Smoking and Health: An Update

1. Smoking and Health: An Update Jonathan M. Samet, MD, MS Director, USC Institute for Global Health Professor and Flora L. Thornton Chair, Department of Preventive Medicine Keck School of Medicine

2. Global Tobacco Epidemic • State of the global tobacco epidemic and an update on the health effects of smoking

3. Prevalence of Current Cigarette Smoking *GATS = Global Adult Tobacco Survey

4. The 2010 Report of the U.S. Surgeon General • Reviews mechanisms by which smoking causes disease • Includes findings from human, animal, and laboratory studies • Evidence important for causation, prevention, diagnosis, and treatment Text and image source: USDHHS. (2010).

5. SGR 2010: Major Conclusions Source: USDHHS. (2010).

6. SGR 2010: Summary on Genetics of Nicotine Addiction Source: USDHHS. (2010).

7. Emerging Information on the Health Effects of Smoking • Tuberculosis • Breast cancer • Diabetes mellitus

8. Smoking and Tuberculosis

9. Smoking and Tuberculosis

10. Risk of Latent TB Infection for Smoking vs. Nonsmoking Image source: (2007). PLoS Med, 4:e20

11. Risk of Clinical TB for Current Smoking vs. Nonsmoking Image source: (2007). PLoS Med, 4:e20

12. Risk of TB Mortality for Smoking vs. Nonsmoking Image source: (2007). PLoS Med, 4:e20

13. Smoking and Tuberculosis

14. Smoking and Tuberculosis Deaths due to tuberculosis among Indian adults ages 30-69 years Estimated excess smoking-associated deaths among Indian adults in 2010 Source: Jha et al. (2008). NEJM, 358, 1137-1137.

15. Tobacco Smoking/SHS Exposure and Breast Cancer Risk

16. Tobacco Smoking/SHS Exposure and Breast Cancer Risk

17. Smoking and Diabetes Image source: Willi et al. (2007). JAMA, 298, 2654-2664.

18. Smoking and Diabetes Image source: Willi et. al. (2007). JAMA, 298, 2654-2664.

19. Menthol Cigarettes • A report of the FDA’s Tobacco Products Scientific Advisory Committee (TPSAC)

20. Menthol Cigarettes • Menthol is an organic compound (a naturally occurring monocyclic terpene alcohol), either derived from natural sources or synthesized, widely used in consumer and medicinal products • Pharmacologically, menthol in cigarette smoke has a cooling effect that may facilitate deeper inhalation and mask the irritation by nicotine and other smoke components • Menthol is present in most cigarettes in the United States, and in about 30% of cigarettes it is present in high enough concentration to make menthol the characterizing flavor

21. Menthol Cigarettes • The FDA is charged with addressing the impact of the use of menthol in cigarettes on the public health • Its scientific committee developed a report on this topic, released in March 2011 • Menthol cigarettes are not common worldwide, but products are being developed

22. Menthol: Possible Effects on Public Health Image source: Tobacco Products Scientific Advisory Committee (TPSAC), FDA. 2011

23. TPSAC Conclusions: • Based on the conclusions to the nine questions, TPSAC provides the following general conclusions: Menthol cigarettes have an adverse impact on public health in the United States There are no public health benefits of menthol compared to non-menthol cigarettes

24. TPSAC’s Recommendation to FDA Removal of menthol cigarettes from the marketplace would benefit public health in the United States