The Health Consequences of SMOKING 1975 U.S.DEPARTMENTOFHEALTH,EDUCATION,ANDWELFARE PUBLIC HEALTH SERVICE Center for Disease Control Atlanta, Georgia 30333 July 23, 197.5 Honorable Carl Albert Speaker of the House of Representatives Washington, D.C. 205 15 Dear Mr. Speaker: As required by Section 8(a) of the Public Health Cigarette Smoking Act of 1969, enclosed is the 1975 report on the health consequences of smoking. The recent scientific information reviewed in the report reaffirms the previous evidence that cigarette smoking is a serious public health problem. It is a major contributor to the development of cardiovascular disease, various types of cancer, and respiratory disease. Its toll in illness and premature death is needless and preventable. The recent literature further refines our understanding of the mechanisms by which smoking influences these disease states. Under this Act, I am also required to submit to you such recommendations for legislation as I deem appropriate. This Department has previously taken a position in support of legislation which would authorize the regulation of cigarettes through the power to ban the manufacture and sale of cigarettes exceeding what are considered excessively hazardous levels of tar, nicotine, carbon monoxide, and other ingredients shown to be injurious to health. The extent to which the cigarette smoking public has over the years spontaneously moved towards this kind of self protection suggests that it would welcome the additional protection such legislation would bring. This Department, therefore, recommends to the Congress that it consider legislation providing this Department or some other appropriate agency with the authority to set maximum permissible levels of hazardous ingredients in cigarettes. With kindest regards. Sincerely, Caspar W. Weinberger Secretary Enclosure For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 - PREFACE Each year the Public Health Service reviews the scientific data related to the health consequences of smoking and submits its review to the Congress. This report, the ninth in the series. summarizes recent research in four major areas: cardiovascular disease. cancer. respiratory disease, and the effects of smoking on the nonsmoker , who shares the environment of those who smoke. As has been the case with each of the previous reports in the series, the research summarized herein further confirms the relation- ships between cigarette smoking and disease and premature death and refines our understanding of the mechanisms underlying these relationships. Cigarette smoking remains the largest single unnecessary and preventable cause of illness and early death. In the eleven years since the report of the Advisory Committee to the Surgeon General in 1964, there has been progress toward reducing this toll. Millions of Americans have stopped smoking cigarettes, and millions more have not taken up smoking. Even for those who continue to smoke, there has been a striking reduction in the "tar" and nicotine content of cigarettes used by the vast majority. At the same time, however, counter-balancing these gains. there has been an increase in cigarette smoking by women and young people. especially teen-age girls. To eliminate the needless death and disability attributable to cigarette smoking, the Public Health Service remains committed today, as in the past, to increasing the knowledge about the health consequences of smoking and to educating the American people as to the nature and extent of the hazards of smoking. This is a task, not for government alone, but for the great institutions of society as a whole ~ the family, the schools, the health care system. Through concerted effort, a climate of respect for our own health and that of others can be created. Such a climate must certainly be conducive to reducing and eventually eliminating the needless burden of disease and premature death imposed by cigarette smoking. +cfii%dLe Assistallt Secretary for Health June 1975 . 111 TABLE OF CONTENTS Page Preface _............................................. iii Table of Contents . . . . . . . . . . . . . . . v Reparation of the Report and Acknowledgments . . . . . . . . . vii INTRODUCTION: Overview - The Health Consequences of Smoking . . . . . . . . . . . . . . . . 1 CHAPTER 1. Cardiovascular Diseases . . . . _ . . . . . . . . 9 CHAPTER 2. CHAPTER 3. CHAPTER 4. Cancer ................................ 39 Non-Neoplastic Bronchopulmonary Diseases ...... 57 Involuntary Smoking ...................... 83 Index1975 ......................................... ..I1 3 Index (Cumulative 1964-l 975) .............................. 118 PREPARATION OF THE REPORT AND ACKNOWLEDGMENTS Previous Reports Reviews of the scientific evidence linking smoking to health effects began in 1964 with Smokilq alrtl Health. Report of the Advisor). Committee to the Swgeorl General of` the Public Health Senvice or as subsequently referred to "the Surgeon General's Report." After this report. Public Law 89-92 was passed requiring supplemental reports to Congress on this subject. In compliance. three reports were submitted: 1. The Health Comequences of Smoking, A Public Health Service Review: I96 7. 2. The Ilealth Comequeuces of S~noki~~g. I965 Supplement to the I96 7 PHS Review. 3. The Health Corlseqnerlces of Smoking, I969 Srtpplemelzt to the 196 7 PHS Review. In April 1970. Public Law 91-122 amended the previous law and called for an updated report on the health effects of smoking no later than January 1. 1971, with annual reports thereafter. The Healtll Conse~lrellct~s of S~lol