Summary of Conclusions and Recommendations
The Scale of the Smoking Problem (Part One)
Conclusions:
Smoking is a major cause of illness and death from chronic respiratory diseases, cardiovascular disease, and cancers of the lung and other sites.
Smoking is the most important cause of premature death in developed countries. It accounts for one fifth of deaths in the UK: some 120,000 deaths a year.
The avoidance of smoking would eliminate one third of the cancer deaths in Britain and one sixth of the deaths from other causes.
Smoking prevalence in young people rose between 1988 and 1997 and the downward trend in adult smoking, noted in the UK since 1972, was reversed in 1996.
A person who smokes cigarettes regularly more than doubles his or her risk of dying before the age of 65.
Addiction to nicotine sustains cigarette smoking and is responsible for the remarkable intractability of smoking behaviour.
Smoking in pregnancy causes adverse outcomes, notably an increased risk of miscarriage, reduced birth weight and perinatal death. If parents continue to smoke after pregnancy there is an increased rate of sudden infant death syndrome.
Cigarette smoking is an important contributor to health inequalities, being much more common amongst the disadvantaged than the affluent members of society.
Recommendations:
The enormous damage to health and life arising from smoking should no longer be accepted; the Government should take effective action to limit this preventable epidemic.
The Government should require of the tobacco industry:
- reasonable standards in the assessment of evidence relating to the health effects of the product it sells,
- acceptance that smoking is a major cause of premature death, and
- normal standards of disclosure of the nature and magnitude of the hazards of smoking to their customers, comparable to that expected from other manufacturers of consumer products.
Independently of specific governmental regulations, tobacco manufacturers should comply with these requirements.
There is an importance and urgency with the smoking problem that needs to be recognised by both the Government and the public.
Environmental Tobacco Smoke (Part Two)
Conclusions:
Exposure to environmental tobacco smoke is a cause of lung cancer and, in those with long term exposure, the increased risk is in the order of 20-30%.
Exposure to environmental tobacco smoke is a cause of ischaemic heart disease and, if current published estimates of magnitude of relative risk are validated, such exposure represents a substantial public health hazard.
Smoking in the presence of infants and children is a cause of serious respiratory illness and asthmatic attacks.
Sudden infant death syndrome, the main cause of post-neonatal death in the first year of life, is associated with exposure to environmental tobacco smoke. The association is judged to be one of cause and effect.
Middle ear disease in children is linked with parental smoking and this association is likely to be causal.
Recommendations:
Smoking in public places should be restricted on the grounds of public health. The level of restriction should vary according to the different categories of public place but smoking should not be allowed in public service buildings or on public transport, other than in designated and isolated areas. Wherever possible, smoking should not be allowed in the work place.
There is a need for public education about the risks of smoking in the home particularly in relation to respiratory diseases in children.
Health education programmes should focus on the dangers of ETS in fetal development and, postnatally, in the sudden infant death syndrome.
The Influence of Price and Promotion on Tobacco Consumption (Part Three)
Conclusions:
Price, advertising and promotion influence tobacco consumption.
Prevalence of smoking in the United Kingdom is increasingly associated with factors of social and economic deprivation.
Recommendations:
The real price of tobacco products should continue to be increased each year to reduce consumption.
All forms of tobacco advertising, promotion and identifiable sponsorship should be banned.
Smoking and Young People (Part Four)
Conclusions:
Targeting of young people by tobacco companies is of particular relevance because of the now acknowledged addictive nature of tobacco.
Price, advertising and promotion influence cigarette consumption among young people.
Interventions to prevent smoking in young people should form part of concerted action involving all agencies including home, school, community and Government.
Recommendations:
Young people, in particular, should be protected by a ban on all forms of tobacco advertising and promotion.
The real price of tobacco products should continue to be increased each year to discourage young people from smoking.
Changes in smoking prevalence in younger age groups should be monitored.
Educating young people about tobacco addiction and its effects on health should remain an important part of the school curriculum.
Young people themselves should be involved in looking at constructive ways of reducing initiation of smoking.
Smoking Cessation (Part Five)
Conclusions:
There is evidence that advice on smoking cessation from health care professionals is effective and worthwhile.
Nicotine replacement offers a useful and effective adjunct to advice and increases cessation rates.
Nicotine Replacement Therapy has not been evaluated in pregnancy.
Recommendations:
Smoking cessation interventions by health care professionals are worthwhile and should be encouraged.
The timing and nature of advice provided by doctors and midwives to pregnant smokers should be standardised and the effectiveness of such measures should be evaluated.
Nicotine Replacement Therapy is recommended to reduce withdrawal symptoms and improve cessation rates in smokers who are motivated to give up.
Consideration should be given to ways of increasing the availability of NRT products including via General Sales List and National Health Service prescriptions.
A randomised controlled trial is needed on the efficacy and safety of nicotine replacement therapy for pregnant women who smoke heavily and are unable to give up smoking with current advice and support.
Research is needed on the efficacy and safety of the long term use of NRT as a harm-reduction agent for smokers unable to quit.
The Effect of Smoking on Cognitive Performance and Mood (Part Six - 6.1)
Conclusions:
In habitual smokers nicotine does not appear to enhance performance above non-smoker levels.
In spite of widespread perceptions to the contrary, stress and anxiety are reduced rather than increased after giving up smoking.
The evidence that smoking relieves stress is weak; rather the reverse is true.
Recommendations:
The public should be made aware of the association between smoking and negative mood states.
Smoking and cancers of the mouth and pharynx (Part Six - 6.2)
Conclusions:
Many cancers of the mouth and pharynx are caused by smoking tobacco and drinking excessive amounts of alcohol, the effect of the two factors together being greater than the sum of each alone.
Oral cancer, in particular, can be easily detected and early treatment is successful.
Recommendations:
The National Screening Committee should consider screening programmes for the early detection of cancers in the mouth.
Mandatory training and updating courses, in the detection of oral cancers, should be organised for dental surgeons and dental hygienists.
Consideration should be given to the re-introduction of dental health checks.
Health education should include information about the increased risk in smokers of these cancers.
The Effect of Smoking on Tooth Loss (Part Six - 6.3)
Conclusions:
Smoking plays a major part in the development of periodontitis, which is the major cause of tooth loss.
Smoking masks the early warning signs of the disease.
Dental surgeons and dental hygienists can play an important role in providing information to the general public on known health risks of smoking including those associated with dental disease.
Recommendations:
The public should be made aware of the role of smoking in the development of gum disease and subsequent tooth loss.
Dentists and dental hygienists should be trained in smoking cessation techniques and encouraged to play an active part in smoking cessation and health education on known health risks of smoking including those associated with dental disease.
Smoking and congenital defects (Part Six - 6.4)
Conclusion:
Maternal smoking in pregnancy may increase the risk of congenital defects. Prevention may require smoking cessation before conception.
Recommendations:
The public should be kept aware of the known hazards of smoking in pregnancy.
Further research on smoking in pregnancy and congenital defects is needed.
Diseases with Lower Risks in Smokers (Part Six - 6.5)
Conclusion:
The health benefits of active smoking in a few conditions are far outweighed by the substantial risks.
Recommendation:
The apparent beneficial effects of smoking on a few aspects of health offer an opportunity for research on the mechanisms involved, and the possibilility of developing new pharmaceutical approaches to treatment.
The Review of Emissions from Cigarettes (Part Seven)
Conclusions:
Reduction in tar yields has contributed modestly to reduction in mortality from some diseases caused by smoking, particularly lung cancer.
Tar reduction is no substitute for not smoking since even low tar cigarettes continue to carry important health risks.
The yields of tar, nicotine, some N-nitroso compounds and carbon monoxide from hand-rolled cigarettes are higher on average than those from manufactured cigarettes.
Nicotine has been shown conclusively to be addictive.
Recommendations:
A policy of further tar reductions in manufactured cigarettes should be pursued without compromising the message of the importance of not smoking.
As a consequence of potential tar reductions, and thus changes to the manufacturing processes, the monitoring of tar, nicotine and carbon monoxide levels should continue. There should also be investigation into changes in harmful compounds as manufacturing processes change.
The public should be made aware of the relatively high yields of harmful compounds in hand rolled cigarettes and of their potential impact on health.
There is a continuting need for population studies, such as the Health Survey for England, which relate tobacco type and yield, smoking behaviour and intake and the incidence and prevalence of tobacco related diseases.
Consideration should be given to smoking status being recorded as part of the death registration process, to aid monitoring of the evolving epidemic of tobacco related diseases.
Voluntary Agreement for the Approval of New Additives to Tobacco Products (Part Eight)
Recommendations:
The use of additives in tobacco products should continue to be closely monitored.
The Technical Advisory Group should regularly review the changing patterns and types of additives.
|
