Tobacco in Australia Facts & Issues A comprehensive online resource tobaccoinaustralia.org.au Book excerpt List of chapters available at tobaccoinaustralia.org.au Introduction Chapter 1 Trends in the prevalence of smoking Chapter 2 Trends in tobacco consumption Chapter 3 The health effects of active smoking Chapter 4 The health effects of secondhand smoke Chapter 5 Factors influencing the uptake and prevention of smoking Chapter 6 Addiction Chapter 7 Smoking cessation Chapter 8 Tobacco use among Aboriginal peoples and Torres Strait Islanders Chapter 9 Smoking and social disadvantage Chapter 10 The obaccot industry in Australian society Chapter 11 Tobacco advertising and promotion Chapter 12 The construction and labelling of Australian cigarettes Chapter 13 The ricingp and taxation of tobacco products in Australia Chapter 14 Social marketing and public education campaigns Chapter 15 Smokefree environments Chapter 16 Tobacco litigation in Australia Chapter 17 The economics of tobacco control Chapter 18 The WHO Framework Convention on Tobacco Control Appendix 1 Useful weblinks to tobacco resources Tobacco in Australia: Facts and Issues. A comprehensive review of the major issues in smoking and health in Australia, compiled by Cancer Council Victoria. First edition published by ASH (Australia) Limited, Surry Hills, NSW, 1989 Second edition published by the Victorian Smoking and Health Program, Carlton South, Victoria (Quit Victoria), 1995 Third (2008) and fourth (2012) editions, and ongoing updating, published by Cancer Council Victoria in electronic format only. ISBN number: 978-0-947283-76-6 Suggested citation: Scollo, MM and Winstanley, MH. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from www.TobaccoInAustralia.org.au OR <Author(s) of relevant chapter section>, <Name of chapter section> in Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; < date of latest update of relevant chapter section> Available from < url of relevant chapter or section> Tobacco in Australia: Facts and Issues comprises chapters written and reviewed by authors with expertise in each subject area. Tobacco in Australia: Facts and Issues is available online, free of charge. A hard copy version of this publication has not been produced. This work has been produced with the objective of bringing about a reduction in death and disease caused by tobacco use. Much of it has been derived from other published sources and these should be quoted where appropriate. The text may be freely reproduced and figures and graphs (except where reproduced from other sources) may be used, giving appropriate acknowledgement to Cancer Council Victoria. Editors and authors of this work have tried to ensure that the text is free from errors or inconsistencies. However in a resource of this size it is probable that some irregularities remain. Please notify Cancer Council Victoria if you become aware of matters in the text that require correction. Editorial views expressed in Tobacco in Australia: Facts and Issues are those of the authors. Production of editions 2 to 4 of this publication has been funded by the Australian Government Department of Health and Ageing. Ongoing updating is also being funded by the Australian Government Department of Health, with contributions from Cancer Councils in all states and territories. Cancer Council Victoria 615 St Kilda Road Melbourne VIC 3004 Project manager: Elizabeth Greenhalgh, Cancer Council Victoria . Website design: Creative Services, Cancer Council Victoria Tobacco in Australia Facts & Issues A comprehensive online resource tobaccoinaustralia.org.au Chapter 3 The health effects of active smoking Chapter 3: The health effects of active smoking 1 Chapter 3 The health effects of active smoking Margaret Winstanley Table of contents 3.0 Introduction Further updates marked per section 3.1 Smoking and heart disease 3.2 Respiratory diseases 3.3 Smoking and cancer 3.4 Lung cancers 3.5 Other cancers 3.6 Reproductive health 3.7 Pregnancy and smoking 3.8 Child health and maternal smoking before and after birth 3.9 Increased susceptibility to infection in smokers 3.10 Eye diseases 3.11 Dental diseases 3.12 Gastro-intestinal diseases 3.13 Musculoskeletal disease 3.14 Skin 3.15 The impact of smoking on treatment of disease 3.16 Smoking and diabetes Tobacco in Australia: 2 Facts and Issues 3.17 Inflammatory conditions and autoimmune disease 3.18 Other conditions with possible links to smoking 3.19 Smoking and accidents 3.20 Tobacco poisoning 3.21 Health effects for younger smokers 3.22 Poorer quality of life and loss of function 3.23 Smoking, dementia and cognitive decline 3.24 Genetic influences on tobacco-caused disease 3.25 Smoking compared with or in combination with other pollutants 3.26 Health effects of brands of tobacco products which claim or imply, delivery of lower levels of tar, nicotine and carbon monoxide 3.27 Health effects of smoking tobacco in other forms 3.28 Health ‘benefits’ of smoking? 3.29 Smoking and body weight 3.30 Deaths attributable to tobacco by disease category 3.31 Morbidity and mortality due to tobacco-caused disease and socio-economic disadvantage 3.32 Health effects of smoking other substances 3.33 Health effects of chewing tobacco, and of other smokeless tobacco products 3.34 Public perceptions of tobacco as a drug, and knowledge and beliefs about the health consequences of smoking 3.35 Health and other benefits of quitting 3.36 The global tobacco pandemic Chapter 3: Health Effects » 3.0 Introduction 3.0 Introduction Last updated: March 2015 Suggested citation: Winstanley, MH & Greenhalgh, EM. 3.0 Introduction. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2015. Available from http://www.tobaccoinaustralia.org.au/chapter-3-health-effects/3-0-background Smoking of tobacco as we know it today, in the form of manufactured or 'factory-made' cigarettes, became common in Australia in the late 1800s. Pipe and cigar smoking was already widespread among men, but the convenience and ready availability of the cigarette soon made it a popular alternative.1 Manufactured cigarettes were supplied to Australians and their allies in the trenches of World War I,1 and by the end of World War II, nearly three quarters of Australian men and one quarter of women were smokers, the majority using cigarettes (see also Chapter 1, Section 1.1). Similar changes in smoking behaviour had occurred in Western Europe and North America, and with them, a marked escalation in lung cancer death rates and the growing suspicion that cigarette use was implicated in this trend. By 1950 several studies had been published in the medical literature2 and the finding that cigarette smoking and lung cancer appeared to be causally linked was reported.3,4 Several series of authoritative, landmark reports have since been published by national and international agencies,i documenting the damaging effects of smoking and calling for action to help halt the smoking epidemic. Of these, the most regular series has been that issued by the Office of the US Surgeon General. Since 1964, comprehensive and rigorous reports on various aspects of tobacco and health have been issued by the US Surgeon General, repeating the conclusion that smoking is "the single greatest cause of avoidable morbidity and mortality in the United States," and never finding reason to reverse any earlier conclusions of causality.5 The 2004 report of the US Surgeon General, The Health Consequences of Smoking, published the following four major conclusions:6 1. Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers in general. 2. Quitting smoking has immediate as well as long-term benefits, reducing risks for diseases caused by smoking and improving health in general. 3. Smoking cigarettes with lower machine-measured yields of tar and nicotine provides no clear benefit to health. 4. The list of diseases caused by smoking has been expanded to include abdominal aortic aneurysm, acute myeloid leukaemia, cataract, cervical cancer, kidney cancer, pancreatic cancer, pneumonia, periodontitis and stomach cancer. In addition, the 2014 report of the US Surgeon General, The Health Consequences of Smoking – 50 Years of Progress, published these major conclusions in regard to the health effects of smoking:7 1. The century-long epidemic of cigarette smoking has caused an enormous avoidable public health tragedy. Since the first Surgeon General’s report in 1964 more than 20 million premature deaths [in the U.S] can be attributed to cigarette smoking. 2. The tobacco epidemic was initiated and has been sustained by the aggressive strategies of the tobacco industry, which has deliberately misled the public on the risks of smoking cigarettes. 3. Even 50 years after the first Surgeon General’s report, research continues to newly identify diseases caused by smoking, including such common diseases as diabetes mellitus, rheumatoid arthritis, and colorectal cancer. 4. In addition to causing multiple diseases, cigarette smoking has many other adverse effects on the body, such as causing inflammation and impairing immune function. 5. The burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products; rapid elimination of their use will dramatically reduce this burden. 3.0.1 Defining causality The US Surgeon General's reports have provided a detailed review of definitions of causality of disease, and how measures of causality may be applied. Causality is determined by evaluating the range of available evidence and considering it against well-established criteria. The more that an observed association fulfils the criteria, the more likely it is that a causal relationship can be inferred. These criteria are outlined in the US Surgeon General's Report for 2004:8 Consistency: This refers to the persistence of the finding of an association between exposure and outcome in a number of methodologically valid studies undertaken in a range of settings.