Measures over the past 50 years to reduce smoking in the US have saved an estimated 8 million premature deaths, increasing the average spans of those lives by almost 20 years, an analysis in a special issue of the Journal of the American Medical Association has found.
January 2014 marks the 50th anniversary of the first report by the surgeon general to highlight the harms of tobacco smoking, and the control measures that have been in place since 1964 have saved a total of 157 million years of life across the population, the study concludes.
That landmark report half a century ago - Smoking and health, released by the Public Health Service at the US Department of Health, Education and Welfare - was, says an accompanying opinion paper to the present study, controversial and highly influential at the time.
Since that time, say the present study authors, "efforts by governments, voluntary organizations, and the private sector" have included:
Education on smoking's dangers
Increases in cigarette taxes
Smoke-free air laws
Marketing and sales restrictions
Smoking-cessation treatment programs.
Smoking mortality from 1964 to 2012
The analysis was led by Theodore Holford, PhD, from the Yale University School of Public Health in New Haven, CT.
The researchers modeled how many fewer deaths resulted from tobacco control and quit smoking measures by comparing the number of deaths that were attributable to smoking between the years 1964 and 2012 with the number that would have occurred had the changes not been made.
According to the study authors:
"The model estimated that a total of 17.7 million smoking-attributable deaths occurred between 1964 and 2012."
Dr. Holford and his colleagues worked out how many extra years of life were gained on average for the people whose lives were saved by the controls over the past half century.
By estimating that there had been a gain of 157 million years of life associated with tobacco control since 1964, and dividing this number across the 8 million lives saved, they have found that "individuals who avoided a premature smoking-related death gained 19.6 years of life on average."
'Continuing problem' despite progress
The authors say there has been great progress against the harms of smoking:
"Tobacco control has made a unique and substantial contribution to public health over the past half century. This study provides a quantitative perspective to the magnitude of that contribution."
However, the study also highlights an ongoing issue: "Despite the success of tobacco control efforts in reducing premature deaths in the US, smoking remains a significant public health problem.
"Today, a half century after the surgeon general's first pronouncement on the toll that smoking exacts from US society, nearly a fifth of US adults continue to smoke, and smoking continues to claim hundreds of thousands of lives annually."
The authors add: "No other behavior comes close to contributing so heavily to the nation's mortality burden. Tobacco control has been a great public health success story but requires continued efforts to eliminate tobacco-related morbidity and mortality."
'Less smoking cessation among people with mental illness'
In another study in the special issue of the JAMA, by Benjamin Le Cook, PhD, from the Harvard Medical School/Cambridge Health Alliance, Cambridge, MA, and colleagues, examines smoking rates among adults with mental illness.
It found that, between 2004 and 2011, smoking rates fell among adults without mental illness - from 19.2% to 16.5%.
But among adults will mental illness, across multiple mental disorders, the rates barely fell, "decreasing only from 25.3% to 24.9%."
The authors blame factors within healthcare provision:
"The fact that smoking rates for individuals receiving mental healthcare have not experienced the same rates of decline as the general population suggests limited adoption of integrated treatments and ongoing barriers to cessation treatment in mental healthcare settings."
Also in the January 8 issue of the JAMA are studies finding:
"Overall prevalence of smoking has decreased globally, although number of smokers, and cigarettes consumed, has increased."
Combination therapy with varenicline (Champix) and bupropion (Zyban), compared with varenicline alone, "shows short-term benefit, but does not improve ability to quit smoking after one year."