总医官报告：吸烟与多数器官的疾病均有关

自从里程碑式的1964年总医官(Surgeon General)报告《吸烟与健康》发布以来，美国的吸烟率已大幅降低，但吸烟仍是美国可预防性疾病和死亡的首要原因，而且与多数器官系统的更多疾病存在因果关系。

题为《吸烟的健康后果——50年来的进步》的新的总医官报告于1月17日在白宫发布，其目的是用医学证据进一步推动联邦政府采取禁烟措施。


Kathleen Sebelius

这份报告称，吸烟与2型糖尿病、类风湿性关节炎、异位妊娠和勃起功能障碍均存在因果关联。吸二手烟已被证实与多种癌症、呼吸疾病和心血管疾病存在因果关联，并且对儿童健康有负面影响。

此外，这份长达980页的报告还明确指出，吸二手烟是卒中的诱因之一，并且吸烟会使癌症患者和癌症存活者的死亡风险增加。

另一项发现是：今天的吸烟者比1964年时的吸烟者具有更高的肺癌风险，原因是如今在香烟中加入了更多的化学添加剂。

今天的女性吸烟者具有与男性相当的肺癌死亡风险，并且死于冠心病的相对风险高于男性。由于吸烟，如今死于慢性阻塞性肺病(COPD)的女性数量已经超过了男性。

目前，美国联邦政府正在采取新的措施以阻止儿童吸烟。健康与人类服务部部长Kathleen Sebelius在声明中指出：“当下，我们正在呼吁美国人加入阻止儿童吸烟的队伍，以使孩子们成为无烟的一代。这不是联邦政府能够独力完成的事业，我们需要与工商界、地方官员、学校和大学、医学界、宗教界以及社区中的积极分子携手，使下一代远离烟草的毒害。”


代理总医官Boris Lushniak

这份报告显示，年轻人吸烟率在1997~2011年期间降低了50%，但是每天仍有3,200名18岁以下儿童开始吸烟，同时另有2,100名年轻人成为每天吸烟者。这份报告认为，人们对吸烟的兴趣主要归咎于烟草行业，后者采取的“积极策略”在吸烟危害方面刻意误导公众。

代理总医官Boris Lushniak指出，在教育程度和收入较低的人群中、在精神病患者中以及在同性恋、双性恋、变性人中，吸烟率不成比例地偏高。

Lushniak博士及参与白宫发布会的其他官员呼吁加大控烟力度，包括制定更严格的监管政策。美国食品药品管理局(FDA)已通过2009年《防止吸烟与控制烟草法案》被赋予了监管烟草的权力。


Margaret Hamburg博士

FDA局长Margaret Hamburg在声明中表示，FDA已做好了采取行动的准备。“FDA正在资助和开展针对烟草产品的监管科学研究，执行旨在减少年轻人接触和迷上烟草产品的法律，以及准备启动一项空前的全国公众教育计划以阻止年轻人使用烟草。”

疾病预防控制中心主任Thomas R. Frieden博士指出，美国政府基于1998年签署的烟草企业主和解协议，每年获得大约80美元/人的烟草税和付款，而与此同时，每年仅花费1.5美元/人用于控烟。CDC已开始敦促政府将控烟费用增至12美元/人。

Lushniak博士指出，对于目前吸烟者和将要吸烟者而言时间不等人。“通过缓慢而稳健的控烟策略终结烟草流行的做法，对于他们已经来不及了。”

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By: ALICIA AULT, Cardiology News Digital Network

While smoking rates have dropped precipitously since the landmark 1964 Surgeon General’s report, "Smoking and Health," smoking is still the leading cause of preventable disease and death in the United States and is now causally linked to additional diseases and conditions across most organ systems.

A new Surgeon General's report, "The Health Consequences of Smoking – 50 Years of Progress," released at a White House event Jan. 17, synthesizes original and review evidence in an effort to further federal antismoking efforts.

The report causally links cigarette smoking to type 2 diabetes, rheumatoid arthritis, ectopic pregnancy, and erectile dysfunction. Secondhand smoke is now causally linked to cancers, respiratory diseases, and cardiovascular diseases, as well as adverse effects on the health of children, the authors wrote.

In addition, the 980-page report establishes that secondhand smoke is a cause of stroke, and that smoking increases the risk of dying in cancer patients and cancer survivors.

Another finding: Cigarette smokers today have a higher risk of lung cancer than did those who smoked in 1964, because of the higher number of chemical additives now used.

Women smokers now have the same risk of death from lung cancer as that of men and a higher relative risk of dying from coronary heart disease than that of men. Because of smoking, the number of women dying from chronic obstructive pulmonary disease (COPD) is now higher than in men.

With this report, the federal government is launching a new effort to prevent children from using tobacco.

"Today, we’re asking Americans to join a sustained effort to make the next generation a tobacco-free generation," Health and Human Services Secretary Kathleen Sebelius said in a statement. "This is not something the federal government can do alone. We need to partner with the business community, local elected officials, schools and universities, the medical community, the faith community, and committed citizens in communities across the country to make the next generation tobacco free."

The report finds that youth smoking rates declined by 50% between 1997 and 2011, but 3,200 children under age 18 still start smoking each day, and an additional 2,100 youth and young adults become daily smokers. The report places most of the blame for continued interest in smoking on the tobacco industry, saying it has used "aggressive strategies" to deliberately mislead the public about the harms of smoking.

Acting Surgeon General Boris Lushniak noted that smoking rates are disproportionately higher among people with less education and lower incomes, among the mentally ill, and among gay, lesbian, bisexual, and transgender individuals.

Dr. Lushniak and other officials at the White House event called for greater tobacco control efforts, including stricter regulation. The Food and Drug Administration was given the power to regulate tobacco through the 2009 Family Smoking Prevention and Tobacco Control Act.

FDA Commissioner Margaret Hamburg said that the agency is ready to take action.

"The FDA is funding and conducting regulatory science research on tobacco products, enforcing the laws that reduce the access and attractiveness of tobacco products to young people, and preparing to launch an unprecedented national public education campaign to prevent youth tobacco use," Dr. Hamburg said in a statement.

Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, noted that while states collect some $80 per person a year in tobacco taxes and payments from the 1998 tobacco industry master settlement agreement, they spend an average of $1.50 per person on control.

The CDC has urged states to spend $12 per person on control, Dr. Frieden said.

Dr. Lushniak noted that for current and about-to-start smokers, "the clock is ticking – they can’t wait for slow and steady progress to end the epidemic. Enough is enough."