This report considers the biological and behavioral mechanisms that may underlie the pathogenicity of tobacco smoke. Many Surgeon General's reports have considered research findings on mechanisms in assessing the biological plausibility of associations observed in epidemiologic studies. Mechanisms of disease are important because they may provide plausibility, which is one of the guideline criteria for assessing evidence on causation. This report specifically reviews the evidence on the potential mechanisms by which smoking causes diseases and considers whether a mechanism is likely to be operative in the production of human disease by tobacco smoke. This evidence is relevant to understanding how smoking causes disease, to identifying those who may be particularly susceptible, and to assessing the potential risks of tobacco products.

This Surgeon General's report returns to the topic of the health effects of involuntary exposure to tobacco smoke. The last comprehensive review of this evidence by the Department of Health and Human Services (DHHS) was in the 1986 Surgeon General's report, The Health Consequences of Involuntary Smoking, published 20 years ago this year. This new report updates the evidence of the harmful effects of involuntary exposure to tobacco smoke. This large body of research findings is captured in an accompanying dynamic database that profiles key epidemiologic findings, and allows the evidence on health effects of exposure to tobacco smoke to be synthesized and updated (following the format of the 2004 report, The Health Consequences of Smoking). The database enables users to explore the data and studies supporting the conclusions in the report. The database is available on the Web site of the Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/tobacco.

People have always smoked, and they probably always will. Every culture in recorded history has smoked something, whether for pleasure or relief, whether as part of an elaborate religious ritual or merely to strike a pose. This is the first truly comprehensive history of smoking, describinbg all of its forms, practices, paraphernalia and materials, in cultures, locations and times throughout the world.

Tobacco use by adolescents and young adults poses serious concerns. Nearly all adults who have ever smoked daily first tried a cigarette before 26 years of age. Current cigarette use among adults is highest among persons aged 21 to 25 years. The parts of the brain most responsible for cognitive and psychosocial maturity continue to develop and change through young adulthood, and adolescent brains are uniquely vulnerable to the effects of nicotine. At the request of the U.S. Food and Drug Administration, Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products considers the likely public health impact of raising the minimum age for purchasing tobacco products. The report reviews the existing literature on tobacco use patterns, developmental biology and psychology, health effects of tobacco use, and the current landscape regarding youth access laws, including minimum age laws and their enforcement. Based on this literature, the report makes conclusions about the likely effect of raising the minimum age to 19, 21, and 25 years on tobacco use initiation. The report also quantifies the accompanying public health outcomes based on findings from two tobacco use simulation models. According to the report, raising the minimum age of legal access to tobacco products, particularly to ages 21 and 25, will lead to substantial reductions in tobacco use, improve the health of Americans across the lifespan, and save lives. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products will be a valuable reference for federal policy makers and state and local health departments and legislators.

This booklet for schools, medical personnel, and parents contains highlights from the 2012 Surgeon General's report on tobacco use among youth and teens (ages 12 through 17) and young adults (ages 18 through 25). The report details the causes and the consequences of tobacco use among youth and young adults by focusing on the social, environmental, advertising, and marketing influences that encourage youth and young adults to initiate and sustain tobacco use. This is the first time tobacco data on young adults as a discrete population have been explored in detail. The report also highlights successful strategies to prevent young people from using tobacco.

What does a pack of cigarettes cost a smoker, the smoker's family, and society? This longitudinal study on the private and social costs of smoking calculates that the cost of smoking to a 24-year-old woman smoker is $86,000 over a lifetime; for a 24-year-old male smoker the cost is $183,000. The total social cost of smoking over a lifetime—including both private costs to the smoker and costs imposed on others (including second-hand smoke and costs of Medicare, Medicaid, and Social Security)—comes to $106,000 for a woman and $220,000 for a man. The cost per pack over a lifetime of smoking: almost $40.00. The first study to quantify the cost of smoking in this way, or in such depth, this accessible book not only adds a weapon to the arsenal of antismoking messages but also provides a framework for assessment that can be applied to other health behaviors. The findings on the effects of smoking on Medicare and Medicaid will be surprising and perhaps controversial, for the authors estimate the costs to be much lower than the damage awards being paid to 46 states as a result of the 1998 Master Settlement Agreement.

If you smoke and are unable or unwilling to quit, this approach can save your life. The book, For Smokers Only: How Smokeless Tobacco Can Save Your Life, provides concrete facts and valuable advice on a revolutionary quit-smoking strategy that is based on scientific research and common sense. Itis written by Dr. Brad Rodu, a leading authority on tobacco harm reduction, and a professor and senior scientist at the University of Alabama/Birmingham Comprehensive Cancer Center. Dr. Roduis stop-smoking strategy is based on three simple facts: 1. Smokers are addicted to nicotine, but nicotine does not cause cancer, heart attacks or emphysema. Those illnesses are caused by the other 3000 products of tobacco combustion. 2. Smokeless tobacco satisfies nicotine craving, but smokeless is 98% safer than smoking. 3. Todayis smokeless, spitless tobacco products can be used invisibly anytime, anywhere, much like a breath mint. "Please surf this site for lots of useful, factual information that can save your life, and the lives of your friends and loved ones." -- Dr. Brad Rodu"

The invention of mass marketing led to cigarettes being emblazoned in advertising and film, deeply tied to modern notions of glamour and sex appeal. It is hard to find a photo of Humphrey Bogart or Lauren Bacall without a cigarette. No product has been so heavily promoted or has become so deeply entrenched in American consciousness. And no product has received such sustained scientific scrutiny. The development of new medical knowledge demonstrating the dire harms of smoking ultimately shaped the evolution of evidence-based medicine. In response, the tobacco industry engineered a campaign of scientific disinformation seeking to delay, disrupt, and suppress these studies. Using a massive archive of previously secret documents, historian Allan Brandt shows how the industry pioneered these campaigns, particularly using special interest lobbying and largesse to elude regulation. But even as the cultural dominance of the cigarette has waned and consumption has fallen dramatically in the U.S., Big Tobacco remains securely positioned to expand into new global markets. The implications for the future are vast: 100 million people died of smoking-related diseases in the 20th century; in the next 100 years, we expect 1 billion deaths worldwide.

Cigarette smoking is one of the most significant preventable causes of death and illness in the world. Given the wide-ranging effects smoking has on many disease processes, it is essential that clinicians understand: • the short- and long-term effects of smoking on the body • the benefits of smoking cessation • why smokers find it difficult to stop • the role of clinicians in promoting and supporting smoking cessation • the treatments available to help smokers overcome their addiction. 'Fast Facts: Smoking Cessation' meets these needs: here, in one place, you will find all the information you need on smoking, tobacco addiction and how best to treat the addiction. Ultimately, the best reason for reading this book is to help your patients who smoke to change their behavior for the better and sustainably. Every GP and support clinic will benefit from this edition, filled with tips, advice and treatment aids for the clinical team. Contents: • Cigarettes as a nicotine delivery system • Smoking patterns • Social, psychological and economic influences on smoking • Effects of smoking and smoking cessation • Addiction to cigarettes • The clinician and smoking • Treatments to aid smoking cessation • Future trends

Over 1,100 delegates from a hundred countries attended the 9th World Conference onTobaccoandHealth. Afterfivedaysofdebate, severalimportantresolutionswereadopted unanimously and will be landmarks in the fight against tobacco. This great success is due to three facts which emerged from the discussions: 1. Itappears clearlynowthattherisksassociated withtobaccoaremuchgreaterthan previously assumed. Out of two regular smokers, one will die from a tobacco­ related disease. 2. Reducing tobacco consumption can be achieved but the data collected in several countriesshowthatitrequiresaglobalstrategy.Thisstrategywasmuchdebatedduring theconference. Theresolutionsadoptedemphasizetheagreementofthedelegateson themainpoints. Actionto fight thegrowingepidemicoftobacco-attributabledisease and death involves convincing the general public, the medical community and decision-makers ofthe need to act for tobacco control. The most efficient tools for helping individuals never to start or successfully to stop using tobacco should be developed; effective tobacco control endeavors are required to counteractthe actions ofthe powerful and influential tobacco manufacturers. With the help and under the aegis ofWHO, DICC, IUATLD, ISFC, IOCD, and IUHPE, an international alliance for health and against tobacco shouldunite all those who are engaged in this fight.