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Gold Standard Research & Evidence for Prevention & Pre-Diagnosis

2020

Hu,Tian, Seana L. Gall, Rachel Widome, Lydia A. Bazzano, Trudy L. Burns, Stephen R. Daniels, Terence Dwyer, Johanna Ikonen, Markus Juonala, Mika Kähönen, Ronald J. Prineas, Olli Raitakari, Alan R. Sinaiko, Julia Steinberger, Elaine M. Urbina, Alison Venn,. "Childhood/Adolescent Smoking and Adult Smoking and Cessation: The International Childhood Cardiovascular Cohort (i3C) Consortium." Journal of the American Heart Association, April 8, 2020.

Despite declining US adolescent smoking prevalence from 40% among 12th graders in 1995 to around 10% in 2018, adolescent smoking is still a significant problem. Using the International Childhood Cardiovascular Cohort (i3C) Consortium, which includes 7 international cohorts recruited in childhood and followed into adulthood, the present study was designed to confirm the important relation between adolescent smoking and daily adult smoking and present new data on adult smoking into the forties and comparison of smoking in the United States, Finland, and Australia.

2019

Campbell, Kristin; Kerri M. Winters-Stone; Joachim Wiskemann; Anne M. May; Anna L. Schwartz; Kerry S. Courneya; David S. Zucker; Charles E. Matthews; Jennifer A. Ligibel; Lynn H. Gerber; Stephen G. Morris; Alpa V. Patel; Trisha F. Hue; Frank M. Perna; Kat. "Exercise Guidelines for Cancer Survivors." Medicine & Science in Sports & Exercise, November 2019.

In the last decade, the United States has seen a 27% decline in cancer deaths due to early detection and improved treatments for cancer. In turn, the number of cancer survivors is growing, with over 15.5 million cancer survivors in the United States—a figure that is expected to double by 2040 (1). Improved prognosis has created a growing need to address the unique health issues facing cancer survivors that result from the disease, its treatment, and related comorbid conditions. For example, the symptom of fatigue can persist in 25% of cancer survivors many years after their treatment has ended and contributes to difficulty returning to work, independent living, and poor quality of life (2). Furthermore, risk of developing heart disease may be elevated by some cancer treatments, and cardiovascular mortality is emerging as a major competing cause of death in cancer survivors along with cancer recurrence (3,4). Cancer is also a disease strongly linked with aging, and almost half of survivors are older than 70 yr (5). The adverse synergistic effects of age, cancer treatment, and related sequelae increase the total burden of cancer. Historically, clinicians advised cancer patients to rest and to avoid physical activity, but early exercise research in the 1990s and 2000s challenged this advice.

Patel, Alpa V.; Christine M. Friedenreich; Steven C. Moore; Sandra C. Hayes; Julie K. Silver; Kristin L. Campbell; Kerri Winters-Stone; Lynn H. Gerber; Stephanie M. George; Janet E. Fulton; Crystal Denlinger; Stephen G. Morris; Trisha Hue. "American College of Sports medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control." Medicine & Science in Sports & Exercise, November 2019.

It was estimated that 18.1 million individuals were diagnosed with cancer in 2018 and 9.6 million individuals died from the disease—making cancer the second leading cause of mortality worldwide (1). In the United States (US) alone, the lifetime risk of developing cancer is 40% in men and 38% in women (2), and 1.74 million individuals were diagnosed with cancer in 2018 (3). There are also high direct and indirect costs related to the cancer burden; for example, in the US alone, the annual cost of cancer care is US $158 billion (4), with billions of additional dollars lost to disability, lost work, and lost household productivity (5). Thus, the burden of cancer remains a significant public health issue worldwide, and there is an increasing need to understand how modifiable health behaviors like physical activity may help prevent and control cancer in the population.

Schmitz PhD, MPH, Kathryn; Anna M. Campbell PhD; Martijn M. Stuiver PT, PhD; Bernardine M. Pinto PhD; Anna L. Schwartz PhD; G. Stephen Morris PT, PhD; Jennifer A. Ligibel MD; Andrea Cheville MD; Daniel A. Galvão PhD; Catherine M. Alfano PhD. "Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer." CA: A Cancer Journal for Clinicians, October 16, 2019.

Multiple US and international organizations have published exercise recommendations for patients living with and beyond cancer, including the American Cancer Society (ACS),1 the American College of Sports Medicine (ACSM),2 Exercise and Sports Science Australia,3 Cancer Care Ontario,4 and the Clinical Oncology Society of Australia.5 In March 2018, the ACSM convened a Second Roundtable on Exercise and Cancer Prevention and Control. This second Roundtable included 17 organizations from multiple disciplines (see Supporting Table 1) and set out to review and update prior recommendations on cancer prevention and control. The products of this Roundtable include 3 articles.

Andy S L Tan; Soneji Samir, Moran, Meghan Bridgid; Choi, Kevin. "JUUL Labs' sponsorship and the scientific integrity of vaping research." The Lancet, August 3, 2019.

As of 2018, 98 countries regulate e-cigarettes, including their sale, marketing, packaging, manufacturing, taxation, reporting, and clean air laws.1 Some countries have banned e-cigarettes completely, such as Argentina, Saudi Arabia, and Singapore,1 whereas other countries, such as the UK, consider e-cigarettes as part of a public health harm reduction strategy.2 The USA has regulated e-cigarettes as a tobacco product since 2016. 

Blake, Kelly D., Amanda L. Klein, Laura Walpert, Len Casey, Cynthia Hallett, Clifford Douglas, Bidisha Sinha, Howard K. Koh. "Smoke-free and tobacco-free colleges and universities in the United States." BMJ Journals, July 2, 2019.

Abstract

Objective To describe the number and proportion of accredited, degree-granting institutions with 100% smoke-free and 100% tobacco-free protections across the USA and by state.

Methods Data on postsecondary education institutions from the US Department of Education National Center for Education Statistics Integrated Postsecondary Education Data System 2015, and smoke-free and tobacco-free campus protections from the American Nonsmokers’ Rights Foundation’s Smokefree and Tobacco-Free Colleges and Universities List 2017, were integrated to calculate the number and proportion of: (1) smoke-free and tobacco-free accredited, degree-granting institutions and (2) students and staff protected by campus policies and state laws. Campus protections are given a 100% smoke-free designation if smoking is not allowed on campus anywhere, at any time; 100% tobacco-free designations extend smoke-free protections to include non-combustible products such as smokeless tobacco.

Results 823 accredited, degree-granting institutions (16.7%) representing 1816 individual campuses, sites and schools have either 100% smoke-free or 100% tobacco-free protections. An estimated 14.9 million college students (26.9%) and 8.9 million faculty and staff (25.4%) are protected by campus policies and state laws. Only three states and two territories have 100% smoke-free or 100% tobacco-free protections in over half of their institutions; four states and six territories have no known 100% smoke-free or 100% tobacco-free campus protections.

Conclusions In 2017, just 16.7% of accredited, degree-granting institutions in the USA had 100% smoke-free or 100% tobacco-free protections. Despite progress, more efforts can ensure that students and staff benefit from comprehensive 100% smoke-free and 100% tobacco-free protections at US colleges and universities.

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.

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.

2018

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.

National Academies of Sciences, Engineering, and Medicine. "Public Health Consequences of E-Cigarettes." Washington, DC: The National Academies Press, 2018.

Millions of Americans use e-cigarettes. Despite their popularity, little is known about their health effects. Some suggest that e-cigarettes likely confer lower risk compared to combustible tobacco cigarettes, because they do not expose users to toxicants produced through combustion. Proponents of e-cigarette use also tout the potential benefits of e-cigarettes as devices that could help combustible tobacco cigarette smokers to quit and thereby reduce tobacco-related health risks. Others are concerned about the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals who have never used tobacco products such as youth and young adults. Given their relatively recent introduction, there has been little time for a scientific body of evidence to develop on the health effects of e-cigarettes.

Public Health Consequences of E-Cigarettes reviews and critically assesses the state of the emerging evidence about e-cigarettes and health. This report makes recommendations for the improvement of this research and highlights gaps that are a priority for future research.

Hackshaw, Allan; Joan K. Morris; Sadie Boniface; Jin-Ling Tang, Dušan Milenković,. "Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports." The BMJ, January 24, 2018.

Around one billion adults worldwide smoke,1 with high prevalence in developing countries, where 49% of men and 11% of women use tobacco.2 Although the prevalence of current smokers has decreased over time in several countries, the global absolute number of smokers has increased owing to population growth.3 Policies have successfully encouraged people to quit, using aids such as nicotine replacement therapy and electronic cigarettes (e-cigarettes).4

Ahmed Jamal, MBBS; Elyse Phillips, MPH; Andrea S. Gentzke, PhD; David M. Homa, PhD; Stephen D. Babb, MPH; Brian A. King, PhD; Linda J. Neff, PhD. "Current Cigarette Smoking Among Adults — United States, 2016." CDC Morbidity and Mortality Weekly Report, January 19, 2018.

The U.S. Surgeon General has concluded that the burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, anti-tobacco mass media campaigns, and barrier-free access to tobacco cessation counseling and medications, are critical to reduce cigarette smoking and smoking-related disease and death among U.S. adults, particularly among subpopulations with the highest prevalences.

2017

Farhad Islami, MD, PhD; Ann Goding Sauer, MSPH; Kimberly D. Miller, MPH; Rebecca L. Siegel, MPH; Stacey A. Fedewa, PhD, MPH; Eric J. Jacobs, PhD; Marjorie L. McCullough, ScD, RD; Alpa V. Patel, PhD; Jiemin Ma, PhD, MHS; Isabelle Soerjomataram, MD, PhD, MS. "Proportion and Number of Cancer Cases and Deaths Attributable to Potentially Modifiable Risk Factors in the United States." CA: A Cancer Journal for Clinicians, November 21, 2017.

Contemporary information on the fraction of cancers that potentially could be prevented is useful for priority setting in cancer prevention and control. Herein, the authors estimate the proportion and number of invasive cancer cases and deaths, overall (excluding nonmelanoma skin cancers) and for 26 cancer types, in adults aged 30 years and older in the United States in 2014, that were attributable to major, potentially modifiable exposures (cigarette smoking; secondhand smoke; excess body weight; alcohol intake; consumption of red and processed meat; low consumption of fruits/vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and 6 cancer-associated infections).

Elyse Phillips, MPH; Teresa W. Wang, PhD; Corinne G. Husten, MD; Catherine G. Corey, MSPH; Benjamin J. Apelberg, PhD; Ahmed Jamal, MBBS; David M. Homa, PhD; Brian A. King, PhD . "Tobacco Product Use Among Adults — United States, 2015." Centers for Disease Control and Prevention, November 10, 2017.

In 2015, approximately one in five U.S. adults (48.7 million) currently used any tobacco product, with most using combustible tobacco products. Any tobacco product use was significantly higher among males; adults aged <65 years; non-Hispanic AI/AN, whites, blacks, and persons of multiple races; persons living in the Midwest; persons with a GED; persons with annual household income <$35,000; persons who were single/never married/not living with a partner or divorced/separated/widowed; persons who were uninsured or insured through Medicaid; persons with a disability; and persons who identified as LGB. Adults with serious psychological distress had the highest prevalence of any tobacco product use of any subpopulation.

Girija Syamlal, MBBS; Brian A. King, PhD; Jacek M. Mazurek, MD. "Tobacco Use Among Working Adults — United States, 2014–2016." Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, October 27, 2017.

Cigarette smoking has declined considerably among U.S. adults over several decades; however, increases have occurred in the use of noncigarette tobacco products in recent years, and the use of multiple tobacco products has become common among current users of noncigarette tobacco products.

Babb, Stephen MPH, Benmei Liu PhD, Brandon Kenemer MPH, Carissa Baker Holmes MPH, Anne M. Hartman MS, MA, James T. Gibson BS, Brian A. King PhD, MPH. "Changes in Self-Reported Smokefree Workplace Policy Coverage Among Employed Adults— United States, 2003 and 2010–2011." Oxford University Press on behalf of Society for Research on Nicotine & Tobacco Research, October 12, 2017.

The workplace is a major source of exposure to secondhand smoke from combustible tobacco products. Smokefree workplace policies protect nonsmoking workers from secondhand smoke and help workers who smoke quit. This study examined changes in self-reported smokefree workplace policy coverage among U.S. workers from 2003 to 2010–2011.

Greta M. Massetti, PhD; William H. Dietz, MD, PhD; Lisa C. Richardson, MD, MPH. "Excessive Weight Gain, Obesity, and Cancer." JAMA, October 3, 2017.

Even though the effects of overweight and obesity on diabetes, cardiovascular disease, all-cause mortality, and other health outcomes are widely known, there is less awareness that overweight, obesity, and weight gain are associated with an increased risk of certain cancers. A recent review of more than 1000 studies concluded that sufficient evidence existed to link weight gain, overweight, and obesity with 13 cancers, including adenocarcinoma of the esophagus; cancers of the gastric cardia, colon and rectum, liver, gallbladder, pancreas, corpus uteri, ovary, kidney, and thyroid; postmenopausal female breast cancer; meningioma; and multiple myeloma.

Drope, J., Cahn, Z., Kennedy, R., Liber, A. C., Stoklosa, M., Henson, R., Douglas, C. E. and Drope, J. "Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine." CA: A Cancer Journal for Clinicians, September 29, 2017.

Over the last decade, the use of electronic nicotine delivery systems (ENDS), including the electronic cigarette or e-cigarette, has grown rapidly. More youth now use ENDS than any tobacco product. This extensive research review shows that there are scientifically sound, sometimes competing arguments about ENDS that are not immediately and/or completely resolvable. However, the preponderance of the scientific evidence to date suggests that current-generation ENDS products are demonstrably less harmful than combustible tobacco products such as conventional cigarettes in several key ways, including by generating far lower levels of carcinogens and other toxic compounds than combustible products or those that contain tobacco. To place ENDS in context, the authors begin by reviewing the trends in use of major nicotine-containing products. Because nicotine is the common core—and highly addictive—constituent across all tobacco products, its toxicology is examined. With its long history as the only nicotine product widely accepted as being relatively safe, nicotine-replacement therapy (NRT) is also examined. A section is also included that examines snus, the most debated potential harm-reduction product before ENDS. Between discussions of NRT and snus, ENDS are extensively examined: what they are, knowledge about their level of “harm,” their relationship to smoking cessation, the so-called gateway effect, and dual use/poly-use. 

Scott Gottlieb, M.D., and Mitchell Zeller, J.D. "A Nicotine-Focused Framework for Public Health." New England Journal of Medicine, August 6, 2017.

Despite extraordinary progress in tobacco control and prevention, tobacco use remains the leading cause of preventable disease and death in the United States. Combustible cigarettes cause the overwhelming majority of tobacco-related disease and are responsible for more than 480,000 U.S. deaths each year. Indeed, when used as intended, combustible cigarettes kill half of all long-term users.

Hines, Jonas Z. MD ; Steven C. Fiala, MPH ; Katrina Hedberg, MD. "Electronic Cigarettes as an Introductory Tobacco Product Among Eighth and 11th Grade Tobacco Users — Oregon, 2015." CDC Morbidity and Mortality Weekly Report (MMWR), June 16, 2017.

During 2011–2015, increased electronic cigarette (e-cigarette) and hookah use offset declines in cigarette and other tobacco product use among youths (persons aged <18 years)

Maura L. Gillison, Tatevik Broutian, Barry Graubard, Robert Pickard, Zhen-Yue Tong, Weihong Xiao, Lisa Kahle, Anil Chaturvedi; Ohio State University, Columbus, OH; National Cancer Institute, Rockville, MD; The Ohio State University, Columbus, OH; Informat. "Impact of HPV vaccination on oral HPV infections among young adults in the U.S.." Meeting Library, ASCO University, June 5, 2017.

The incidence of HPV-positive oropharyngeal cancers has risen in recent decades among US men. The potential impact of HPV vaccines on oral HPV infections has yet to be evaluated in efficacy-trials or surveillance studies.

HPV vaccination substantially reduced vaccine-type oral HPV infection prevalence among young adults (ages 18-33 years) in the US population during 2011-2014. However, due to low vaccine uptake, population-level effectiveness was modest overall and particularly low in men.

Ralph S. Caraballo, PhD ; Paul R. Shafer, MA ; Deesha Patel ; Kevin C. Davis, MA ; Timothy A. McAfee, MD. "Quit Methods Used by US Adult Cigarette Smokers, 2014–2016." Centers for Disease Control and Prevention, April 13, 2017.

Quitting cigarette smoking greatly reduces the risk of developing smoking-related diseases; although the health benefits are greater for people who stop at earlier ages, there are benefits at any age (1). The use of electronic cigarettes (e-cigarettes) has increased in the United States (2). Little is known about how the rise in e-cigarette use, particularly among current and former adult cigarette smokers, may have affected quitting behaviors. This study assessed common methods used to try to quit cigarettes among a nationally representative online sample of US adult current smokers surveyed from April 2014 through June 2016.

Dutra, Lauren M.; Stanton A. Glantz, Nadra E. Lisha, Anna V. Song. "Beyond experimentation: Five trajectories of cigarette smoking in a longitudinal sample of youth." February 9, 2017.

The first goal of this study was to identify the most appropriate measure of cigarette smoking for identifying unique smoking trajectories among adolescents; the second goal was to describe the resulting trajectories and their characteristics.

Tobacco-induced disease remains the leading preventable cause of death in the United States, with minorities bearing a disproportionate burden of the disease burden. Because 80% of adult smokers begin smoking before age 18, tobacco control efforts often focus on preventing adolescents from smoking their first cigarette. However, only one-third of youth who experiment with cigarettes ever become regular smokers. As a result, these programs miss a key opportunity to prevent the transition from experimentation to established smoking, which may occur in the mid-to-late 20s. In combination with growing recognition that young adulthood (ages 18 to 25) is a critical period of vulnerability, particularly due to significant life changes such as starting college, separating smokers into different trajectories (patterns of smoking) and identifying when escalation and de-escalation occurs can inform efforts to prevent transition to regular smoking.

2016

Elissa Meites, MD; Allison Kempe, MD; Lauri E. Markowitz, MD. "Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on Immunization Practices." Centers for Disease Control and Prevention, December 16, 2016.

This report provides recommendations and guidance regarding use of HPV vaccines and updates ACIP HPV vaccination recommendations previously published in 2014 and 2015

"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, December 8, 2016.

This report confirms that the use of electronic cigarettes (or e-cigarettes) is growing rapidly among American youth and young adults. While these products are novel, we know they contain harmful ingredients that are dangerous to youth. Important strides have been made over the past several decades in reducing conventional cigarette smoking among youth and young adults. We must make sure this progress is not compromised by the initiation and use of new tobacco products, such as e-cigarettes. 

Maki Inoue-Choi, PhD, MS; Linda M. Liao, PhD, MPH; Carolyn Reyes-Guzman, PhD, MPH; Patricia Hartge, ScD; Neil Caporaso, MD; Neal D. Freedman, PhD, MPH. "Association of Long-term, Low-Intensity Smoking With All-Cause and Cause-Specific Mortality in the National Institutes of Health–AARP Diet and Health Study." JAMA Internal Medicine, December 5, 2016.

A growing proportion of US smokers now smoke fewer than 10 cigarettes per day (CPD), and that proportion will likely rise in the future. The health effects of smoking only a few CPD over one’s lifetime are less understood than are the effects of heavier smoking, although many smokers believe that their level is modest.

Berko, Jeff MPH; Goetzel, Ron Z. PhD; Roemer, Enid Chung PhD; Kent, Karen MPH; Marchibroda, Janet MBA. "Results From the Bipartisan Policy Center's CEO Council Physical Activity Challenge to American Business." Journal of Occupational & Environmental Medicine, December 2016.

Physical inactivity is a major public health threat: inactive adults are at an elevated risk of early death, heart disease, stroke, type 2 diabetes, and depression. Despite these dire consequences, fewer than half of American adults meet the recommended guidelines for daily physical activity. Sedentary jobs contribute to this problem, but the workplace also presents an opportunity for intervention. 

Bergouignan, Audrey , Kristina T. Legget, Nathan De Jong, Elizabeth Kealey, Janet Nikolovski, Jack L. Groppel, Chris Jordan, Raphaela O’Day, James O. Hill and Daniel H. Bessesen. "Effect of frequent interruptions of prolonged sitting on self-perceived levels of energy, mood, food cravings and cognitive function." International Journal of Behavioral Nutrition and Physical Activity, November 3, 2016.

While physical activity has been shown to improve cognitive performance and well-being, office workers are essentially sedentary. We compared the effects of physical activity performed as (i) one bout in the morning or (ii) as microbouts spread out across the day to (iii) a day spent sitting, on mood and energy levels and cognitive function.

Song, Mingyang, MD, ScD; Edward Giovannucci, MD, ScD. "Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States." JAMA Oncology, September 1, 2016.

Lifestyle factors are important for cancer development. However, a recent study has been interpreted to suggest that random mutations during stem cell divisions are the major contributor to human cancer. 

Conclusions and Relevance: A substantial cancer burden may be prevented through lifestyle modification. Primary prevention should remain a priority for cancer control.

Michael C. Fiore, MD, MPH, MBA. "Tobacco Control in the Obama Era — Substantial Progress, Remaining Challenges." New England Journal of Medicine, August 24, 2016.

The steady decline in smoking rates among U.S. adults that began in the early 1960s has acceleratedsubstantially during the 7 years of the Barack Obama presidency.

Moore, PhD, Steven C. MPH; I-Min Lee, MBBS, ScD; Elisabete Weiderpass, PhD; et al. "Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults." Journal of the American Medical Association , June 2016.

Importance  Leisure-time physical activity has been associated with lower risk of heart-disease and all-cause mortality, but its association with risk of cancer is not well understood.

Objective  To determine the association of leisure-time physical activity with incidence of common types of cancer and whether associations vary by body size and/or smoking.

Steven C. Moore, PhD, MPH; I-Min Lee, MBBS, ScD; Elisabete Weiderpass, PhD; et al. "Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults." Journal of the American Medical Association , June 2016.

Importance  Leisure-time physical activity has been associated with lower risk of heart-disease and all-cause mortality, but its association with risk of cancer is not well understood.

Objective  To determine the association of leisure-time physical activity with incidence of common types of cancer and whether associations vary by body size and/or smoking.

Azvolinsky, Anna . "Unraveling How Obesity Fuels Cancer." Oxford Academic, Journal of the National Cancer Institute, April 2, 2016.

“We are getting more and more precise about the different risk factors for the various subtypes of cancer,” said Stephen Hursting, Ph.D., M.P.H., professor in the department of nutrition at the University of North Carolina at Chapel Hill. One established factor is obesity, now well linked to at least ten cancers, including pancreatic, colorectal, endometrial, and hormone receptor–positive, postmenopausal breast cancer. 

2015

Polinski, Jennifer M., ScD, MPH; Benjamin Howell, PhD, MPP; Troyen A. Brennan, MD, JD, MPH; William H. Shrank, MD, MSHS . "Impact of the CVS tobacco sales removal on smoking cessation: when CVS Health quit tobacco, many smokers quit, too." CVS Health, 2015.

The study, conducted by the CVS Health Research Institute, evaluated cigarette pack purchases at drug, food, big box, dollar, convenience and gas station retailers in the eight months after CVS Pharmacy stopped selling tobacco products.

Thornburg, Jonathan; Quentin Malloy, Seung-Hyun Cho, William Studabaker, and Youn Ok Lee. "Exhaled Electronic Cigarette Emissions: What’s Your Secondhand Exposure? ." RTI Press, Research Briefs, March 2015.

As e-cigarette use rapidly proliferates in the United States, research is needed to determine potential health risks posed by emissions from e-cigarettes. Currently, little scientific evidence on the toxicant exposures posed by e-cigarette use is available, particularly for a non-user’s secondhand exposures in public places.

Laurie P. Whitsel, PhD, Neal Benowitz, MD, Aruni Bhatnagar, PhD, FAHA, Chris Bullen, MBChB, PhD, Fred Goldstein, Lena Matthias-Gray, BS, Jessica Grossmeier, PhD, MPH, John Harris, MEd, Fikry Isaac, MD, MPH, Ron Loeppke, MD, MPH, Marc Manley, MD, MPH, Kare. "Guidance to Employers on Integrating E-Cigarettes/Electronic Nicotine Delivery Systems Into Tobacco Worksite Policy." Journal of Occupational and Environmental Medicine, March 2015.

In recent years, new products have entered the marketplace that complicate decisions about tobacco control policies and prevention in the workplace. These products, called electronic cigarettes (e-cigarettes) or electronic nicotine delivery systems, most often deliver nicotine as an aerosol for inhalation, without combustion of tobacco. This new mode of nicotine delivery raises several questions about the safety of the product for the user, the effects of secondhand exposure, how the public use of these products should be handled within tobacco-free and smoke-free air policies, and how their use affects tobacco cessation programs, wellness incentives, and other initiatives to prevent and control tobacco use. In this article, we provide a background on e-cigarettes and then outline key policy recommendations for employers on how the use of these new devices should be managed within worksite tobacco prevention programs and control policies

2014

In a new study of cancer patients who smoke, those using e-cigarettes (in addition to traditional cigarettes) were more nicotine dependent and equally or less likely to have quit smoking traditional cigarettes than non-users. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the findings raise doubts about the potential benefits of e-cigarettes for helping cancer patients give up smoking.

"Coverage for Tobacco Use Cessation Treatments." Centers for Disease Control and Prevention, 2014.

This updated 2014 document provides an overview of the evidence base for tobacco cessation insurance coverage, best practices for designing cessation coverage, and the current status of cessation coverage.

"Best Practices for Comprehensive Tobacco Control Programs ." Centers for Disease Control and Prevention, 201.

Tobacco use is the single most preventable cause of disease, disability, and death in the United States. Nearly one-half million Americans still die prematurely from tobacco use each year, and more than 16 million Americans suffer from a disease caused by smoking. Despite these risks, approximately 42.1 million U.S. adults currently smoke cigarettes. And the harmful effects of smoking do not end with the smoker. Secondhand smoke exposure causes serious disease and death, and even brief exposure can be harmful to health. Each year, primarily because of exposure to secondhand smoke, an estimated 7,330 nonsmoking Americans die of lung cancer and more than 33,900 die of heart disease. Coupled with this enormous health toll is the significant economic burden. Economic costs attributable to smoking and exposure to secondhand smoke now approach $300 billion annually.

U.S. Department of Health and Human Services. "The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. ." U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

This comprehensive report chronicles the devastating consequences of 50 years of tobacco use in the United States. It updates data on the numerous health effects resulting from smoking and exposure to secondhand smoke, and details public health trends, both favorable and unfavorable, in tobacco use. This report marks the steady progress achieved in reducing the prevalence of smoking and validates tobacco control strategies that have consistently proven to be effective. It also examines strategies with the potential to eradicate the death and disease caused by the tobacco epidemic at long last, and identifies specific measures that should be taken immediately to move smoking off its decades-old number one spot as the largest single cause of preventable death and disease for the citizens of the United States. Finally, the report documents that effective interventions are available and calls for their full implementation.

2013

Lankford, Tina; Jason Lang, Brian Bowden, and William Baun. "Workplace Health: Engaging Business Leaders to Combat Obesity." Journal of Law, Medicine & Ethics, December 1, 2013.

Recognizing the adverse impact of obesity on employee productivity and health, many businesses have invested resources in worksite strategies to increase physical activity and improve the diets of their employees. Employers play a pivotal role in creating health-supportive environments for their employees as well as the community at large. Employers that contribute to a healthier workforce have the potential to reduce their out-of-pocket health care costs and improve productivity within their workforce. Further, through community engagement, employers can foster the improved health and stability of their future workforce

Lee, Joseph G L, Leah M Ranney, Adam O Goldstein. "Cigarette butts near building entrances: what is the impact of smoke-free college campus policies?." BMJ Journals, February 15, 2013.

Abstract

Background Indoor and outdoor tobacco-free campus policies for schools, hospitals and universities are increasingly being adopted. Yet, little direct evidence exists on the impact of tobacco-free campuses on tobacco outcomes.

Objectives To identify differences in cigarettes smoked at main campus building entrances by campus policy strength.

Methods Researchers collected cigarette butts (n=3427) at main building entrances (n=67) at baseline and follow-up on 19 community college campuses stratified by strength of campus outdoor tobacco policy (none, perimeter/designated area, 100% tobacco free). Outcome measures included the number of butts per day at building entrances averaged to create a campus score. Analysis of variance techniques examined differences in scores by the strength of campuses' outdoor tobacco policy.

Results One hundred per cent tobacco-free community college campuses had significantly fewer cigarette butts at doors than campuses with no outdoor restrictions. Butts on community college campuses with partial policies were not statistically different from campuses with no policy or campuses with a 100% tobacco-free policy but indicated that a dose–response relationship may exist.

Conclusions This study provides some of the first evidence on the impact of 100% tobacco-free outdoor policies on college campuses using an objective and reproducible measure. Such policies likely provide a more healthful environment for students, staff, faculty and visitors.

2012

Recent research suggests that obesity and excess weight can play a prominent role in the incidence and progression of various cancers.

Tobacco is the leading cause of preventable and premature death, killing an estimated 443,000 Americans each year. Cigarette smoking costs the nation $96 billion in direct medical costs and $97 billion in lost productivity annually. In addition to the billions in medical costs and lost productivity, tobacco is enacting a heavy toll on young people.

Each day in the United States, over 3,800 young people under 18 years of age smoke their first cigarette, and over 1,000 youth under age 18 become daily cigarette smokers. The vast majority of Americans who begin daily smoking during adolescence are addicted to nicotine by young adulthood. Despite the well-known health risks, youth and adult smoking rates that had been dropping for many years have stalled. When this Administration took office, we decided that if these numbers were not changing, we had to do something. We accelerated our efforts to fight tobacco by helping Americans stop smoking and protecting young people from starting to smoke.

2011

"Position Statement on Tobacco on College and University Campuses." American College Health Association, November 2011.

The American College Health Association (ACHA) acknowledges and supports the findings of the Surgeon General that tobacco use in any form, active and/or passive, is a significant health hazard...ACHA joins with other professional health associations in promoting tobacco-free environments.

Smith Carls,Ginger, PhD, Ron Z. Goetzel, PhD, Rachel Mosher Henke, PhD, Jennifer Bruno, BS, Fikry Isaac, MD, and Janice McHugh, DBA, RN, COHN-S. "The Impact of Weight Gain or Loss on Health Care Costs for Employees at the Johnson & Johnson Family of Companies." Journal of Occupational and Environmental Medicine, January 2011.

Objective: To quantify the impact of weight gain or weight loss on health care costs.

Conclusions: Preventing weight gain through effective employee health promotion programs is likely to result in cost savings for employers.

2010

Steven A. Schroeder, M.D. and Kenneth E. Warder, PhD. "Don’t Forget Tobacco." New England Journal of Medicine, July 15, 2010.

At a time when all eyes are focused on health care reform, escalating medical costs, and childhood obesity, cigarette smoking remains by far the most common cause of preventable death and disability in the United States.

David P. Hopkins, MD, MPH, Sima Razi, MPH, Kimberly D. Leeks, PhD, MPH, Geetika Priya Kalra, MPA, Sajal K. Chattopadhyay, PhD, Robin E. Soler, PhD. "Smokefree Policies to Reduce Tobacco Use: A Systematic Review." American Journal of Preventive Medicine, February 2010.

In 2001, a systematic review for the Guide to Community Preventive Services identified strong evidence of effectiveness of smoking bans and restrictions in reducing exposure to environmental (secondhand) tobacco smoke. As follow-up to that earlier review, the focus here was on the evidence on effectiveness of smokefree policies in reducing tobacco use. Smokefree policies implemented by worksites or communities prohibit smoking in workplaces and designated public areas. The conceptual approach was modified for this review; an updated search for evidence was conducted; and the available evidence was evaluated. Published articles that met quality criteria and evaluated changes in tobacco-use prevalence or cessation were included in the review. 

2008

Hannon, Peggy A., PhD, MPH; Jeffrey R. Harris, MD. "Interventions to Improve Cancer Screening Opportunities in the Workplace." American Journal of Preventive Medicine, July 2008.

All of the latest cancer screening intervention recommendations from the Community Guide can be implemented in the workplace via four important avenues: health insurance benefits, workplace policies, workplace programs, and workplace communications. Health insurance affects workers’ access to and use of preventive care, including cancer screening.  Workplace policies also can improve employees’ access to cancer screening. Workplace programs offer workers relatively easy access to and social support for cancer screening. Workplace communications can improve knowledge and shape beliefs, attitudes, and perceived norms about cancer screening, and about the health insurance benefits, policies, and programs aimed at improving screening.

2006

Fitch, Kate, RN, MEd; Kosuke Iwasaki, FIAJ, MAAA; Bruce Pyenson, FSA, MAAA. "Covering Smoking Cessation as a Health Benefit." Milliman: Consultants and Actuaries, December 6, 2006.

This report provides information so employers can make informed choices based on the costs and benefits of smoking cessation programs – and compare these to other routinely provided benefits.

2005

Bruce Pyenson, FSA, MAAA, and Patricia A. Zenner, RN. "Cancer Screening: Payer Cost/Benefit thru Employee Benefits Programs." Milliman: Consultants and Actuaries, November 18, 2005.

This paper demonstrates that covering and promoting full compliance with established screening recommendations thru employer sponsored programs is low cost and cost effective for employee benefit programs.

2002

Fichtenberg, Caroline M.; Stanton A Glantz. "Effect of smoke­free workplaces on smoking behaviour: systematic review." British Medical Journal, March 21, 2002.

Passive smoking is linked with cancer, heart disease, respiratory illness and is the leading source of indoor airpollution. In the United States, passive smoking has been linked to the deaths of at least 53 000 non-smokers each year, about one non-smoker for each eight smokers that tobacco kills. 

We investigated the effects of smoke-free workplaces on cigarette consumption and compared these effects with those obtained by raising taxes.