September 20th

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1 SMOKING AND LUNG CANCER Jean-François Boivin September 20th

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9 ZEITSCHRIFT FÜR KREBSFORSCHUNG 1939; 49:

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19 Relative risk = 249/ =

20 131/017= / 0.17 = / 0.17 =

21 Risk difference = = per 1000 men / year 21

22 Risk difference = = per 1000 men / year = = 2.16 per 1000 men / year = = 4.00 per 1000 men / year 22

23 Biases Confounding Measurement Losses to follow-up Generalizability 23

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27 By the mid-1920s smoking had become commonplace in the United States and cigarette tobacco was the most popular form of tobacco consumption. At the same time women had just won the right to vote, widows were succeeding their husbands as governors of such states as Texas and Wyoming, and more were attending college and entering the workforce. While women seemed to be making great strides in certain areas, socially they still were not able to achieve the same equality as their male counterparts. Women were only permitted to smoke in the privacy of their own homes. Public opinion and certain legislation at the time did not permit women to smoke in public, and in 1922 a woman from New York City was arrested for lighting a cigarette on the street. George Washington Hill, president of the American Tobacco Company and an eccentric businessman, recognized that an important part of fhis market was not tbeing tapped dinto. Hill believed that cigarette sales would soar if he could entice more women to smoke in public. Mrs. Taylor-Scott Hardin parades down New York's Fifth Avenue with her husband while smoking "torches of freedom,"a gesture of protest for absolute equality with men. 27

28 In 1928 Hill hired Bernays to expand the sales of his Lucky Strike cigarettes. Recognizing that women were still riding high on the suffrage movement, Bernays used this as the basis for his new campaign. He consulted Dr. A.A. Brill, a psychoanalyst, to find the psychological basis for womens smoking. Dr. Brill determined that cigarettes which were usually equated with men, represented torches of freedom for women. The event caused a national stir and stories appeared in newspapers throughout the country. Though not doing away with the taboo completely, l Bernays's efforts had a lasting effect on women smoking. 28

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32 1st World Conference on Smoking and Health End of WW II 1st Surgeon General s Report Broadcast Ad Ban 1st Great American Smokeout Nicotine Medications Available Over the Counter Fairness Doctrine Messages on TV And Radio Master Settlement Agreement Great Depression 1st Smoking Cancer Concern Nonsmokers Rights Movement Begins Federal Cigarette Tax Doubles Surgeon General s Report on Environmental Tobacco Smoke 32

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43 Term paper The following assignment must be completed by November 19th. Students are advised to work in groups of approximately 2-3 persons. Class presentations will be given on November 19th and 24th. A written paper summarizing the presentation is also required. Preamble: Tobacco use is a major cause of death from cancer, cardiovascular disease, and pulmonary disease. Cigarette smoking is also a risk factor for respiratory tract and other infections, osteoporosis, reproductive disorders, adverse postoperative events and delayed wound healing, duodenal and gastric ulcers, and diabetes. In addition, smoking has a strong association with fire-related related and trauma-related related injuries. (Benowitz 2010) On the other hand, smoking is also associated with some favorable health outcomes. Question: Provide an estimate of the number of deaths attributable to cigarette smoking in the world during the 20th century. Comments about this assignment: You should devote approximately 25 hours to this assignment (two hours per week on average throughout the entire course). This question could actually require hundreds of hours of work to obtain a satisfactory answer. On the other hand, quick back-of the-envelope calculations could be completed very rapidly. You should focus on the structure of the problem and the identification of the types of data required to arrive at an estimate. Given the limited amount of time and information available to you, describe the simplifying assumptions that you have decided to make in your calculations. Your answer must be quantitative: you must provide one numerical estimate of the number of deaths (or perhaps a few plausible alternatives). ti Your answer should also include quantitative information that was used in arriving at your estimate. Your class presentation should last approximately 20 minutes, including time for questions. Your written text should be based on the PowerPoint presentation, following the same structure. It should correspond to approximately one page per PowerPoint slide. Your written text must be received by JF Boivin by December 3rd. Assignments received after this date will receive a maximum mark of 50%. Students who do not wish to present their work in class may work alone. You must then provide a more substantial written text, equivalent to 50 hours of work, in lieu of the PowerPoint presentation and the group work. Reference: Benowitz NL. Nicotine addiction. New England Journal of Medicine 2010; 362: Version 27 August 2010