The Importance of Modern Research and Its Impact on Smoking Since the Early 1950s

In 1950, the Journal of The American Medical Association published a study conducted by Wynder and Graham titled “Tobacco Smoking as a Possible Etiologic Factor in Branchiogenic Carcinoma: A Study of 684 Proven Cases” ⁴. This study focused on lung cancer prevalence in relation to cigarettes and although it was not the first article published on these variables, this particular report sparked interest in the correlation of these two factors and over the next decade hundreds of more reports were published with research linking smoking cigarettes and lung cancer ⁴.

Since then, smoking has been estimated to be responsible for close to 90% of lung cancers ². The last ten percent are related to Radon consumption, occupational exposures to carcinogens such as asbestos, and, lastly, outdoor pollution ². 

Lung cancer began growing in both the female and male populations from the 1930s to the 1990s, but the start of an exponential increase in lung cancer became evident around the 1950s ⁶. The below graphs show a dramatic increase of 96% in women and 451% in men during these decades (Kufe, et al., 2003). This was also a major cause of cancer death in women specifically, with there being more deaths from lung cancer than breast cancer ⁶.

Female Rates of Cancer:

Male Rates of Cancer:

⁶

Smoking prevalence reached a peak in 1954 with 45% of individuals in the United States smoking on a daily basis, disregarding concerns over lung cancer at the time ³. This percentage has since decreased, however the survival rate of lung cancer remains relatively unaltered ³. In fact, despite changes in regulation and education on the topic of smoking, approximately 541,000 Americans currently living today have been diagnosed with lung cancer at some point in their lives ². It is still the most common type of cancer worldwide ². 

Although there is a proven significant correlation between lung cancer and smoking cigarettes, individuals with different diseases can be at higher risk for lung cancer despite their cigarette use ³. For instance, those with “heart disease, atherosclerotic peripheral vascular disease, laryngeal cancer, oral cancer, esophageal cancer, chronic obstructive pulmonary disease, intrauterine growth retardation, and low birthweight” are naturally more susceptible to getting this condition ³.

There are many factors that can influence a person’s affinity for smoking. For instance, it has been proven that those who have partners and/or parents who are nonsmokers are more likely to be non-smokers themselves ⁷. On the other hand, if an individual has parents who are smokers or if they enter into a relationship where their partner smokes, then it is more likely that they will start as well ⁷. This could be due to the fact that people group together based on similarities, or it could be because individuals tend to change their habits in response to others’ behaviors ⁷.

The prevalence of smoking also has been linked to the different communities that an individual is part of, with the highest prevalence of smoking being among high-school-aged men and the lowest being among Asian American and Hispanic women ¹. In general, men smoke more than women ¹. Those in the lower Northeastern region and higher Southern region of the United States smoke less also ¹.

Since the publication of this research, however, the rates of both smoking and lung cancer have decreased dramatically. In fact, over the past forty-two years the rate of new lung cancer cases has dropped 36% for men ².  A large portion of this decrease is contributed to the lower prevalence of smoking due to changing community values and dramatically higher regulations on tobacco in the United States ¹.  For one, the price of cigarettes increased due to new governmental taxation and resulted in many individuals stopping the habit due to the expensive financial nature ¹.

The largest improvements, however, were seen with new educational efforts on the negative side effects of tobacco ¹. These efforts were mainly aimed at children and through numerous ads, health warning labels, and school programs there was a dramatic decrease in new smokers among younger generations ¹. There is expected to be a continued downward trend in years to come ¹.

References

1. American Heart Association News. Smoking in America: Why more Americans are kicking the habit. American Heart Association, https://www.heart.org/en/news/2018/08/29/smoking-in-america-why-more-americans-are-kicking-the-habit, Published August 30, 2018, Accessed February 4, 2023.
2. American Lung Association. Lung Cancer Fact Sheet. American Lung Association, https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet#:~:text=The%20rate%20of%20new%20lung,for%20both%20men%20and%20women, Accessed January 23, 2023.
3. Centers for Disease Control and Prevention (CDC). About MMWR. CDC, https://www.cdc.gov/mmwr/about.html, Published 2003, Accessed January 23, 2023.
4. Centers for Disease Control and Prevention. MMWR Weekly Achievements in Public Health, 1900-1999: Tobacco Use– United States, 1900-1999.  CDC, https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843a2.htm, Published November 5, 1999, Accessed January 23, 2023.
5. Centers for Disease Control and Prevention (CDC). MMWR Weekly Ernst L. Wynder, M.D. CDC, (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843bx.htm#:~:text=In%201950%2C%20the%20Journal%20of,but%20its%20sophisticated%20design%2C%20impressive, Published November 5, 1999, Accessed January 23, 2023. 
6. Kufe, D. W., Pollock, R. E., Weichselbaum, R. R., Bast, R. C., Gansler, T. S., Holland, J. F., Frei III, E. Holland-Frei Cancer Medicine (6th ed.). : BC Decker. https://www.ncbi.nlm.nih.gov/books/NBK12354/, Published 2003, Accessed Janurary 23, 2023.
7. Leonard, K. E.. Spousal Influence on Smoking Behaviors in a US Community Sample of Newly Married Couples. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808349, Published June 23, 2005, Accessed February 23, 2023.