ABSTRACT: Most scientists believe a change in prevalence of a health risk behavior in a population will manifest itself between ten and thirty years after the change takes place. Since 1964, the War on Tobacco has caused one of the largest changes in health behavior of a population ever known, over a relatively short period of time. It is now past the time when we have a right to expect profound changes in the health profile of Americans due to the War on Tobacco. This article examines the smoking behavior of various American birth groups, identifies the years when smoking related disease should occur based on the age of these birth groups, and concludes no significant health profile changes have occurred that can be credited to the War on Tobacco. Further, it is concluded  that no cost savings treating tobacco related disease have been realized.  Comparisons are made to the health profiles of Europeans who have had no War on Tobacco which confirm our War on Tobacco is worthless. Literature is cited that predict our young generations of Americans can also expect no health bonanza from the War on Tobacco.

The author is a retired pharmaceutical chemist who noticed no improvement in health of Americans while accessing the medical literature during his career. His personal health profile does not include any smoking related diseases, and he believes anti tobacco  activists and public health officials have diminished the quality of his life more than any tobacco company.

TIME TRENDS ON SMOKING AND HEALTH AND THE VALUE OF THE WAR ON TOBACCO   by David Kuneman

I have been compiling smoking rates and smoking related disease rates gathered over the last thirty years by government agencies.  Time trends of most medical conditions blamed on smoking are stationary or rising even as the prevalence of smoking declines.  The data I am about to present should be of interest to anyone concerned  with claims smoking rates are a major health cost to society. I have compiled as much of this data as possible from Statistical Abstracts of the United States (SAUS) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results ( SEER) Program.  The SEER Program is a scientifically selected population-based registry of 9 geographic regions within the United States used to identify and quantify our overall health trends. These are widely regarded as the best data available. The tables below present these data. The smoking rate data in some tables are inserted by me for the convenience of the reader, and not part of the original database cited. Birth group refers to birth year plus or minus five years.  Thus, for example, birth group 1905 refers to those born from 1900 to 1910. 

Identification of years when most smoking related disease should strike.

I have obtained historical (cigarette only) smoking data from J. Harris,  J. Nat. Cancer Inst. , Vol. 71, #3, Sept, 1983, p473 of the birth groups of Americans old enough to be in the smoking related disease risk group between 1973 and 1998.Current smoker at age 60, birth year 1925, data were extrapolated by me because these are 1985 data and Harris published during 1983. Harris concluded male smokers born 1905 +5 and females born 1925 +5 smoked the heaviest lifetime dose.  By birth group, male smokers peak cigarette use was actually males born 1925 during 1953, but they began quitting much earlier in their lives than prior birth groups and smoked almost exclusively cigarettes; their lifetime consumption was less than 1905 males.  Harris reported the mixing of cigarettes with other tobacco products was more common among earlier male birth groups. I also conclude the 1905 male birth group smoked the heaviest lifetime dose because males born 1905 inhaled more tobacco combustion products: first, they also smoked more cigars, ( Table I ) second, they smoked more unfiltered cigarettes which were most popular before the 1950s when these males were already in middle age. The plain fact is when a filter cigarette is smoked, one can see tar build up in the filter. This is tar that is never ingested by the smoker. Studies consistently claim unfiltered cigarettes are more dangerous than filtered. Third, they arrived at the age of smoking inception during the 1920’s when smoking was very popular and acceptable, and fourth, they were already average age 59 when the first Surgeon General’s report was published in 1964, supposedly too late to benefit much from the rash of quitting that followed.  At the time of Harris’ publication, cigars were thought to be less risky than cigarettes which was the official explanation why males who lived during most of the 1800’s never suffered from lung cancer. When cigar smoking again gained popularity during the 1990’s, reports that cigars are indeed as hazardous as cigarettes began appearing. If true, then males born 1905 ( smoking both) ought to be most at risk from smoking related disease. However, these recent cigar reports never gave a satisfactory explanation why lung cancer was extremely rare before 1930.

Table I ,Domestic Cigar Consumption, 5-year intervals, in Millions

*Calculated from data  from “Historical Statistics of the U.S”. House document #93-78 part1 and the Production of Tobacco, W.W. Garner, U.S. Dept of Agriculture, 1947.

Males, average birth years 1895 and 1905, reached the age of smoking inception when males smoked an average of 223 cigars per capita annually. Latter birth groups reached the age of smoking inception after cigar consumption began declining.

Another reason to believe male smokers born 1905 were the heaviest is due to their low quitting/ decade-after-age-30-numbers.  These data in Table II are from Harris.  We have been bombarded with claims substantial reduction of smoking related disease occurs when people quit before the disease strikes, and even quitting after the disease strikes can have benefits.  Birth group 1905 males ought to have more smoking related disease because they smoked the most at age 50, and almost as much as 1895 males at age 60.   The cigar issue doesn’t apply to female birth groups. Female birth groups 1915 and 1925 actually had somewhat similar smoking histories, both smoking 37% at age 50, but those born 1925 took up the habit earlier in their lives while the 1915 birth group smoked the most at age 60.  Smoking at age 50 ought to be the most important parameter because most smoking related cancers occur after age 60 and claims are common that ten years after quitting, risk of cancer declines dramatically.

Based on age of these birth groups,  smoking related disease incidences during 1973 occurred  mostly among those born 1905 +5,  during 1985 among those born 1915, and during 1996-1998 among those born 1925.  The slightly longer time span, I have presented, between birth and expected incidences at later intervals is due to overall life expectancy increases occurring from 1970 to 1998.

( refer to J. Amer. Med Assoc., Feb9, 1994, p435, T5. Most smoking related cancers are diagnosed age 60 to 80, with peak age 70. Birth year overlap is about 25% over ten-year intervals )

Table II, Harris Cigarette-only Smoking Prevalence by Birth Group

From SAUS1992, T19&39 and SAUS 2000, T13, I obtained data from the U.S. Census Bureau, Current Population Reports, and have calculated percents of each birth group still living among those over age 60, of the same sex, during various decades. m= male, f= female  NA= not yet age 60.

Table III, Percent of all Persons Over Age 60, by Birth Group

Among those over age 60, the highest portion of persons are under age 70 during all years studied. Therefore one should expect smoking related disease patterns during any decade to be most dependant on smoking behavior of those born 60 to 70 years earlier.  The reason vertical data total more than 100% is because our population  over age 60 increased during the later years. The reason the 1999 horizontal data don’t total 100% is the 1935 birth group is then over age 60 and not included in this table.  Male and female 1935 birth groups both smoked less than those birth groups shown.

During 1980, the males born 1905 , still alive, were average 75 years old, and females born 1925, 55 years old. Considering average life expectancy, ( 72 for males, and 79 for females),  most of the heaviest male smokers were no longer alive to influence the incidence trend of smoking related diseases during  and after 1980.  This would leave only males born 1915&1925 who smoked 1% to 10% less at age 50 and 5% to 16% less at age 65 at risk for these diseases after 1980. After 1990, males and females born 1915 have less influence on smoking related disease incidences because they comprise only 33-34 % of all persons over age 60.  Females, still alive, had steady smoking rates at age 50 and 60. Therefore we should expect peak smoking related disease incidences among males during the 1970’s and after 1980, declining incidences. Among females, rising incidences during the 1970’s and steady smoking related disease incidences after 1980.

There is, however, a reason to expect smoking related disease declines even earlier than 1980.   IF claims are true smoking reduces life expectancy an average of 14 years, then all of the projections made above should have occurred 14 years earlier.  Perhaps the average life expectancy numbers for males is composed of 70% never smoking males and males who quit before age 50, living to an average age of  76 and 30% at risk smokers living to an average age of 62.  The overall life expectancy would still be age 72, but the smoking component would have died at average age 62, or  average 1967 among those born 1905 and average 1977 among those born 1915.  Those persons, still living, in the birth groups 1905-1915 during, 1980, and 1990 would then be mostly those who never smoked or quit early in their lives.  This would leave only males, birth group 1925 and latter, who smoked less than birth groups 1905 and 1915 at age 50 and much less at age 60 alive to suffer smoking related diseases after 1980. Similar calculations for females, average life expectancy 79, yield  average death age 69 for the smoking component, and by 1985,  only the portion of the 1915 birth group that didn’t smoke is still alive instead of almost all the 1915 birth group and this would lead to declining smoking related disease among still-living women because their smoking exposure thereafter would be declining. 

I have addressed an alternate approach to determine if smokers live an average 14 years less than nonsmokers. From SAUS, 1992,T199, I have obtained data from U.S. Centers for Disease Control, Office of Smoking and Health surveys of those aged 25-44 years-old during 1965, and aged 45-64 years-old, during 1985:

* during 1965, of those aged 25-44, 49.5% smoked and their quit ratio was 23.6%

*during 1985, of those aged 45-64, 31.6% smoked, and their quit ratio was 49.7%.

The definition of quit ratio is “percent of persons who ever smoked who are former smokers”.  From this data, it is possible to calculate percent ever smokers of both surveys.  Subtracting 100 from the quit ratio yields percent ever smokers who are current smokers. Dividing percent current smokers by percent ever smokers who are current smokers = percent ever smokers. I obtained:  *for those aged 25-44 during 1965, 64.8% ever smoked.

*for those aged 45-64 during 1985, 62.8% ever smoked.

But, these are the same people, simply aged 20 years. IF many more of the ever smokers and current smokers than never smokers had died off before 1985, they would not have been able to participate in the 1985 survey and the 1985 survey results would have yielded much lower ever smoker results.  As a consequence, I conclude the difference between 64.8% ever smokers during 1965 and 62.8% ever smokers of the same group, during 1985 proves smokers don’t die off 14 years earlier than nonsmokers. Perhaps, the two percent difference is due to smoking, but, as will be discussed later, this 2% could easily be explained by other risks more prevalent among smokers, such as blue collar or military employment.

Yet, according to the 1990 Surgeon General’s Report, “The Health Benefits of Smoking Cessation”, after ten years of abstinence, the risk of lung cancer is 30-50% of the risk of continuing smoking. Cessation also reduces the risk of cancers of the larynx, oral cavity, esophagus, pancreas, and bladder. Heart disease death is reduced 50% after only one year of abstinence.  After quitting, stroke risk returns to ordinary levels after  5 to 15 years.  With sustained abstinence,  chronic obstructive pulmonary disease risk returns to normal, and peripheral vascular disease risk is substantially reduced. He also states death risk due to influenza and pneumonia is substantially reduced. Overall, those who quit before age 50, have one-half the risk of dying in the next 15 years than those who continue to smoke.  Below, we will determine if that actually happened.

From the Tables I and III, it is possible to calculate composite smoking data of all those over age 60 during decades 1970,1980, and 1990 to prepare the following table which compares it to health outcomes that actually occurred during those decades. Bear in mind these composite figures are only accurate if smokers live as long as nonsmokers; otherwise smoking data would be lower.

Table IV, HEALTH-RELATED TRENDS DURING OUR HEAVIEST SMOKING YEARS