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.

The invention of mass marketing led to cigarettes being emblazoned in advertising and film, deeply tied to modern notions of glamour and sex appeal. It is hard to find a photo of Humphrey Bogart or Lauren Bacall without a cigarette. No product has been so heavily promoted or has become so deeply entrenched in American consciousness. And no product has received such sustained scientific scrutiny. The development of new medical knowledge demonstrating the dire harms of smoking ultimately shaped the evolution of evidence-based medicine. In response, the tobacco industry engineered a campaign of scientific disinformation seeking to delay, disrupt, and suppress these studies. Using a massive archive of previously secret documents, historian Allan Brandt shows how the industry pioneered these campaigns, particularly using special interest lobbying and largesse to elude regulation. But even as the cultural dominance of the cigarette has waned and consumption has fallen dramatically in the U.S., Big Tobacco remains securely positioned to expand into new global markets. The implications for the future are vast: 100 million people died of smoking-related diseases in the 20th century; in the next 100 years, we expect 1 billion deaths worldwide.

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.

The cigarette is the deadliest artifact in the history of human civilization. It is also one of the most beguiling, thanks to more than a century of manipulation at the hands of tobacco industry chemists. In Golden Holocaust, Robert N. Proctor draws on reams of formerly-secret industry documents to explore how the cigarette came to be the most widely-used drug on the planet, with six trillion sticks sold per year. He paints a harrowing picture of tobacco manufacturers conspiring to block the recognition of tobacco-cancer hazards, even as they ensnare legions of scientists and politicians in a web of denial. Proctor tells heretofore untold stories of fraud and subterfuge, and he makes the strongest case to date for a simple yet ambitious remedy: a ban on the manufacture and sale of cigarettes.

Los Angeles Times Book Prize Finalist Winner of the Willie Lee Rose Prize Winner of the PROSE Award in United States History Hagley Prize in Business History Finalist A Smithsonian Best History Book of the Year “Vaping gets all the attention now, but Milov’s thorough study reminds us that smoking has always intersected with the government, for better or worse.” —New York Times Book Review From Jamestown to the Marlboro Man, tobacco has powered America’s economy and shaped some of its most enduring myths. The story of tobacco’s rise and fall may seem simple enough—a tale of science triumphing over corporate greed—but the truth is more complicated. After the Great Depression, government officials and tobacco farmers worked hand in hand to ensure that regulation was used to promote tobacco rather than protect consumers. As evidence of the connection between cigarettes and cancer grew, scientists struggled to secure federal regulation in the name of public health. What turned the tide, Sarah Milov reveals, was a new kind of politics: a movement for nonsmokers’ rights. Activists took to the courts, the streets, city councils, and boardrooms to argue for smoke-free workplaces and allied with scientists to lobby elected officials. The Cigarette puts politics back at the heart of tobacco’s rise and fall, dramatizing the battles over corporate influence, individual choice, government regulation, and science. “A nuanced and ultimately devastating indictment of government complicity with the worst excesses of American capitalism.” —New Republic “An impressive work of scholarship evincing years of spadework...A well-told story.” —Wall Street Journal “If you want to know what the smoke-filled rooms of midcentury America were really like, this is the book to read.” —Los Angeles Review of Books

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.

A favorite icon for cigarette manufacturers across China since the mid-twentieth century has been the panda, with factories from Shanghai to Sichuan using cuddly cliché to market tobacco products. The proliferation of panda-branded cigarettes coincides with profound, yet poorly appreciated, shifts in the worldwide tobacco trade. Over the last fifty years, transnational tobacco companies and their allies have fueled a tripling of the world's annual consumption of cigarettes. At the forefront is the China National Tobacco Corporation, now producing forty percent of cigarettes sold globally. What's enabled the manufacturing of cigarettes in China to flourish since the time of Mao and to prosper even amidst public health condemnation of smoking? In Poisonous Pandas, an interdisciplinary group of scholars comes together to tell that story. They offer novel portraits of people within the Chinese polity—government leaders, scientists, tax officials, artists, museum curators, and soldiers—who have experimentally revamped the country's pre-Communist cigarette supply chain and fitfully expanded its political, economic, and cultural influence. These portraits cut against the grain of what contemporary tobacco-control experts typically study, opening a vital new window on tobacco—the single largest cause of preventable death worldwide today.