Measuring the Health Impact of Smoking and Health Care Providers' Performance in Addressing the Problem

In the preface to the 1990 U.S. Surgeon General's report on the health benefits of smoking cessation, U.S. Surgeon General Antonia C. Novello stated that “smoking represents the most extensively documented cause of disease ever investigated in the history of biomedical research” (1). Since then, the evidence on the dangers of smoking has continued to grow, and U.S. Surgeon General Richard H. Carmona issued a 941-page report in 2004 that summarized the voluminous literature on the myriad ways in which smoking affects every organ system in the body (2).

One might question whether more research on the health effects of smoking is still needed and whether this research funding should be redirected to studies focusing on smoking behavior and strategies to prevent or treat tobacco use and dependence. However, research on the health effects of tobacco use continues to provide value by elucidating the etiology of disease, identifying previously unknown associations between smoking and disease (acute myelogenous leukemia is a relatively recent example), providing new information for tobacco education campaigns, informing the development of sound public policy on tobacco, and further defining the effect of smoking on population subgroups (3).

In this issue, Vollset and colleagues' article (4) improves our understanding of the effect of smoking in persons of middle age (40 to 70 years of age). The authors conducted a population-based study of 24 505 women and 25 034 men who resided in 3 counties in Norway and were born between 1925 and 1941. The investigators found that among these women and men, 26% and 41%, respectively, of continuing heavy smokers (≥20 cigarettes per day) died in middle age, compared with 9% and 14%, respectively, of never smokers.

The complete follow-up of mortality among this large cohort of women and men over a 25-year period was a strength …