A hundred years ago, would anyone who said "smoking is harmful to health" be considered a lunatic?

Many smokers know that smoking is harmful to health but cannot stop smoking. Non-smokers know that smoking is harmful to health but are often forced to breathe in secondhand smoke. Many people are just “looking at the words and sighing” when it comes to the familiar “smoking is harmful to health” on cigarette boxes! In fact, this sentence was not printed on cigarette boxes at the beginning. Its birth was very difficult and tortuous, and there is a vigorous history of public health campaigns hidden behind it.

1 Early confrontation

Archaeological discoveries show that tobacco was used in the Americas more than 12,000 years ago. After the discovery of the New World, tobacco spread rapidly across Europe. In 1609, English colonist John Rolfe arrived in Jamestown, Virginia, becoming the first settler to successfully grow tobacco (often called "brown gold" at the time) for commercial use. By the 18th century, tobacco had spread across much of the world.

This 1670 painting shows enslaved Africans working in a tobacco shed on a colonial tobacco plantation. (Source: Wikipedia)

In the 20th century, the popularity of electrical appliances gave American tobacco companies a more convenient channel for dissemination. They began to work with doctors to advertise, telling people that smoking is good for health. Even babies were used in cigarette advertisements to recommend cigarettes to their mothers. Under such a dissemination orientation, many people began to smoke.

An advertisement in 1942 encouraging women to smoke Camel cigarettes (Source: Wikipedia)

At the same time, some people found that the number of lung cancer patients was increasing. According to the British Bureau of Statistics at the time, the number of lung cancer deaths in the UK increased sharply every year from 1922 to 1947, almost 15 times the previous year. And it was not only in the UK, but also in other places.

Some awakened people ignited the flame of anti-smoking. Tobacco manufacturers certainly smelled ominous smells, and in order to cope with the crisis, they launched filter cigarettes. In 1931, the first cigarette with a built-in cotton filter was born in the United States Philip Morris. In terms of publicity, tobacco manufacturers used doctors to promote the idea that filters can filter out harmful substances, allowing smokers to enjoy smoking more.

Components of filter cigarettes: ①Cigarette filter; ②Imitation cork tip paper; ③Cigarette paper; ④Tobacco (Source: Wikipedia)

Seeing the growing anti-smoking voices, tobacco companies even set up a tobacco industry research committee and joined forces with some experts to blame the surge in lung cancer on industrial pollution and genetics. In order to fight back, the medical community expanded the concept of pathogens to "non-biological pathogens". Some people believe that when there is a lot of epidemiological evidence, even if no clear cause can be found, smoking and lung cancer should be considered as a causal relationship.

2 Difficult Birth: Nearly 20 Years of Trouble: Smoking is Harmful to Health

As early as 1949, British scientist Richard Doll and his mentor Bradford Hill visited thousands of people who were diagnosed or suspected of lung cancer and asked about their living conditions in order to find the law of cancer. Later, Doll found that many of his patients were smokers. Doll suspected that smoking and lung cancer were related. But many people did not believe it. So Doll continued to work in Cambridge and other places, collecting data from more than 5,000 people, and further confirmed that smoking causes lung cancer.

In 1951, Doll published the relevant research results in the British Medical Journal, but few people responded. The reason was: the survey data was too small and the results were unconvincing. Doll then conducted a long-term follow-up study on 34,439 male doctors. By 1956, some of these doctors who were heavy smokers had died of lung cancer, while non-smokers had almost never had this situation. They published a paper on "The Relationship between Lung Cancer and Other Causes of Death and Smoking." The second report on the mortality rate of British physicians. Doll's investigation continued afterwards. ( Note: In 2001 , Doll and his team conducted the final questionnaire survey, and then in 2004, more than 50 years after their first report, they published the final article. The 50-year study ended, and the results at this time were no longer the relationship between smoking and lung cancer, but an analysis of the life expectancy of smokers. )

Figure caption: This table shows the relationship between various diseases and smoking duration (Source: Screenshot of the paper)

In 1958, American scientists Caleb Hammond and Daniel Horn published a shocking and far-reaching research result that was even more direct: smoking is harmful to health. Compared with Doll's study, the survey data of this survey was a step up - about 20,000 volunteers were mobilized and about 200,000 elderly people were tracked. Most people chose to believe this result.

In 1962, under the pressure of the growing calls for tobacco control, the US government set up an investigation committee to investigate the relationship between cigarettes and health. Although half of the committee members smoked, they finally concluded that "smoking causes lung cancer" and believed that the filter of cigarettes could not filter out the harmful substances in cigarettes . Therefore, the investigation committee recommended tobacco control measures to the government.

On January 11, 1964 , Luther Terry, director of the U.S. Public Health Service, released the 1964 annual report, in which he summarized the committee's research, which amounted to more than 7,000 studies, and publicly recognized for the first time that smoking causes lung cancer . In order to reduce the impact on the economy, they chose to hold a press conference on a Saturday. However, this press conference still caused a huge sensation and was called "the starting point of the tobacco control movement." Soon, the number of smokers began to decrease. But not long after, the number of smokers rose again. This made officials from the Ministry of Health realize that if they wanted to control smoking, it would be difficult to achieve it with just a press conference, and more effective tobacco control measures were needed. By 1965, U.S. law clearly stipulated that a reminder that "smoking is harmful to health" must be written on cigarette packaging. In 1967, radio and television stations were required to broadcast public service advertisements against smoking. In 1971, cigarette advertising was completely banned.

On January 11, 1964, the U.S. Surgeon General published the "Report on Smoking and Health" (Source: Wikipedia)

3. Tobacco control : “ Smoking is harmful to health ” in China

In 1897, the first Chinese cigarette appeared in Shanghai and quickly became popular. Fortunately, some people in the medical community in my country soon realized the harm of cigarettes.

As early as 1934, Chinese scientist Lü Fuhua, while studying in Germany, proved experimentally that tobacco tar is carcinogenic to rabbits, and published the related article "Research on the Carcinogenicity of Rabbits Coated with Tobacco Tar" in the German journal "Frankfurt Pathology".

Since 1978, Professor Weng Xinzhi, known as the "Father of Tobacco Control in China", has joined other medical experts to publish articles and set up organizations to urge people to stay away from cigarettes. Taking advantage of the National Science Conference at that time, Professor Weng also facilitated the "Notice on Promoting the Harmfulness of Smoking and Controlling Smoking", which started China's tobacco control movement.

In 1991, my country enacted relevant laws to explicitly prohibit minors from smoking, and required that the tar content level and "smoking is harmful to health" be marked on cigarette and cigar packaging. At the same time, it was prohibited to broadcast and publish tobacco product advertisements on radio stations, television stations, newspapers and periodicals.

Since the 21st century, with the deepening of awareness of the harm of cigarettes and the increase in related research, my country's measures to control tobacco have become more and more perfect. There are more and more smoke-free public areas such as smoke-free hospitals and smoke-free carriages. As a country that has long signed the World Health Organization's Framework Convention on Tobacco Control, there are fewer and fewer public places where smoking is allowed in our country. It must be said that this is a great achievement of our country's long-term anti-smoking and tobacco control.

4 Smoking is really harmful to health: new evidence is increasing!

According to WHO statistics in 2013, there are about 1.3 billion smokers in the world, 80% of whom live in low- and middle-income countries. Tobacco causes more than 8 million deaths each year, of which about 1.3 million are non-smokers exposed to secondhand smoke. Some scholars have proposed that there is a tobacco "highway" from the mouth to the lungs, and smoking can cause a variety of fatal diseases such as lung cancer and oral cancer. In fact, the diseases we are familiar with caused by smoking are just the "tip of the iceberg".

Source: Visual China

In August 2021, a team led by Eastert of the American University of Medicine studied the effects of tobacco on hearing and vision. Through hearing and vision experiments on 40 patients with age-related macular degeneration, the researchers found that because smoking damages the body's antioxidant system and metabolic capacity , it has a negative impact on both hearing and vision .

In December 2022, a research team led by Professor Zhengming Chen of the University of Oxford, Professor Chen Wang of the Chinese Academy of Medical Sciences, and Professor Li Liming of the School of Public Health of Peking University jointly published a study in The Lancet-Public Health, which followed up more than 510,000 Chinese adults for 11 years and analyzed the relationship between cigarettes and 470 diseases and 85 causes of death . The study found that in China, cigarettes are significantly associated with 56 diseases and 22 causes of death , including infectious diseases, cancer, respiratory tract, eye, metabolic, neurological and esophageal diseases. The data showed that about 20% of men and about 3% of women in the survey died from cigarettes. And it is suggested that the sooner you quit smoking, the more obvious the benefits. However, there are thousands of ways to quit smoking, and those who successfully quit smoking are, after all, individual cases rather than a universal phenomenon.

Source: Visual China

However, a study in 2020 gave us some inspiration. In a study titled "Smoking Risk Perception Assessment," Annette and Dr. Kaufman mentioned that risk perception is people's ability to feel danger. The researchers evaluated people's risk perception of smoking, and the results showed that some people can better perceive the risks of smoking and do not smoke , but some people cannot perceive the risks of smoking well, so they choose to smoke . This may provide us with new ideas for smoking control and smoking cessation.

References:

【1】Nuwer, Rachel. Mammoths Roamed when Humans Started Using Tobacco at Least 12,300 Years Ago[J]. Scientific American, 11 October 2021.

【2】Xu Guihua. The role of Chinese tobacco control NGOs in the history of tobacco control, The 15th National Academic Symposium on Tobacco Control

【3】Jamestown. Virginia: An Overview[J]

【4】WHO official website;

【5】Doll R, Peto R. Mortality in relation to smoking: 50 years' observations on male British doctors[J]. BMJ Online First bmj.com, 22 June 2004.

【6】The Health Consequences of Smoking—50 Years of Progress, A Report of the Surgeon General[J]. US DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2014.

【7】Antigona C. Trofor1, 2, Papadakis S. Knowledge of the health risks of smoking and impact of cigarette warning labels among tobacco users in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys[J]. Tobacco Induced Diseases, 2018.

【9】Marina Istrate1, HasbeiPopa M. Effects of cigarette smoking on sensorineural hearing impairment and age related macular degeneration[J]. Tobacco Prevention & Cessation, 2021.

【9】Ka Hung Chan, Neil Wright, Xiao D. Tobacco smoking and risks of more than 470 diseases in China: a prospective cohort study[J]. lancet Public Health, 2022.

【10】Annette R. Kaufman PhD, MPH. Measuring Cigarette Smoking Risk Perceptions[J]. Nicotine & Tobacco Research, 2020.

Author: Jiuyi Popular Science Creator

Reviewer: Wu Yibo, Industry Researcher, Yangtze River Delta Health Research Institute, Shanghai Jiao Tong University

Produced by: Science Popularization China

Produced by: China Science and Technology Press Co., Ltd., China Science and Technology Publishing House (Beijing) Digital Media Co., Ltd.