Excerpt

In 1964, the Surgeon General released a landmark report on the dangers of smoking. During the intervening 45 years, 29 Surgeon General’s reports have documented the overwhelming and conclusive biologic, epidemiologic, behavioral, and pharmacologic evidence that tobacco use is deadly. Our newest report, How Tobacco Smoke Causes Disease, is a comprehensive, scientific discussion of how mainstream and secondhand smoke exposures damage the human body. Decades of research have enabled scientists to identify the specific mechanisms of smoking-related diseases and to characterize them in great detail. Those biologic processes of cigarette smoke and disease are the focus of this report.

Contents

• Message from Kathleen Sebelius
• Foreword
• Preface
• Acknowledgments
• 1. Introduction, Evaluation of Evidence on Mechanisms of Disease Production, and Summary
  • Introduction
  • Major Conclusions
  • Chapter Conclusions
  • References
• 2. The Changing Cigarette
  • Introduction
  • Cigarette Design Changes over the Years
  • New Cigarette Products
  • Low-Nicotine Cigarettes
  • Cigarette-Like Products
  • Evaluation of New Cigarette Products
  • New Oversight of Tobacco Products
  • Summary
  • Conclusions
  • References
• 3. Chemistry and Toxicology of Cigarette Smoke and Biomarkers of Exposure and Harm
  • Introduction
  • Chemistry
  • Biomarkers
  • Summary
  • Conclusions
  • References
• 4. Nicotine Addiction: Past and Present
  • Introduction
  • Definition of Nicotine Addiction
  • Tobacco Constituents and Pharmacokinetics
  • Components of Nicotine Addiction
  • Pathophysiology of Nicotine Addiction
  • Genetics
  • Prevalence and Trajectory Toward Nicotine Dependence
  • Epidemiology of Tobacco Use and Nicotine Dependence in Adults
  • Trajectory of Recovery or Relapse
  • Evidence Summary
  • Conclusions
  • References
• 5. Cancer
  • Introduction
  • Carcinogen Exposure, Metabolism, and DNA Adducts
  • DNA Repair and Conversion of Adducts to Mutations
  • Gene Mutations in Tobacco-Induced Cancer
  • Loss of Mechanisms for Growth Control
  • Other Aspects
  • Evidence Summary
  • Conclusions
  • References
• 6. Cardiovascular Diseases
  • Introduction
  • Tobacco Use and Cardiovascular Disease
  • Secondhand Tobacco Smoke and Cardiovascular Disease
  • Pathophysiology
  • Hemodynamic Effects
  • Smoking and the Endothelium
  • Thrombogenic Effects
  • Inflammation
  • Smoking and Diabetes
  • Lipid Abnormalities
  • Cardiovascular Biomarkers
  • Smoking Cessation and Cardiovascular Disease
  • Methods to Reduce Exposure
  • Evidence Summary
  • Conclusions
  • References
• 7. Pulmonary Diseases
  • Introduction
  • Smoking and Respiratory Defense Mechanisms
  • Oxidative Stress
  • Oxidative Stress in Chronic Obstructive Pulmonary Disease
  • Genetics of Pulmonary Disease and Susceptibility to Tobacco Smoke
  • Pathogenesis of Emphysema
  • Summary
  • Evidence Summary
  • Conclusions
  • Implications
  • References
• 8. Reproductive and Developmental Effects
  • Introduction
  • Review of Epidemiologic Literature on Smoking
  • Pathophysiological and Cellular and Molecular Mechanisms of Smoking
  • Implications
  • Evidence Summary
  • Conclusions
  • References
• 9. A Vision for the Future
  • The Global Tobacco Epidemic
  • Reducing the Risks from Smoking
  • Ending the Tobacco Epidemic
  • Concluding Remarks
  • Appendix 9.1 Recommendations for Future Research
  • Appendix 9.2 Ending the Tobacco Problem: A Blueprint for the Nation
  • Appendix 9.3 Promoting Healthy Lifestyles: Policy, Program, and Personal Recommendations for Reducing Cancer Risk
  • References
• List of Abbreviations
• Definitions and Alternative Nomenclature of Genetic Symbols Used in This Report

Suggested citation:

U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.

Use of trade names is for identification only and does not constitute endorsement by the U.S. Department of Health and Human Services. Any recommendations expressed by nongovernmental individuals or organizations do not necessarily represent the views or opinions of the U.S. Department of Health and Human Services.