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Massachusetts Medical Society's Physician Focus

January 2014

Smoking, Tobacco, and Health


  • Fifty years ago, the U.S. Surgeon General issued the nation’s first comprehensive report on smoking and public health.

  • Despite progress over five decades in reducing its use, tobacco is still the leading cause of preventable disease and premature death in the U.S.

  • Smoking and tobacco are linked to a multitude of health problems, including heart and respiratory diseases, cancer, and diabetes.

  • Every day, more than 1,000 youth under 18 become daily cigarette smokers, and among high-school seniors, one out of four is a regular cigarette smoker.

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In 1964, U.S. Surgeon General Rear Admiral Luther Terry, M.D. issued the nation’s first comprehensive report on the dangers of tobacco. The landmark document concluded, in understated fashion, “Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.”

The report marked the start of the nation’s public health struggle against tobacco and smoking, and although the last five decades have seen much progress in reducing tobacco use among all ages, smoking and tobacco remain at the top of the list of public health concerns. “We’re fifty years down the line,” says Alan Woodward, M.D., chairman of Tobacco Free Mass and a member of the Massachusetts Public Health Council, “and still these products are the number one cause of preventable death and chronic illness in this country.”

Dr. Woodward was joined by Douglas Ziedonis, M.D., M.P.H., Professor and Chair of the Department of Psychiatry at the University of Massachusetts Medical School and UMass Memorial Health Care in Worcester, as guests on the January 2014 episode of Physician Focus to review the progress made against smoking and tobacco since the Surgeon General’s first report. Hosting this edition is James Kenealy, M.D.

The dangers of tobacco use remain clear and convincing, says Dr. Ziedonis. The biggest health impact is on the heart, but smoking is also linked to numerous other conditions, such as emphysema, cancer, diabetes, poor wound healing, impotence and even wrinkles and bad breath – the last two perhaps not life-threatening, but certainly capable of diminishing a person’s appearance and desirability.

Even with all those negative effects, Dr. Ziedonis, whose specialty is addiction psychiatry, views tobacco first as an addiction. “Nicotine affects the brain in certain areas,” he says, “and is clearly an addictive substance delivered in a very dangerous format with tobacco. You’re breathing it in, getting all the toxins and carcinogens.”

Indeed, cigarette smoke is estimated to have some 700 different toxins and carcinogens, as well as additives put in by cigarette manufacturers that can make the addiction stronger.

Young people and individuals with mental illness are of particular concern to physicians, as they are two of the most susceptible groups to tobacco use.

Ninety percent of smokers start before they’re 18 years of age, and 99 percent start before 26 – ages when the adolescent brain is much more susceptible to addiction. The figures for those with mental illness are striking: 44 percent of all cigarettes consumed in the U.S. are by people with mental health problems.

Today, nearly one in five Americans still smoke, and other tobacco products like smokeless tobacco, flavored cigars, and electronic cigarettes pose new challenges, especially for young people.

As a result, public health officials are focusing current anti-tobacco efforts on the young, with such efforts as a movement to make all colleges in the state smoke-free. “It’s time we redouble our efforts,” Dr. Woodward notes, “and try to prevent another generation from becoming tobacco and nicotine addicted.”

The physicians remain optimistic about such efforts. They point to the many successful actions already taken to curb tobacco – no smoking laws and regulations for public and private venues, higher tobacco taxes, and the various aids available to help people quit.

And though today’s target may be youth, the physicians have not lost sight of others. “Even if you’re in your ‘60s or 70s’ and you quit,” Dr. Ziedonis says, “you’ll be able to lengthen your life and improve your health.”

“Fifty years ago we identified the problem,” he says, “but didn’t identify solutions. Since the Surgeon General’s report, we have developed a lot of treatments. Seven medications are now available, and there are a variety of ways people can quit. It’s never too late.”

View the complete video above, including additional conversation about how tobacco and smoking become an addiction, the challenges that electronic cigarettes and smokeless tobacco products present, how the tobacco industry markets its products, messages for young people to prevent them from smoking, and resources to help people quit.

MMS/Richard Gulla

Become An Ex

Tobacco Free Kids

Tobacco Free Mass.

U.S. Centers for Disease Control and Prevention

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"Youth and Tobacco" PSA

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"Resources for Quitting" PSA

From left, James Kenealy, M.D.; Douglas Ziedonis, M.D., M.P.H.; Alan Woodward, M.D.
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