tuberculosis
Mortality risk ratio* (99% CI)
Smoking-attributable
risk
Men 2.3 (2.1-2.6) 38 %
Women 3.0 (2.4-3.9) 9 %
*RR comparing smokers to nonsmokers, adjusted for age, education, and alcohol
Deaths due to tuberculosis among Indian adults ages 30-69 years
Estimated excess smoking-associated deaths among Indian adults in 2010
Number of excess TB deaths
Men 120,000 of 315,000
Women 14,000 of 155,000
Source: Jha et al. (2008). NEJM, 358, 1137-1137.
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2011 Johns Hopkins Bloomberg School of Public Health
Tobacco Smoking/SHS Exposure and Breast Cancer Risk
Source YearStudies
reviewedConclusions
International Agency for Research on Cancer (IARC)
2004
Active smoking:
36 case-control studies, 8 cohort studies, 1 large pooled analysisSecondhand
smoke: 10 case-control studies, 5
cohort studies
Active smoking:There is evidence suggesting lack of carcinogenicity
of tobacco smoking in humans for cancers of the female breast and endometrium.
Secondhand smoke:The collective evidence on breast cancer risk associated with involuntary exposure of never
smokers to tobacco smoke is inconsistent.
U.S. Surgeon General’s Report
200417 case-control
studies, 5 cohort studies
Active smoking:The evidence is suggestive of no causal relationship
between active smoking and breast cancer.
Subgroups of women cannot yet be reliably identified who are at an increased risk of breast cancer because of smoking, compared with the
general population of women.
Whether women who are at a very high risk of breast cancer because of mutations in BRCA1 or
BRCA2 genes can lower their risks by smoking has not been established.
U.S. Surgeon General’s Report
200614 case-control
studies, 7 cohort studies
Secondhand smoke:The evidence is suggestive but not sufficient to
infer a causal relationship between SHS and breast cancer.
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2011 Johns Hopkins Bloomberg School of Public Health
Tobacco Smoking/SHS Exposure and Breast Cancer Risk
Source YearStudies
reviewedConclusions
Cal/EPA 200626 studies
(including 3 meta-analyses)
Secondhand smoke:Human epidemiological studies, supported by the
fact that at least 20 of the chemical constituents of ETS are mammary carcinogens, provide evidence consistent with a causal association between ETS exposure and breast cancer in younger primarily
premenopausal women.
There is little, if any, evidence of an increase in breast cancer risk in older primarily
postmenopausal women.
Canadian Expert Panel on Tobacco Smoke and Breast Cancer
2009
Active smoking:7 reviews and 4 meta-analyses Secondhand
smoke: 5 reviews and 4 meta-
analyses Genetics and
active smoking:3 meta-analyses
Active smoking:Based on the weight of evidence from
epidemiologic and toxicological studies and understanding of
biological mechanisms, the associations between active smoking and both pre- and postmenopausal
breast cancer are consistent with causality.
Secondhand smoke:The association between SHS and breast cancer in
younger, primarily premenopausal women whohave never smoked is consistent with causality. The
evidence is considered insufficient to passjudgment on SHS and postmenopausal breast
cancer.16
2011 Johns Hopkins Bloomberg School of Public Health
Smoking and Diabetes
Image source: Willi et al. (2007). JAMA, 298, 2654-2664.
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2011 Johns Hopkins Bloomberg School of Public Health
Smoking and Diabetes
Image source: Willi et. al. (2007). JAMA, 298, 2654-2664.
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2011 Johns Hopkins Bloomberg School of Public Health
Menthol CigarettesMenthol Cigarettes
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A report of the FDA’s Tobacco Products Scientific Advisory Committee (TPSAC)
2011 Johns Hopkins Bloomberg School of Public Health
Menthol Cigarettes
Menthol is an organic compound (a naturally occurring monocyclic terpene alcohol), either derived from natural sources or synthesized, widely used in consumer and medicinal products
Pharmacologically, menthol in cigarette smoke has a cooling effect that may facilitate deeper inhalation and mask the irritation by nicotine and other smoke components
Menthol is present in most cigarettes in the United States, and in about 30% of cigarettes it is present in high enough concentration to make menthol the characterizing flavor
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2011 Johns Hopkins Bloomberg School of Public Health
Menthol Cigarettes
The FDA is charged with addressing the impact of the use of menthol in cigarettes on the public health Its scientific committee developed a report on this
topic, released in March 2011
Menthol cigarettes are not common worldwide, but products are being developed
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2011 Johns Hopkins Bloomberg School of Public Health
Menthol: Possible Effects on Public Health
Image source: Tobacco Products Scientific Advisory Committee (TPSAC), FDA. 2011
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2011 Johns Hopkins Bloomberg School of Public Health
TPSAC Conclusions:
Based on the conclusions to the nine questions, TPSAC provides the following general conclusions:
Menthol cigarettes have an adverse impact on public
health in the United StatesThere are no public
health benefits of menthol compared to
non-menthol cigarettes
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2011 Johns Hopkins Bloomberg School of Public Health
TPSAC’s Recommendation to FDA
Removal of menthol cigarettes from the marketplace would
benefit public health in the United States
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