You are here
Research & Evidence
The findings from this report reinforce the need to support evidence-based programs to prevent youth and young adults from using tobacco in any form, including e-cigarettes. The health and well-being of our nation’s young people depend on it.
E-cigarette use among youth and young adults : a report of the Surgeon General.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention
Sauer, Ann Goding; Rebecca L. Siegel; Ahmedin Jemal; and Stacey A. Fedewa. "Current Prevalence of Major Cancer Risk Factors and Screening Test Use in the United States: Disparities by Education and Race/Ethnicity." American Association for Cancer Research, April 2019.
Overall cancer death rates in the United States have declined since 1990. The decline could be accelerated by eliminating socioeconomic and racial disparities in major risk factors and screening utilization. We provide an updated review of the prevalence of modifiable cancer risk factors, screening, and vaccination for U.S. adults, focusing on differences by educational attainment and race/ethnicity. Individuals with lower educational attainment have higher prevalence of modifiable cancer risk factors and lower prevalence of screening versus their more educated counterparts. Smoking prevalence is 6-fold higher among males without a high school (HS) education than female college graduates. Nearly half of women without a college degree are obese versus about one third of college graduates. Over 50% of black and Hispanic women are obese compared with 38% of whites and 15% of Asians. Breast, cervical, and colorectal cancer screening utilization is 20% to 30% lower among those with <HS education compared with college graduates. Screening for breast, cervical, and colorectal cancers is also lower among Hispanics, Asians, and American Indians/Alaska Natives relative to whites and blacks. Enhanced, multilevel efforts are needed to further reduce the prevalence of modifiable risk factors and improve screening and vaccination, particularly among those with lower socioeconomic status and racial/ethnic minorities.
Warren, MD, PhD, Graham W.; Kathleen B. Cartmell, PhD; Elizabeth Garrett-Mayer, PhD. "Attributable Failure of First-line Cancer Treatment and Incremental Costs Associated With Smoking by Patients With Cancer." JAMA, April 5, 2019.
The cost of cancer treatment is increasingly associated with unfavorable financial outcomes in cancer care,but whether increased costs reflect increased value is unknown. Principles for value-based care in oncology include patient-centered solutions, optimal care, and cost-containment strategies that do not limit patient access or innovation. Guidelines have been developed to define clinically meaningful outcomes in cancer care, but a recent analysis of drug approvals by the US Food and Drug Administration between 2014 and 2016 showed that many drugs did not meet survival goals. Whereas drug cost and efficacy have been the primary focus for considering value in cancer care, relatively little consideration has been given to other potentially modifiable factors that could affect cancer treatment costs, including health behaviors such as smoking.
The US 2014 Surgeon General’s report concluded that continued smoking among patients with cancer caused adverse outcomes including increased overall- and cancer-specific mortality, risk for second primary cancer, and associations with increased toxic effects from cancer treatment. Smoking cessation in the general population is known to improve health outcomes and create significant reductions in health expenditures. Whereas many studies found that smoking cessation after a cancer diagnosis can improve survival, to our knowledge, there have been no evaluations of the association between continued smoking among patients with cancer and the costs of cancer treatment. Understanding the financial effects of smoking among patients with cancer is needed to develop value-based approaches that could lead to improved cancer treatment outcomes. The objective of this study was to model the additional attributable first-line cancer treatment failures associated with continued smoking and to estimate the attributable incremental cost associated with the need to treat first-line cancer treatment failures attributed to continued smoking.
Sung, Hyuna; Rebecca L Siegel, Philip S Rosenberg, Ahmedin Jemal. "Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry." Lancet Public Health, February 4, 2019.
Background: Cancer trends in young adults, often under 50 years, reflect recent changes in carcinogenic exposures, which could foreshadow the future overall disease burden. Previous studies reported an increase in early onset colorectal cancer, which could partly reflect the obesity epidemic. We examined age-specific contemporary incidence trends in the USA for 30 common cancers, including 12 obesity-related cancers.
Interpretation: The risk of developing an obesity-related cancer seems to be increasing in a stepwise manner in successively younger birth cohorts in the USA. Further studies are needed to elucidate exposures responsible for these emerging trends, including excess bodyweight and other risk factors.
Berry KM, Fetterman JL, Benjamin EJ, et al. "Association of Electronic Cigarette Use With Subsequent Initiation of Tobacco Cigarettes in US Youths." JAMA Netw Open, February 1, 2019.
This large, nationally representative study of US youths supports the view that e-cigarettes represent a catalyst for cigarette initiation among youths. The association was especially pronounced in low-risk youths, raising concerns that e-cigarettes may renormalize smoking behaviors and erode decades of progress in reducing smoking among youths. Although the individual-level risk of cigarette initiation was comparable for prior e-cigarette users and prior other tobacco product users, the proportion of new cigarette use attributable to prior e-cigarette use appears larger than the proportion attributable to prior use of all other products combined. These findings strengthen the rationale for aggressive regulation of youth access to and marketing of e-cigarettes to achieve future decreases in the prevalence of cigarette use among youths.
Schnoll R, Leone F, Veluz‐Wilkins A,et al. . "A randomized controlled trial of 24 weeks of varenicline for tobacco use among cancer patients: Efficacy, safety, and adherence." Psycho‐Oncology, January 24, 2019.
Continuing to smoke after a cancer diagnosis undermines prognosis. Yet few trials have tested Food and Drug Administration (FDA)‐approved tobacco use medications in this population. Extended use varenicline may represent an effective treatment for cancer patients who smoke given barriers to cessation including a prolonged time line for relapse.
"Cancer Facts & Figures 2019." American Cancer Society, January 8, 2019.
Estimated numbers of new cancer cases for 2019, excluding basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder. Estimates are not available for Puerto Rico.
Note: State estimates are offered as a rough guide and should be interpreted with caution. State estimates may not add to US total due to rounding.
Siegel, Rebecca L., MPH; Kimbertly D. Miller, MPH; Ahmedin Jemal, DVM, PhD. "Cancer Statistics, 2019." Wiley Online Library, January 8, 2019.
Cancer is a major public health problem worldwide and is the second leading cause of death in the United States. In this article, we provide the estimated numbers of new cancer cases and deaths in 2019 in the United States nationally and for each state, as well as a comprehensive overview of cancer occurrence based on the most current population-based data for cancer incidence through 2015 and for mortality through 2016. We also estimate the total number of deaths averted because of the continuous decline in cancer death rates since the early 1990s and analyze cancer mortality rates by county-level poverty.
U.S. Surgeon General Jerome Adams. "Surgeon General’s Advisory on E-cigarette Use Among Youth." December 18, 2018.
I, Surgeon General of the United States Public Health Service, VADM Jerome Adams, am emphasizing the importance of protecting our children from a lifetime of nicotine addiction and associated health risks by immediately addressing the epidemic of youth e-cigarette use. The recent surge in e-cigarette use among youth, which has been fueled by new types of e-cigarettes that have recently entered the market, is a cause for great concern. We must take action now to protect the health of our nation’s young people.
Patrick, Megan E., PhD; Richard Miech, PhD; Lloyd Johnston, PhD; Patrick M. O’Malley, PhD; Jerald G. Bachman, PhD. "Adolescent Vaping and Nicotine Use in 2017–2018 — U.S. National Estimates." New England Journal of Medicine, December 17, 2018.
A rapid increase in the prevalence of vaping among adolescents has aroused public health concern. Adolescents who “vape” use a device such as an electronic cigarette to inhale a heated aerosol, which typically contains nicotine. In 2017, vaping was the most common use of any tobacco-like product among adolescents.1 This is a rapid rise from a near-zero prevalence of vaping in 2011.2 We assessed whether the prevalence of nicotine vaping increased among adolescents from 2017 to 2018.
Pankaj Parag Sharma, Mark Benden, Ranjana K. Mehta, Adam Pickens & Gang Han . "A quantitative evaluation of electric sit-stand desk usage: 3-month in-situ workplace study." IISE Transactions on Occupational Ergonomics and Human Factors, September 13, 2018.
Sit-stand desk interventions are deployed to reduce sedentary time and improve ergonomic adjustability in modern workplaces, with ultimate goals of improving health and productivity. Sit-stand desks, however, require workers to take an active role in changing the desk position, and usage compliance of the sit-stand function has been a challenge. This study used computer software to objectively record continuous data on electric sit-stand desk usage during computer use, to understand current desk usage behaviors in a large office environment involving ∼300 workers for 3 months. We found that workers completed roughly one desk position change per work day, and one-fourth of the workers always had the desk in a seated position (during computer use). The methods used here demonstrate a novel approach to record sit-stand desk usage continuously during active computer use.
Kuiper NM, Loomis BR, Falvey KT, Gammon DG, King BA, Wang TW, et al. "Trends in Unit Sales of Flavored and Menthol Electronic Cigarettes in the United States, 2012–2016." Centers for Disease Control and Prevention, Preventing Chronic Disease, August 23, 2018.
CDC and RTI International analyzed retail scanner data to assess national and state-specific trends in sales of flavored and menthol e-cigarettes. Findings from this analysis include:
- During 2012-2016, flavored e-cigarette sales as a percentage of all e-cigarette sales rose national from about 2% to nearly 20% in all but four states
- Menthol e-cigarette sales remained stable nationally at 35-40%
- Over half of total e-cigarette sales in 2016 were flavored or menthol products, and sales varied by product type
- Continued monitoring of the variety of flavored tobacco products available in the United States, including combustible, noncombustible, and electronic tobacco products, is critical for informing comprehensive tobacco prevention and control strategies
Wang, Teresa W., PhD; Michael A. Tynan; Cynthia Hallett, MPH; Laura Walpert, JD; Maggie Hopkins; Darryl Konter; Brian A. King, PhD. "Smoke-Free and Tobacco-Free Policies in Colleges and Universities ― United States and Territories, 2017." Morbidity and Mortality Weekly Report (MMWR), June 22, 2018.
Each year in the United States, cigarette smoking causes an estimated 480,000 deaths, including approximately 41,000 deaths from secondhand smoke exposure among nonsmoking adults. Smoke-free policies protect nonsmokers from secondhand smoke exposure, reduce the social acceptability of smoking, help in preventing youth and young adult smoking initiation, and increase smokers’ efforts to quit smoking. Given that 99% of adult cigarette smokers first start smoking before age 26 years and many smokers transition to regular, daily use during young adulthood, colleges and universities represent an important venue for protecting students, faculty, staff members, and guests from secondhand smoke exposure through tobacco control policies
Halpern, Scott D., M.D., Ph.D., Michael O. Harhay, Ph.D., Kathryn Saulsgiver, Ph.D., Christine Brophy, Andrea B. Troxel, Sc.D., and Kevin G. Volpp, M.D., Ph.D.. "A Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation." New England Journal of Medicine, June 14, 2018.
BACKGROUND: Whether financial incentives, pharmacologic therapies, and electronic cigarettes (e-cigarettes) promote smoking cessation among unselected smokers is unknown.
CONCLUSIONS: In this pragmatic trial of smoking cessation, financial incentives added to free cessation aids resulted in a higher rate of sustained smoking abstinence than free cessation aids alone. Among smokers who received usual care (information and motivational text messages), the addition of free cessation aids or e-cigarettes did not provide a benefit. (Funded by the Vitality Institute; ClinicalTrials.gov number, NCT02328794.)
Marian Freedman and Michael G Burke, MD. "High-nicotine e-cigarettes lead to more smoking and vaping." Contemporary Pediatrics, February 1, 2018.
Compared with adolescents who use e-cigarettes with relatively low or no nicotine concentrations, those who use e-cigarettes with higher nicotine concentrations are more likely to progress to more frequent and intense combustible cigarette smoking and vaping.
National Academies of Sciences, Engineering, and Medicine. "Incorporating weight management and physical activity throughout the cancer care continuum: Proceedings of a workshop." Washington, DC: The National Academies Press., 2018.
The National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a public workshop, Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum, on February 13 and 14, 2017, in Washington, DC. The purpose of this workshop was to highlight the current evidence base, gaps in knowledge, and research needs on the associations among obesity, physical activity, weight management, and health outcomes for cancer survivors, as well as to examine the effectiveness of interventions for promoting physical activity and weight management among people living with or beyond cancer. Workshop sessions also reviewed the opportunities and challenges for providing weight management and physical activity interventions to cancer survivors. This publication summarizes the presentations and discussions from the workshop.