This report considers the biological and behavioral mechanisms that may underlie the pathogenicity of tobacco smoke. Many Surgeon General's reports have considered research findings on mechanisms in assessing the biological plausibility of associations observed in epidemiologic studies. Mechanisms of disease are important because they may provide plausibility, which is one of the guideline criteria for assessing evidence on causation. This report specifically reviews the evidence on the potential mechanisms by which smoking causes diseases and considers whether a mechanism is likely to be operative in the production of human disease by tobacco smoke. This evidence is relevant to understanding how smoking causes disease, to identifying those who may be particularly susceptible, and to assessing the potential risks of tobacco products.

This Surgeon General's report returns to the topic of the health effects of involuntary exposure to tobacco smoke. The last comprehensive review of this evidence by the Department of Health and Human Services (DHHS) was in the 1986 Surgeon General's report, The Health Consequences of Involuntary Smoking, published 20 years ago this year. This new report updates the evidence of the harmful effects of involuntary exposure to tobacco smoke. This large body of research findings is captured in an accompanying dynamic database that profiles key epidemiologic findings, and allows the evidence on health effects of exposure to tobacco smoke to be synthesized and updated (following the format of the 2004 report, The Health Consequences of Smoking). The database enables users to explore the data and studies supporting the conclusions in the report. The database is available on the Web site of the Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/tobacco.

Smoking causes and contributes to a large number of human diseases, yet due to the large number of potentially hazardous compounds in cigarette smoke -- almost 5,000 chemicals have been identified, establishing the link between smoking and disease has often proved difficult. This unbiased and scientifically accurate overview of current knowledge begins with an overview of the chemical constituents in cigarette smoke, their fate in the human body, and their documented toxic effects on various cells and tissues. Recent results detailing the many ways components of cigarette smoke adversely affect human health are also presented, highlighting the role of smoking in cardiovascular, respiratory, infectious and other diseases. A final chapter discusses current strategies for the treatment and prevention of smoking-induced illness. Despite the obvious importance of the topic, this is the first comprehensive reference on tobacco smoke toxicity, making for essential reading for all toxicologists and healthcare professionals dealing with smoking-related diseases.

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.

Tobacco use by adolescents and young adults poses serious concerns. Nearly all adults who have ever smoked daily first tried a cigarette before 26 years of age. Current cigarette use among adults is highest among persons aged 21 to 25 years. The parts of the brain most responsible for cognitive and psychosocial maturity continue to develop and change through young adulthood, and adolescent brains are uniquely vulnerable to the effects of nicotine. At the request of the U.S. Food and Drug Administration, Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products considers the likely public health impact of raising the minimum age for purchasing tobacco products. The report reviews the existing literature on tobacco use patterns, developmental biology and psychology, health effects of tobacco use, and the current landscape regarding youth access laws, including minimum age laws and their enforcement. Based on this literature, the report makes conclusions about the likely effect of raising the minimum age to 19, 21, and 25 years on tobacco use initiation. The report also quantifies the accompanying public health outcomes based on findings from two tobacco use simulation models. According to the report, raising the minimum age of legal access to tobacco products, particularly to ages 21 and 25, will lead to substantial reductions in tobacco use, improve the health of Americans across the lifespan, and save lives. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products will be a valuable reference for federal policy makers and state and local health departments and legislators.

Data suggest that exposure to secondhand smoke can result in heart disease in nonsmoking adults. Recently, progress has been made in reducing involuntary exposure to secondhand smoke through legislation banning smoking in workplaces, restaurants, and other public places. The effect of legislation to ban smoking and its effects on the cardiovascular health of nonsmoking adults, however, remains a question. Secondhand Smoke Exposure and Cardiovascular Effects reviews available scientific literature to assess the relationship between secondhand smoke exposure and acute coronary events. The authors, experts in secondhand smoke exposure and toxicology, clinical cardiology, epidemiology, and statistics, find that there is about a 25 to 30 percent increase in the risk of coronary heart disease from exposure to secondhand smoke. Their findings agree with the 2006 Surgeon General's Report conclusion that there are increased risks of coronary heart disease morbidity and mortality among men and women exposed to secondhand smoke. However, the authors note that the evidence for determining the magnitude of the relationship between chronic secondhand smoke exposure and coronary heart disease is not very strong. Public health professionals will rely upon Secondhand Smoke Exposure and Cardiovascular Effects for its survey of critical epidemiological studies on the effects of smoking bans and evidence of links between secondhand smoke exposure and cardiovascular events, as well as its findings and recommendations.

Tobacco smoking is a major public health issue worldwide. Smoking causes more than a quarter of all cancer deaths, with nearly 80% of deaths from lung cancer, 80% of deaths from bronchitis and emphysema and almost one fifth of deaths from cardiovascular disease. The role of tobacco smoke in the development of cancer, cardiovascular and respiratory diseases is widely discussed in the chapters of this book. It is responsible for many preventable diseases, contributes to a large number of premature deaths and accounts for enormous economic costs. The chapters in this book review a variety of topics related to the sociodemographic characteristics of people consuming tobacco, tobacco product promotion and merchandising consequences of smoking on health, the studied mechanism of damage and the different interventions promoted for tobacco control. The mechanisms by which cigarette smoke affects health are diverse. Thousands of chemical components -- mainly toxins and carcinogens -- are part of tobacco smoke. These components could act through specific or nonspecific mechanisms in the development of cancer, cardiovascular and respiratory disease. Common pathways include DNA damage, gene mutations, vasomotor dysfunction and oxidative stress, among others. The effects on health of first-hand and second-hand smoke exposure have been widely studied, and there is growing evidence regarding consequences of third-hand smoke exposure. The constituents, dynamic transformation and distribution of third-hand smoke are a fruitful area of study, as much as the quantification of its exposure. In this book, many useful indicators of exposure to environmental tobacco smoke, ranging from surrogate indicators to direct measurements of the components that reflect dose are analysed. Advances in this field can provide useful information on the extent and effects of smoking, implementing and assessing tobacco control policies. Furthermore, the World Health Organization developed a framework for an international treaty that provides evidence-based recommendations for health promotion and tobacco control. After more than ten years of its implementation, the effectiveness of different strategies adopted worldwide is analysed and reflections on the new challenges of its implementation are presented. In this book, smoking is reviewed pertaining to the effects and implications for health, as well as the current challenges on implementation and evaluation of tobacco control interventions.