SMOKING AND LUNG CANCERSMOKING AND LUNG CANCER

Jean François BoivinJean-François Boivin

1September 20th 2010

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ZEITSCHRIFT FÜR KREBSFORSCHUNG 1939; 49: 57-859

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R l i i k 2 49 / 0 1 14 6Relative risk = 2.49 / 0.17 = 14.6

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1 31 / 0 17 = 7 71.31 / 0.17 = 7.7

2.33 / 0.17 = 13.7

4.17 / 0.17 = 24.5

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Risk difference = 2 49 0 17 = 2 3 per 1000 men / yearRisk difference = 2.49 – 0.17 = 2.3 per 1000 men / year

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Risk difference = 1 31 0 17 = 1 14 per 1000 men / yearRisk difference = 1.31 - 0.17 = 1.14 per 1000 men / year

= 2.33 - 0.17 = 2.16 per 1000 men / year

= 4.17 - 0.17 = 4.00 per 1000 men / year

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BiasesBiases

ConfoundingConfoundingMeasurementMeasurementMeasurementMeasurement

Losses to followLosses to follow--upup

Generalizability Generalizability 23

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• By the mid-1920s smoking had become commonplace in the United States and cigarette tobacco was the most popular form ofcigarette 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 moresuch 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 aswere 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 inthe 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. Mrs. Taylor-Scott Hardin

parades down New York's Fifth Avenue with her

• George Washington Hill, president of the American Tobacco Company and an eccentric businessman, recognized that an important part f hi k t t b i t d i t Hill

husband while smoking "torches of freedom,"a gesture of protest for absolute equality with men.

of his market was not being tapped into. Hill believed that cigarette sales would soar if he could entice more women to smoke in public. 27

In 1928 Hill hired Bernays to expand th l f hi L k St ikthe sales of his Lucky Strike cigarettes. Recognizing that women were still riding high on the suffrage movement Bernays used this as themovement, Bernays used this as the basis for his new campaign. He consulted Dr. A.A. Brill, a psychoanalyst to find thepsychoanalyst, to find the psychological basis for womens smoking. Dr. Brill determined that cigarettes which were usually g yequated 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

l t l B ' ff t h dcompletely, Bernays's efforts had a lasting effect on women smoking. 28

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1st World Conference on Smoking and Health

1st Surgeon General’s Report

Broadcast Ad Ban

End of WW II

1st GreatAmericanSmokeout Nicotine

M di ti A il bl

50005000

End of WW II

Fairness DoctrineMessages on TVAnd Radio

Medications AvailableOver the Counter

MasterSettlementAgreement

4000

40003000

4000

1st Smoking Cancer Concern Nonsmokers’

RightsMovementBegins

SurgeonGeneral’sReport onEnvironmental Tobacco Smoke

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1000

Great Depression

Federal CigaretteTax Doubles

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1900 19001910 1920 1930 1940 1950 1960 1970 1980 1990 1998

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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 requiredNovember 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 and trauma related injuries ”(Benowitz 2010) On thea strong association with fire-related and trauma-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 g ( p g g ) qcould 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 th b f d th ( h f l ibl lt ti ) Y h ld lthe number of deaths (or perhaps a few plausible alternatives). 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%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; 362:2295-2303.

Version 27 August 2010