Researchers at the Yale University School of Public Health, New Haven, Connecticut estimate that tobacco control in the United States since 1964 has been associated with the avoidance of an estimated 8 million premature smoking-attributable deaths, with the beneficiaries of these avoided early deaths having gained, on average, nearly 2 decades of life. In their study, which was designed to model reductions in smoking-related mortality associated with the implementation of tobacco control since 1964, the authors present data confirming the results, which are published in the January 8, 2014 issue of JAMA the Journal of the American Medical Association. The authors of the study add that smoking-attributable death occurred in approximately 17.7 million people during this time period and that efforts must continue to reduce the effect of smoking on the nation’s death toll. [1]

January 2014 marks the 50th anniversary of the first surgeon general’s report on smoking and health. The report inaugurated efforts to reduce cigarette smoking and its effects on health. Those efforts by governments, voluntary organizations, and the private sector education on smoking dangers, increases in cigarette taxes, smoke-free air laws, media campaigns, marketing, and sales restrictions, lawsuits, and cessation treatment programs have comprised the nation’s tobacco control efforts, according to the authors of the study. [2]

Fifty years ago this week, Luther Terry, then surgeon general of the United States, convened a press conference to release the first surgeon general’s report Smoking and Health. [3] That report, based on review of an estimated 7,000 documents, suggested that ‘cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking outweighs all other factors, and the risk of developing lung cancer increases with the duration of smoking and number of cigarettes smoked per day and diminishes by discontinuing smoking.'[3]


Tobacco control has made a unique and substantial contribution to public health over the past half-century. This study provides a quantitative perspective on the magnitude of that contribution.


Smoking-related mortality
Theodore R. Holford, Ph.D., Susan Dwight Bliss Professor of Epidemiology & Public Health (Biostatistics) at the Yale University School of Public Health, New Haven, Connecticut, and colleagues conducted a study to model reductions in smoking-related mortality associated with the implementation of tobacco control since 1964. Smoking histories for individual birth cohorts that actually occurred and under likely scenarios had tobacco control never emerged were estimated. National mortality rates and mortality rate ratio estimates from analytical studies of the effect of smoking on mortality yielded death rates by smoking status. Actual smoking-related mortality from 1964 through 2012 was compared with estimated mortality under no tobacco control. National Health Interview Surveys yielded cigarette smoking histories for the U.S. adult population in 1964-2012.

Theodore R. Holford, Ph.D., Susan Dwight Bliss Professor of Epidemiology & Public Health (Biostatistics).

8 million lives saved
The model estimated that a total of 17.7 million smoking-attributable deaths occurred between 1964 and 2012. Overall, an estimated reduction of 8.0 million premature smoking-attributable deaths (or ‘lives’ saved) was associated with tobacco control during this time period (5.3 million men and 2.7 million women). More than half of these, 4.4 million, occurred before age 65 years. The estimated number of lives saved each year has increased steadily over time.

From 1964-2012, it is estimated that overall, a gain of 157 million years of life was associated with tobacco control, 111 million for men and 46 million for women. This suggests that individuals who avoided a premature smoking-related death gained 19.6 years of life on average (157 million years divided by 8.0 million lives saved), Holford noted.

Increasing life expectancy
For the population as a whole, life expectancy for men at age 40 years has increased by 7.8 years. Without tobacco control, the estimated increase would have been 5.5 years. ?Hence, 2.3 years or 30% of improved life expectancy for men is projected to be associated with tobacco control. In women, life expectancy at age 40 years increased 5.4 years, but without tobacco control, it would have been projected to increase by only 3.8 years. Tobacco control appears to be associated with 1.6 years of improvement in life expectancy for women or 29% of the gain.

“Tobacco control has made a unique and substantial contribution to public health over the past half-century. This study provides a quantitative perspective to the magnitude of that contribution,” Holford confirmed.

Reducing premature death
“Despite the success of tobacco control efforts in reducing premature deaths in the United States, smoking remains a significant public health problem,” Holford further noted.

“Today, a half-century after the surgeon general’s first pronouncement on the toll that smoking exacts from U.S. society, nearly a fifth of U.S. adults continue to smoke, and smoking continues to claim hundreds of thousands of lives annually. No other behavior comes close to contributing so heavily to the nation’s mortality burden. Tobacco control has been a great public health success story but requires continued efforts to eliminate tobacco-related morbidity and mortality.” [1][4][5]

Photo: Theodore R. Holford, Ph.D., Susan Dwight Bliss Professor of Epidemiology & Public Health (Biostatistics). Photo Courtesy: Yale University School of Public Health, New Haven, Connecticut.

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