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Suggested Citation:"Index." Institute of Medicine. 2001. Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction. Washington, DC: The National Academies Press. doi: 10.17226/10029.
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Index A psychological and behavioral aspects, 41, 118, 161, 254, 256-257, 259 Abortion, see Spontaneous abortions risk perception, 68 Accidents Surgeon General’s report, 24, 600 automobile, 42-44 (passim), 46, 50, 56 withdrawal, 405, 569 fires, vii, 570-571 drug treatments, 96, 101, 104-114 Accord, 4, 65, 95, 603 (passim), 123 Acetylcholine (Ach), 161, 244-245, 252, 254, nicotine pharmacology, 161, 244, 266, 269, 347, 568 245, 248, 254-260 (passim), 263- Action on Smoking and Health, 126 267 (passim) Activated charcoal filters, see Charcoal Additives, 82, 86, 90-91, 432, 571, 598, 601 filters advertising, 72, 73-74 Added ingredients, see Additives animal models, 90-91, 149 Addiction, vii, 1, 5, 25, 28, 29, 35, 40, 41, blending processes, viii, 26, 82, 85, 87, 161, 162, 201, 601 94, 128, 209, 287 see also Alcohol and drug abuse; FDA regulation, 128, 224 Relapse menthol, 62, 64, 72, 73, 77, 86-87, 98, adolescents, 261 183, 319, 406-407, 438, 439 advertising and, 66 PREP risk assessment, 144, 149, 165, African Americans, 407 212 dose-response relationship, 255-256, regulation, 128, 149, 209, 210, 212, 224- 264, 266 225 FDA attempt to regulate tobacco, 126, risk perception, 72-74, 77 127, 129, 258, 604 smokeless tobacco, 299-300 genetic predisposition to, 161, 256, 347- surveillance, 189, 196 348 Adolescents, 67, 235, 320-321, 602 nicotine pharmacology, 161, 243, 244, see also Schools 245, 248, 254-260 (passim), 263- addiction, 261 267 (passim) drug treatments, 112, 116 607

608 INDEX gender factors, 74, 172, 543, 545, 552 addiction, 261 sexual behavior, 44-46, 50, 51 body weight, 569 National Youth Tobacco Survey, 185- cancer, 389, 390, 405, 410-413, 420, 421, 187 424, 425 pregnancy, 44, 172, 543, 545, 552 cardiovascular disease, 472, 473, 474- prevalence of tobacco use, 1, 22, 38, 319 475, 482 risk perception, 41, 68, 72, 73-74, 112, chronic obstructive pulmonary (COPD), 185 503, 508, 509-511, 513, 515 sexual behavior, 44-46, 50, 51; see also dementia, 564 “pregnancy” supra dose-response relationship, 164 smokeless tobacco, 302 environmental tobacco smoke (ETS), state laws banning sales to, 120, 125, 424, 509-511 202, 604 influenza and pneumonia, 526 Surgeon General’s reports, 24, 125, 598, initiation of smoking, 73-74, 185, 191, 601 319, 331, 381, 395, 405, 425, 508, surveillance, 185, 192 543, 601 Youth Risk Behavior Survey, 93, 185- nicotine metabolism, 250 187, 261, 320-321 ocular disease, 566 Adrenal hormones, 105, 107, 108, 109, 110, orthopedic disease, 565 244, 245, 252, 253, 480, 549 PREPs, 76, 161, 164, 319, 321, 331 Adult Use of Tobacco Surveys (AUTS), 69, reproductive and developmental 76 effects, 547 Advance, 4, 92 teenage pregnancy, 44, 172, 543, 545, Advertising, 7, 8, 26, 32, 72, 86 552 see also Labeling; Marketing risk assessment, general, 67, 145, 186, additives, 72, 73-74 321 antismoking, 125 smokeless tobacco use, 93, 302 bans on, 120, 125, 597, 602 surveillance, 185, 186, 191, 192, 194, 321 children and adolescents, 24 Agency for Healthcare Research and cigarette-like products, 94 Quality, 172 historical perspectives, 60-66, 72-73, 74, AIDS, 23, 44, 45, 48, 52, 53 76, 120, 125-126, 595, 597, 602, Air pollutants, 44, 54, 225, 296, 333, 390, 603 505, 508-509, 519 regulation of, 7, 10, 120, 125-126, 127, occupational toxins, 33, 140, 151, 164, 128, 141, 203, 206, 207, 208, 211, 166, 180, 195, 298, 329, 332, 350, 216-221, 222, 229, 232, 595, 597, 375, 377, 390, 408, 419, 420, 431, 602, 603 433, 508, 599 smokeless tobacco, 93 Alcohol and drug abuse Aerosols, viii, 284-285 auto accidents, 42, 43, 44, 46, 50, 56 cigarette-like products, 93-94 behavioral treatments, 118-119 nicotine inhalers, 97-98 dementia, 564 African Americans, 321, 603 measures of, 255, 257-266 (passim) birthweight, 548 methadone, 42, 48, 49-50, 51, 52, 55, 114 cancer, 406-407, 416 naltrexone, 108 mentholated cigarettes, 72, 73, 86, 406- National Household Survey on Drug 407 Abuse, 50, 92-93, 185-187, 260, nicotine metabolism, 250 261 Age factors oropharyngeal disease, 415-416, 418 see also Adolescents; Birthweight; pharmacodynamics, 253, 570 Children; Reproductive and policy, 39-40, 46-50, 51, 52, 53, 55, 56, developmental effects 601

INDEX 609 pregnant women, 172, 545, 547 Asbestos, 89, 298, 408, 501, 599 psychological mechanisms, 41 Asians/Pacific Islanders, 22, 250, 406, 407, relapse, 47, 49 543, 603 surveillance, 195 Japanese, 88-89, 261, 286, 342, 409 synergistic effects, 342, 415-416, 418, Asthma, 170, 500-501, 518-525, 527, 530-531, 426, 428 551 Alzheimer’s disease, 254, 564-565 Atherosclerosis, 157, 162, 169, 253, 270, 296, American Cancer Society 313, 332, 339, 343, 471, 472, 476- Cancer Prevention Study (CPS) I/II, 67, 477, 479-483 (passim), 485, 490, 75, 76, 167, 170, 400, 487, 512-513, 492, 493 530, 531 Attitudes and beliefs, 54 American Indians, 22, 543, 603 see also Depression; Risk perception American Legacy Foundation Survey, 320- desire to cease smoking, 22, 71, 74-76, 321 78, 122, 186, 476, 512, 514, 515 Aneurysms, 470, 481, 491 negative opinion of tobacco use, 124- Animal models, 12-13, 15, 17, 34, 141, 149, 125, 187, 319 175, 287, 291, 293 pregnant women, 187-188 addiction, 258, 263-264, 265-266 public understanding of PREP content, additives, 90-91, 149 60 cardiovascular disease, 149, 479, 486 surveillance of, 8, 10, 185-188 (passim), cancer, 13, 293-295, 367, 374, 376, 383, 192, 196, 197 384-387, 422, 429, 432-433, 434, 435 toward unsafe behavior, negative cost of, 383 attitudes, 43 DNA adducts, 327, 385-387 Automobile safety, vii dose-response relationship, 16, 145, 163, regulation, 41-44, 50, 52, 53, 56 165 AUTS, see Adult Use of Tobacco Surveys fetal lung development, 511 infectious diseases, 296-297 nicotine antibodies, 107-108 B nicotine pharmacology, 244, 253, 258, Behavioral effects of tobacco use, 3, 118, 268 PREP risk assessment, 144, 145, 147, 389 148-149, 162, 163, 165, 208, 212- see also Inhalation depth and intensity; Smoking topography 213, 303, 350, 351, 384-386 regulatory principles, 10, 208, 212-213, addiction, 41, 118, 161, 254, 256-257, 259 215 childhood cognitive/behavioral disorders, 268, 550 reproductive and developmental effects, 550 cigarettes smoked per day, 22, 74, 88-89, transgenic animals, 298-299, 385, 391 102, 113, 115, 119, 120, 151, 163, 164, 167, 170, 173, 300, 319, 343, Antagonists, 4, 106-108, 110, 116, 244 mecamylamine, 107, 124, 266 349, 375, 391, 392, 395, 396, 398- Antibodies, 107-108, 297, 330-331 399, 401, 404, 412, 419, 437, 474, 487, 488, 489, 512, 513-514, 515, lymphocytes, 156, 296-297, 314, 338, 346, 376, 399, 417, 436, 518, 519 516, 530 Antidepressants, 4, 104-106 compensatory smoking, 2, 26, 67, 88, 121, 164, 219, 266, 285, 322, 380, see also Bupropion; Zyban nortriptyline, 4, 104, 106, 124 402, 403, 405, 477, 517 Aromatic amines, 148, 374, 377-378, 379, desire to cease smoking, 22, 71, 74-76, 78, 186, 476, 512, 514, 515 420-421 Arsenic, 72, 148, 184, 374 PREPs, 7, 73-76, 185, 197, 315 Arthritis, see Rheumatoid arthritis surveillance, 183, 185-188, 191-192, 195, 197

610 INDEX Behavioral Risk Factor Surveillance cardiovascular disease, 12, 154, 156, 168, System, 185-187, 320-321, 543 169, 253, 313, 332, 336-337, 339, Behavioral treatments, 116-119, 121, 532 343, 354, 483-486, 490-491 drug treatment, general, and, 118-119 surrogate markers, 168, 483-486, 490 nicotine replacement products and, 96, chronic obstructive pulmonary disease 115 (COPD), 170, 502 Beliefs, see Attitudes and beliefs cohort studies, 352-353, 354, 438 Benzene, 89, 95, 148, 287, 290, 374, 379 cost of techniques, 153, 315, 318, 322 Benzo[a]pyrene (BaP), 86, 87, 94, 148, 319, definitional issues, 150, 311 373-374, 375-376, 380, 391-392, environmental tobacco smoke (ETS), 407, 544 317, 323, 329, 348, 422, 436, 491 Bidis, 82, 83, 321 enzymatic processes, 314, 327, 334, 342, Biologically effective dose, 150, 160, 309- 345-346, 389 315 (passim), 326-333, 348, 350, epidemiology and, 142, 160, 161, 309, 351, 353 339, 438 cancer, 151, 166, 313, 327-330, 332-333, exposure, 145, 150-161, 237, 309-317, 380, 381, 388, 433, 435, 437 323-355, 396-397 defined, 150, 311, 388 internal exposure, 150, 151, 160, 163- Biomarkers, 11-12, 13, 16, 121, 142, 144, 145, 164, 309, 323, 349, 350, 351, 388, 149-150, 162-163, 240, 309-317, 396, 431, 435, 437 323-366 half-life, 152, 154, 156, 157, 158, 250, 297, see also Cotinine; In vitro assays; Plasma 316, 323, 324, 328, 333, 376, 422 markers; Serum markers; internal exposure, 150, 151, 160, 163- Surrogate markers; Urine 164, 309, 323, 349, 350, 351-352, biomarkers 388, 396, 431, 435, 437 biologically effective dose, 150, 151, 160, lipids, 12, 154, 169, 243, 253, 314, 330- 166, 309-315 (passim), 326-333, 331, 336-337, 343, 378-379, 471, 348, 350, 351, 353, 380, 381, 388, 479, 482, 485, 486, 491-492 433, 435, 437 leukotrines, 156, 344, 388, 519-520, biopsies, 311, 323, 341, 414, 417, 437, 518 563 bronchoalveolar lavage, 13, 156, 295, mutagenesis, 313, 314, 323, 326, 327, 338-339, 343-344, 437, 517 334, 340-342, 345, 346-347, 353; carbon monoxide as, 313, 323, 324-325, see also “carcinogenesis” supra 330-331 nicotine, 323, 324-325, 326, 347 carcinogenesis, general, 150-151, 153, see also Cotinine 154, 163-167 (passim), 333, 380, plasma markers, 99, 113, 250, 293 381, 388, 422, 424, 433, 435-436, nonneoplastic respiratory disease, 170- 437 171, 501-503, 506, 507, 512, 517, see also “mutagenesis” infra 527, 531, 532 cotinine, 407, 422, 424, 429 urine, 503, 506, 523, 524, 525, 529, DNA adducts, 153, 292, 293, 313, 531 314, 327-335 (passim), 341, 346, oropharyngeal disease, 156, 333, 342, 348, 353, 368-370 (passim), 375- 338-339 378 (passim), 385-390 (passim), platelet activation, 12, 156, 157, 168, 169, 399, 405, 409, 417, 420-424 252, 253, 296, 337-339, 343, 354, (passim), 429, 435, 492 479, 480, 481, 483-486, 490, 491, serum, 333, 422 492, 493, 561 surrogate markers, 166, 327, 330, PREP risk assessment, 142, 144, 145, 435-436 150-161, 162-163, 165, 237, 309- urine, 326, 353-354, 376, 378, 407, 317, 323-352, 388, 435-436, 553 420-421, 422, 424, 429, 435, 437

INDEX 611 regulatory issues, 10, 11-12, 207-208, Breast cancer, 385, 395, 598 211, 220, 348-349 British American Tobacco Company, 65 reproductive and developmental Bronchi, 24, 156, 500, 505, 514, 520, 522, effects, 174, 191, 545, 548, 553, 526, 551 570, 572 bronchitis, 21, 295, 338, 502, 503, 505, research recommendations, 352-355, 510, 525, 529, 551 438, 491 cancer and carcinogenesis, 285, 298, 375, saliva, 209, 267, 300, 311, 323, 325, 422, 376, 391, 392, 393, 437, 518 428, 523, 525 epithelium, 298, 375, 376, 393 standards, 348-349 Bronchoalveolar lavage, 13, 156, 295, 338- surveillance, 182, 184-185, 190-191, 196 339, 343-344, 437, 517 vascular activation, 12, 157, 169, 337, Bronchoscopy, 157, 171, 339, 392, 502-503, 490-491 517, 531 Biopsies, 311, 323, 341, 414, 417, 437, 518 Brown & Williamson, 21, 61, 92, 184, 204, Birthweight, 11, 23, 24, 149, 172, 173-174, 228, 584, 601 188, 193, 212, 267, 340-341, 344, Bupropion, 4, 98, 104, 105-106, 115, 231, 529, 543, 547-549, 550, 551, 552, 233-234, 347 554, 596 see also Zyban Black persons, see African Americans FDA actions, 123-124, 172, 552-553 Black vs blond tobacco pregnant women, 172, 174, 552-553, 554 bladder cancer, 419 Zyban, 30, 104, 123-124 hemoglobin adducts, 332 Buspirone, 109 lung cancer, 401-402 oropharnygeal cancer, 416 Bladder cancer, 24, 333, 355, 368, 377-378, C 380, 388, 390, 418-421, 428 Blending processes, viii, 26, 82, 85, 87, 94, Canada, 219 Cancer and carcinogens, 1, 4, 23, 147-148, 128, 209, 287 see also Black vs blond tobacco 163-167, 174, 367-469 Blond tobacco, see Black vs blond tobacco additives, 90-91 adenocarcinomas (AD), 392, 393, 404 Blood pressure, 154, 336-337, 343, 479, 482, 491 African Americans, 406-407, 416 hypertension, 252, 319, 477, 479, 481, age factors, 389, 390, 405, 410-413, 420, 421, 424, 425 547, 548, 568 antihypertensive drugs, 4, 107, 108- animal models, 13, 293-295, 367, 374, 109, 124 376, 383, 384-387, 422, 429, 432- 433, 434, 435 preeclampsia, 268, 560, 572 low, 107, 109, 252, 268, 269 aromatic amines, 148, 374, 377-378, 379, Body weight, 340-341, 343, 344, 422, 482, 420-421 benzene, 89, 95, 148, 287, 290, 374, 379 565, 569-570 age factors, 569 benzo[a]pyrene (BaP), 86, 87, 94, 148, birthweight, 11, 23, 24, 149, 172, 173- 319, 373-374, 375-376, 380, 391- 392, 407, 544 174, 188, 193, 212, 267, 340-341, 344, 529, 543, 547-549, 550, 551, biologically effective dose, 151, 166, 313, 552, 554, 596 327-330, 332-333, 380, 381, 388, 433, 435, 437 nicotine effects, 126, 158-159, 162, 255, 267, 270, 568-569 biomarkers, 150-151, 153, 154, 163-167 ventilation and, 286 (passim), 333, 380, 381, 388, 422, 424, 433, 435-436, 437 Bone, see Orthopedic effects Bradford Hill criteria, 381, 382

612 INDEX adducts, 153, 292, 293, 313, 314, 327- endometrial, 368, 421-422 335 (passim), 341, 346, 348, 353, lung, 24, 401, 402-403, 404-406, 410, 368-370 (passim), 375-378 411, 412, 413, 598, 599 (passim), 386-390 (passim), 399, head and neck, 195, 301, 372, 427, 428 405, 409, 417, 420-424 (passim), historical perspectives, 21-26 (passim), 429, 435, 492 367, 594, 595, 597, 598, 600, 604; cotinine, 407, 422, 424, 429 see also Surgeon General serum, 333, 422 incidence, 367, 384, 392, 410, 411, 415, 418 surrogate markers, 166, 327, 330, inflammation, 394, 416 435-436 inhalation depth and retention, 390, urine, 326, 353-354, 376, 378, 407, 392, 395, 420, 426 420-421, 422, 424, 429, 435, 437 international perspectives, 88-89, 407- biopsies, 311, 323, 341, 414, 417, 437, 518 408, 418, 423, 424, 425 bladder, 24, 333, 355, 368, 377-378, 380, in vitro assays, 154, 165, 367, 376, 383- 388, 390, 418-421, 428 384, 385, 391-392, 432 breast, 385, 395, 598 large-cell carcinomas, 392, 393 bronchial, 285, 298, 375, 376, 391, 392, liver, 376, 377, 378, 385, 386, 420, 430 393, 437, 518 low-yield products, general, 399-404 carbon monoxide, 294, 407 lung, viii, 21, 23, 24, 66, 67, 86, 88-89, cervical, 24 149, 166-167, 192, 193, 215, 293- clinical research, 165, 383, 414, 433, 437 295, 296-297, 302, 333, 342, 355, cohort studies, 377, 395, 396-397, 400- 368, 372, 385, 386, 388, 390, 391- 403, 405, 411-413, 420 415, 423, 425, 426, 431, 598 colonic, 394 cohort studies, 395, 396-397, 400-403, definition of carcinogen, 368 405, 411-413 dietary factors, 164, 166, 375, 376, 390, mortality, 392, 398, 411-414 404, 406, 408, 409, 414, 431, 433 metastasis, 297, 395, 418, 501 dose-response relationship, 163-165, mortality, 392, 398, 400, 411-414, 415, 167, 334-340, 381, 395-397, 415, 418, 419, 426, 434 416, 419, 421, 431; see also nicotine as carcinogen, 167, 402, 403, “biologically effective dose” supra 405 endometrial, 368, 421-422 nitrosamines, 4, 67, 86, 87, 91-92, 93, environmental tobacco smoke, 53, 390, 148, 151, 210, 215, 294, 300, 301, 396, 398, 408, 422-424, 434, 439, 604 319, 326-327, 328, 348, 373-374, enzymatic processes, 368, 369, 370, 376, 376-377, 379, 380, 403, 405, 429- 377, 389, 394, 433, 436 430, 603, 604 epidemiology, 165, 166, 367, 383, 418, environmental tobacco smoke, 424 420, 424 racial/ethnic differences, 406, 407 epithelial cells, 375, 376, 393, 394, 416, smokeless tobacco, 4, 93, 428, 429 420-421 oncogenes, 294, 341-342, 371, 389, 391, esophagus, 1, 23, 24, 232, 372, 377, 425, 393 429, 597 oropharyngeal, 23, 167, 301, 333, 342, exposure, 383-384, 390, 395-397, 398-399, 368, 372, 415-418, 425, 427-429, 401, 404, 412, 419, 420, 437; see 597 also “dose-response relationship” pancreatic, 372 supra particulates, 148, 374, 436 filtered cigarettes, 91, 164, 332, 399-400, polycyclic aromatic hydrocarbons 402-404, 405, 416, 419-420, 431 (PAHs), 86, 148, 149, 295, 322, gender factors, 389, 416, 418, 419, 421, 326-327, 328-331, 333, 348, 374, 424, 426, 436 375-376, 377, 379, 391-392, 418, breast, 385, 395, 598 570

INDEX 613 PREP risk assessment, 3, 150-151, 153, drug treatments and reduction of, 110, 154, 163-167, 208, 218, 222, 373, 113, 114 374-375, 379-392, 421, 430-439 regulatory issues, 210, 218 in vitro assays, 154, 167, 367, 383- reproductive and developmental 384, 385 effects, 172, 173-174, 549, 550, low-yield products, general, 399-404 552, 554 lung cancer, 294-295, 395-399, 407- smoker knowledge of, 72-73 409 surveillance, 184 see also “biomarkers” supra yield assessments, 87, 88, 90, 92, 94, 95, processing of tobacco, 85 184, 210 race/ethnicity, 406-408, 416, 436 Carcinogens, see Cancer and carcinogens regulatory issues, 10, 208, 215 Cardiovascular disease, 4, 24, 252-253, 302, research methodology, 378, 379-394, 470-499 410, 434-439 see also Blood pressure; Extracardiac research recommendations, 434-439 vascular disease serum markers, 333, 422 age factors, 472, 473, 474-475, 482 small-cell lung carcinomas (SCLC), 392, aneurysms, 470, 481, 491 393-394, 395, 402, 404 animal models, 149, 479, 486 smokeless tobacco, 4, 93, 300-301, 426-429 atherosclerosis, 157, 162, 169, 253, 270, socioeconomic factors, 407, 414; see also 296, 313, 332, 339, 343, 471, 472, “race/ethnicity” supra 476-477, 479-483 (passim), 485, squamous cell carcinomas (SCC), 67, 490, 492, 493 299, 301, 372, 392, 393, 404, 415, biomarkers, 12, 154, 156, 168, 313, 332, 418 336-337, 339, 343, 354 surrogate markers, 166, 327, 330, 435- cholesterol levels, 289, 296, 477, 482 436 cotinine, 168, 487 tar, 373-374, 399-404, 407 platelet activation, 12, 156, 157, 168, tumor suppressor genes (including 169, 252, 253, 296, 337-339, 343, p53), 155, 336, 341-342, 343, 371- 354, 479, 480, 481, 483-486, 490- 372, 375, 376, 391-392, 393-394, 491, 492, 493, 561 405, 409, 415, 417, 418-419, 420, surrogate markers, 168, 483-486, 490 421, 428-429, 435 urine, 485, 486 urine biomarkers, 326, 353-354, 376, 378, carbon monoxide, 168, 481, 487 407, 420-421, 422, 424, 429, 435, children, 482, 493 437 cholesterol levels, 289, 296, 477, 482 volatile organic compounds, 89, 148, clinical research, 168, 169-170, 212, 491 374 coronary heart disease, viii, 1, 21, 23, 67, Cancer Prevention Study (CPS) I/II, 67, 75, 157, 195, 208, 212, 222, 252-253, 76, 167, 170, 400, 487, 512-513, 347, 470, 471-481, 483, 487, 488, 530, 531 505, 599 Carbon monoxide, 2, 24, 26, 86, 288, 517, cotinine, 168, 487 570, 597 dose-response relationship, 167-168, see also Potential reduced-exposure 169, 471, 472, 473, 477, 483, 486- products (PREPs) 487 behavioral treatments and reduction of, endothelial function, 479, 480, 481, 484- 117 485, 486, 490, 491, 492 as biomarker, 313, 323, 324-325, 330-331 environmental tobacco smoke (ETS), cancer, 294, 407 169, 470, 478, 491 cardiovascular disease, 168, 481, 487 enzymatic processes, 478, 484, 487 cigarette-like products, 94, 95 epidemiology, 471, 472, 473, 477

614 INDEX exposure, 474, 477; see also “dose-response Cessation programs, vii, x, 24, 41, 116-119, relationship” supra 352 filtered cigarettes, 168 see also Behavioral treatments; Chewing gender factors, 168, 472, 473, 477, 481, gum; Drug treatments Oral/ 482 nasal sprays; Patches; genetic factors, 478, 490, 492 Psychotrophic drugs; School- incidence, 167, 470, 471, 472, 473, 479, 487 based prevention/cessation inflammation, 168, 252, 253, 270, 291, programs 482-483, 485, 490, 491, 492 Charcoal filters, 88, 89, 92, 94, 286, 287, 406, in vitro assays, 168, 480 603 lipids and lipoproteins, 12, 154, 169, Chewing gum, vii, 4, 5, 14, 91, 96, 98, 99, 253, 314, 330, 336-337, 343, 471, 101, 103, 113-114, 115, 129, 253, 479, 482, 485, 486, 491-492 266-267, 599 low-yield products, 471, 477 cardiovascular disease, 471 mortality, 470, 472, 473, 477, 487 Nicorete, 97, 123, 129 nicotine, 168, 470-471 Chewing tobacco, 83, 84, 247-248, 426, 428 nicotine replacement therapy (NRT), 98- Children, 320-321 99, 112, 115, 252-253, 471 see also Adolescents; Birthweight; platelet activation, 12, 156, 157, 168, 169, Reproductive and developmental 252, 253, 296, 337-339, 343, 354, disorders; Schools 479, 480, 481, 483-486, 490-491, advertising, 24 492, 493, 561 asthma, 501, 518-525 (passim), 530, 551 pregnant smokers, children of, 545, 548, cardiovascular disease, 482, 493 552 cognitive deficits, 268, 550-551 regulatory issues, 10, 208, 212 environmental tobacco smoke, 286, 348, research recommendations, 491-493 422, 500, 510-511, 521, 522-525, risk assessment, 149, 154, 162, 167-170, 528-530, 549; see also Family/ 174, 208, 212, 222, 470-499, 598, home factors 599 nonneoplastic respiratory diseases, 500, risk perception, 68 501, 506, 508, 510-511, 518-526 stroke, 24, 168, 470, 473, 476, 487, 489, (passim), 528-530, 551 600 prevalence of tobacco use, 1 surgery, 473, 476 respiratory infections, 501, 506, 526, surrogate markers, 168, 483-486, 490 528-529, 551 surveillance, 188, 193, 195 sales of tobacco to, 120, 125, 202, 604 synergistic effects of toxins, 477-478 Cholesterol levels, 289, 296, 477, 482 thrombosis, 154, 157, 336-337, 339, 356, Chromosomes, 152, 293, 313, 314, 333, 334- 481, 485-486, 491 335, 340, 341, 342, 346, 368, 369, urine biomarkers, 485, 486 372, 389, 391, 393, 406, 414-415, vascular activation, 12, 157, 169, 337, 417, 419, 420, 435, 545 490-491, 493 see also Mutagenesis and mutagens Caucasians, 73, 86, 250, 406, 407, 416, 513, loss of heterozygosity, 152, 313, 314, 543, 548 334, 340, 342, 391, 393, 414-415, Cell cultures, see In vitro assay 419, 435 Centers for Disease Control and Prevention Chronic obstructive pulmonary disease (CDC), 207, 221 (COPD), 1, 21, 23, 149, 174, 302, smokeless tobacco, 93 500, 503-518, 520, 527, 530-531, surveillance, general, 180, 184, 185 532, 584, 598, 599 Youth Risk Behavior Survey, 93, 185- age factors, 503, 508, 509-511, 513, 515 187, 261, 320-321 animal studies, 13, 295 Cerebrovascular disease, see Stroke biomarkers, 170, 502

INDEX 615 bronchitis, 21, 295, 338, 502, 503, 505, Cohort studies, 174, 193, 196, 437-438, 482, 510, 525, 529, 551 548, 567 clinical studies, 13, 171 biomarkers, 352-353, 354, 438 definition of, 503 bladder cancer, 377, 420 epidemiology, 503-505, 509, 512 chronic obstructive pulmonary disease gender factors, 500, 509, 512, 514, 515, 516 (COPD), 511 mortality, 505, 508, 509, 512, 513-514 diabetes, 567 Surgeon General’s report, 24 lung cancer, 395, 396-397, 400-403, 405, synergistic effects of toxins, 508-509 411-413 time factors, 503, 511-512 pregnant women, 173, 547 ventilation, 503, 510 College of American Pathologists, 349 Cigarette Labeling and Advertising Act, Colon 125 cancer, 394 Cigars, viii, 82, 83, 85, 243-244, 425-426, 473, inflammatory bowel disease, 174, 302, 508, 597 560, 561-562, 574 Clinical research, 7, 13, 16, 17, 34, 115-116, Combustion, viii, 3, 4, 66, 210, 598 147, 175-176, 232, 238, 352, 584 cigarette-like products, 93 see also Biomarkers fires and fire-safe cigarettes, 87, 571, 604 addiction, 263, 264-266 measurement, 284 behavioral treatments, 116-118 nicotine pharmacology, 243 body weight, 570 surveillance, 184 cancer, 165, 383, 414, 433, 437 temperature factors, viii, 27, 210, 284 cardiovascular disease, 168, 169-170, Compensatory smoking, 2, 26, 67, 88, 121, 212, 491 164, 219, 266, 285, 322, 380, 402, clonidine, 108-109 403, 405, 477, 517 cytochrome P-450, 109-110 Comprehensive Smokeless Tobacco Health depression, 569 Education Act, 125 antidepressants, 105-106, 115-116 Comprehensive Smoking Health Education FDA drug approval criteria, 122, 215, Act, 125 227 Consumer Product Safety Act, 125 nicotine antagonists, 107 Contraceptives nicotine replacement products, 96, 101- devices, 45 103, 113-115, 533 oral, 477, 481, 544, 597 nonneoplastic respiratory disease, 13, Controlled Substances Act, 123, 125 171, 511-512, 514, 518, 522, 523- COPD, see Chronic obstructive pulmonary 525, 529, 530, 532-533 disease regulatory issues, 122, 208, 209, 212, Coronary heart disease, viii, 1, 21, 23, 67, 213, 215, 227, 229 157, 195, 208, 212, 222, 252-253, reproductive and developmental 347, 470, 471-481, 483, 487, 488, effects, 173-174, 547, 548, 554 505, 599 subjects unwilling/unable to quit, 122 Coronary vascular disease, see surveillance and, 183, 193, 197 Cardiovascular disease tobacco industry product testing, 128 Cost factors, monetary, 383 Clonidine, 4, 108-109, 124 aggregating harm, 55 Coalition on Smoking and Health, 126 animal models, 383 Cognitive effects auto accidents, 44 aging, 162 biomarkers, 153, 315, 318, 322 dementia, 174, 254, 564-565 cigarettes, 119, 129, 187, 262 developmental disorders, 268, 550-551 taxation, 119, 128, 202, 596, 603 memory, 254, 319, 564 drug treatments, 110 nicotine, 254, 255, 259, 270, 564 funding, 49, 215, 218, 229

616 INDEX health insurance discounts, 598 Dementia, 174 in vitro studies, 149 Alzheimer’s disease, 254, 564-565 nicotine replacement products, 101-102, Demographic factors, see Age factors; 129, 554-555 Educational attainment; Gender surveillance, 181, 195 factors; Military personnel; Cotinine, 174, 184-185, 187, 293, 321, 323, Race/ethnicity; Socioeconomic 324, 325, 326, 348, 353 status carcinogenesis, 407, 422, 424, 429 Department of Justice, 603 cardiovascular disease, 168, 487 Depression, 104, 174, 186, 256-257, 347, 568- drug treatments, 109-110, 114 569 nonneoplastic respiratory disease, 517, antidepressants, 105-106, 115-116, 254, 523, 525, 526, 529, 530, 532 256, 570 pharmacology of, 248, 249, 250, 265 Dermatologic diseases, 158, 174, 193-194, pregnancy, 545, 548, 553, 572 246, 301, 338-339, 385, 566 surveillance, 184-185, 187 Developmental disorders, see Reproductive Court cases, see Litigation and developmental disorders Crohn’s disease, 561-562, 574 Devices, see Medical devices Curing of tobacco, 8, 82, 83, 84, 91, 128, 189, Diabetes, 174, 482, 548, 567 209, 299-300 Diagnostic and Statistical Manual of Current Population Survey, 185-187 Mental Disorders (DSM), 255, Cyanide, 72, 89, 291, 324-325, 401, 549, 561, 257, 258-259, 260-262 572 Dietary factors, 89, 151, 175, 206, 294, 296, Cytochrome P-450, 109, 152, 248, 269, 298, 325, 329, 333, 508, 573 323, 327, 334, 342, 375, 377, 378, cancer, 164, 166, 375, 376, 390, 404, 406, 385, 409, 417, 421, 570 408, 409, 414, 431, 433 pregnancy, 547 DNA, 291-292, 294, 299, 313, 314-315, 342- D 343, 344-347, 353, 368-370, 372, 384, 385, 486, 492 Definitional issues, 27-28 adducts, 153, 292, 293, 313, 314, 327-335 see also Standards (passim), 341, 346, 348, 353, 368- biomarkers assessment, 150, 311 370 (passim), 372, 375-378 carcinogen, 368 (passim), 385-390 (passim), 398- chronic obstructive pulmonary (COPD), 399, 405, 409, 417, 420-424 503 (passim), 429, 435, 492 cigar, 83 chromosomes, 152, 293, 313, 314, 333, cigarette, 27, 82, 83 334-335, 340, 341, 342, 346, 368, Diagnostic and Statistical Manual of 369, 372, 389, 391, 393, 406, 414- Mental Disorders (DSM), 255, 415, 417, 419, 420, 435, 545 257, 258-259, 260-262 loss of heterozygosity, 152, 313, 314, exposure, 1, 27-28, 311 334, 340, 342, 391, 393, 414-415, harm reduction, 2, 25, 38-40 419, 435 hazard identification, 33-34 repair, 152, 315, 326, 332, 334, 342-347 mutagen, 368 (passim), 369-370, 372, 376, 377, nicotine, 27, 126 378, 388, 389, 390, 394, 399, 409, PREPs, 3, 28, 205 478 regulatory, 11, 27-28, 30, 124, 126, 205, Dopamine, 105, 109, 110, 244, 245, 256, 257, 225-226 266, 347-348, 551, 568, 571, 572 safer cigarette, 2, 25 Dose-response relationship, viii, ix, 9, 11, surveillance, 180, 181, 194 14, 15, 16, 33, 34, 111, 149-161, tobacco constituent, 368 316, 326-333, 343

INDEX 617 see also Biologically effective dose; antidepressants, 4, 104, 106, 124; see also Exposure Bupropion addiction, 255-256, 264, 266 antihypertensive drugs, 107, 108-109 age factors, 164 clonidine, 4, 108-109, 124 alcohol use, 415, 416 behavioral therapy and, 96, 115, 118-119 animal models, 16, 145, 163, 165 carbon monoxide, reduction of, 110, antidepressants, 105-106 113, 114 cancer, 163-165, 167, 334-340, 381, 395- cardiovascular disease and, 110, 113, 397, 415, 416, 419, 421, 431 114 cardiovascular disease, 167-168, 169, committee charge, 3-4, 31-32, 33, 34, 471, 472, 473, 477, 483, 486-487 142, 202-203, 205 dermatologic conditions, 566 cost of, 110 environmental tobacco smoke (ETS), cotinine, 109-110, 114 423-424, 436 definitional issues, 27, 28 exposure-to-adverse effect, ix, 140, 145, Food and Drug Administration, 29-30, 166, 511, 530 205, 226-228 gender factors, 164 bupropion, 123-124, 172, 552-553 historical perspectives, 23 Investigational New Drug, 122, 215 nicotine replacement doses per day, historical perspectives, 95 255-256, 264, 266 mortality reduction, 111, 112-113 nonneoplastic respiratory disease, 170, nicotine receptors, 97, 103, 105, 106-107, 171, 510-514, 521, 523, 527-528, 110 531, 532 over-the-counter drugs, 31, 94, 96, 97, ocular disease, 565 102, 110, 120, 123, 263 oropharyngeal disease, 415 pregnant women, 116 Parkinson’s disease, 571-572 relapse into smoking, 111 PREP risk assessment, 14, 15, 33, 34, withdrawal, 96, 101, 104-114 (passim), 140, 141, 144-147, 152, 154, 156, 123 158, 159, 160, 167, 237-238, 271, DSM, see Diagnostic and Statistical Manual 310, 312, 325, 326, 352, 381, 395- of Mental Disorders 396 Dye exclusion tests, 292 race/ethnicity, 164, 407 renal disease, 567-568 rheumatoid arthritis, 562 E reproductive and developmental effects, 172-173, 544, 545, 546, Eclampsia, see Preeclampsia Eclipse, 4, 65, 94-95, 129, 215, 517-518, 602 548, 550, 554-555 time factors, ix, 140, 141, 145, 511 Economic factors, see Cost and cost-benefit Drug abuse, see also Alcohol and drug factors; Funding; Socioeconomic status; Taxation abuse; Addiction Drug interactions, 122, 269, 570 Education, see Labeling; Public education Drug treatments, 2, 9, 17, 25, 29-30, 82, 95- Educational attainment, 390, 425, 530, 543, 547, 564 116, 121 see also Chewing gum; Medical devices; Emphysema, see Chronic obstructive Nicotine replacement therapy; pulmonary disease Employment factors, see Workplace Oral/nasal sprays; Psychotrophic drugs; Patches Endometrial cancer, 368, 421-422 adolescents, 112, 116 Endothelial function, 161-162, 168, 169, 302, 354 antagonists, 4, 106-108, 110, 116, 244 mecamylamine, 107, 124, 266 cardiovascular disease, 479, 480, 481, 484-485, 486, 490, 491, 492

618 INDEX nicotine pharmacology, 252, 253, 268, cytochrome P-450, 109, 152, 248, 269, 270 298, 323, 327, 334, 342, 375, 377, reproductive and developmental 378, 385, 409, 417, 421, 570 effects, 546, 548, 572 mitochondria, 154, 314, 336-337, 341, 394 Enforcement, 11, 30, 40, 43-44, 48, 120, 125, Epidemiology, 15, 16, 17, 23, 26, 33, 34, 183, 196, 207, 209, 226, 238, 239 193, 195, 197, 202, 594 Environmental interventions, 119-121, 256 see also Cohort studies; Mortality; public smoking restrictions, 120, 206, Surveillance 225, 597, 599, 600, 601 asthma, 518-519, 520, 521 workplace restrictions, 119-120, 422 biomarkers and, 142, 160, 161, 309, 339, Environmental tobacco smoke (ETS), vii, 5, 438 25, 35, 51, 53-54, 147-148, 201, cancer, 165, 166, 367, 383, 418, 420, 424 597, 604 cardiovascular disease, 471, 472, 473, age factors, 424, 509-511; see also 477 “children” infra chronic obstructive pulmonary (COPD), asthma, 521-522 503-505, 509, 512 biomarkers, 317, 323, 329, 348, 422, 436, dose-response assessments, 140 491 environmental tobacco smoke (ETS), cancer, 53, 390, 396, 398, 408, 422-424, 424, 509-510, 521 434, 439, 604 orthopedic effects, 565 cardiovascular disease, 169, 470, 478, 491 PREPs, 6, 7, 8, 10, 13-14, 141, 142, 147, children, 286, 348, 422, 500, 510-511, 153, 160, 165, 193, 195, 197, 203, 521, 522-525, 528-530, 549; see also 206, 208, 221, 222, 229, 232, 236, “family...” and “reproductive...” 238, 437-438, 584 infra regulatory issues, 8, 10-11, 129, 203, 206, cigarette-like products, 94 207, 208, 221, 222, 229 dose-response relationship, 423-424, 436 smokeless tobacco, 301 epidemiology, 424, 509-510, 521 Epithelial cells, 244-245, 295, 313, 316, 563 family/home factors, 120, 186, 319, 422, bladder cancer, 420-421 510, 521, 523, 525, 528, 544, 597 bronchial, 298, 375, 376, 393 gender factors, 424, 544, 545, 548, 551, 599 cancer, 375, 376, 393, 394, 416, 420-421 infants, 549 respiratory system, other than bronchi, international perspectives, 423, 424 500, 519, 525-526 nitrosamines, 424 wound healing, 561 nonneoplastic respiratory diseases, 500, Erectile dysfunction, 545 509-511, 521-522, 528-530, 531, Esophageal cancer, 1, 23, 24, 232, 372, 377, 551 425, 429, 597 regulatory factors, 225; see also Estrogen, 346, 405, 422, 566 Environmental interventions Ethnicity, see Race/ethnicity reproductive and developmental ETS, see Environmental tobacco smoke effects, 544, 545, 548, 549, 551 Exposure, viii, 31, 33-34, 140, 141, 143, 145, Surgeon General’s report, 24, 597, 600 232, 583 surveillance, 194 see also Dose-response relationship; toxicology, 283, 285, 287, 289-290 Environmental interventions; Enzymatic processes, 84, 152, 166, 253, 292, Environmental tobacco smoke; 505, 571, 570 Inhalation depth and retention; biomarkers, 314, 327, 334, 342, 345-346, Potential reduced-exposure 389 products (PREPs); Yield carcinogenesis, 368, 369, 370, 376, 377, assessment 389, 394, 433, 436 biomarkers, 145, 150-161, 237, 309-317, cardiovascular disease, 478, 484, 487 323-355, 396-397

INDEX 619 internal exposure, 150, 151, 160, 163- Federal government 164, 309, 323, 349, 350, 351, 388, see also Legislation; Regulatory issues; 396, 431, 435, 437 specific departments and agencies cancer risk, 383-384, 390, 395-397, 398- funding, 49, 215, 218, 229 399, 401, 404, 412, 419, 420, 437 national surveillance system, 8, 181, 207 cardiovascular disease, 474, 477 national tobacco control program, 7, 35, cigarettes smoked per day, 22, 74, 88-89, 202, 206-207, 229, 232 102, 113, 115, 119, 120, 151, 163, Federal Trade Commission (FTC), 15, 30, 164, 167, 170, 173, 300, 319, 343, 67, 207, 210, 600 349, 375, 391, 392, 395, 396, 398- marketing, 61, 211, 213 399, 401, 404, 412, 419, 437, 474, PREPs, 2, 15, 26, 61, 67, 207, 210, 221, 487, 488, 489, 512, 513-514, 515, 227, 350 516, 530 smoking machines, 2, 3, 26-27, 87-88, 90, compensatory smoking, 2, 26, 67, 88, 210-211, 226, 283-284, 317-319, 121, 164, 219, 266, 285, 322, 380, 350, 352, 373, 380, 395, 404 402, 403, 405, 477, 517 surveillance, 183, 184, 189, 190 definitional issues, 2, 27-28, 311 Females, see Gender factors duration of smoking, 67, 76, 151, 168, Fertility, 173, 544-545 390, 395, 396-397, 401, 402, 404, Fetal lung development, 149, 298, 511, 551 419, 420, 471, 493, 508, 566, 572 FEV, see Forced expiratory volume duration of smoking cessation, 75, 115, Fibers, 89, 94, 165, 189, 225 186, 409-415, 419, 438, 470, 473, Fibroblasts, 561, 563 475, 476, 487, 490, 562 Filters, 2, 26, 52, 56, 60, 64, 82, 88, 89-90, 91, exposure-to-adverse effect, ix, 140, 145, 92, 121 166, 511, 530 see also Ventilation historical perspectives, vii, 26-27 cancer risk, 91, 164, 332, 399-400, 402- nicotine replacement doses per day, 98, 404, 405, 416, 419-420, 431 105-106, 113, 248 cardiovascular disease, 168 PREPs, 31, 33, 34, 140, 141, 143, 145, 148, charcoal, 88, 89, 92, 94, 286, 287, 406, 150-161, 191, 237-238, 309, 310, 603 311, 323, 349, 350, 351 cigars, 83 regulatory principles, 10, 204, 207-208, 215 DNA adducts, 332 research methodology, 309-366 FDA regulation, 128 snuff, daily consumption, 300 historical perspectives, 379, 594, 595, surveillance, 191 601 Extracardiac vascular disease, 470, 481, 545, international perspectives, 286 552, 561, 563, 565 oropharyngeal disease, 416 placental, 545 regulatory issues, 128, 210, 225 stroke, 24, 168, 470, 473, 476, 487, 489, 600 risk assessment, 143, 164, 168, 399-400, Eyes, see Ocular disease 402-404 surveillance, 183, 189 toxicological measures, 284, 287 F ventilation, 26, 71, 87, 88, 89, 90, 121, 211, 286, 287, 317, 380, 399, 597 Fagerström Tolerance Questionnaire, 260 Fires, vii, 570-571 Family/home factors, 120, 186, 319, 422, Fire Safe Act, 87, 571 510, 521, 523, 525, 528, 544, 597 Fire-safe cigarettes, 87, 571, 604 see also Genetic factors Food and Drug Administration (FDA), 30, FDA, see Food and Drug Administration 207 Federal Cigarette Labeling and Advertising addiction, 126, 127, 129, 258, 604 Act, 595 additives, 128, 224 Federal Communications Commission, 125

620 INDEX bupropion, 123-124, 172, 552-553 nicotine pharmacokinetics, 247-248 clinical trial criteria, 122, 215, 227 nicotine replacement therapy (NRT), committee charge, 3-4, 41, 205 267, 270 definition of cigarette, 27, 126 peptic ulcers, 175, 560-561, 573 devices, 30, 91, 124, 125-126, 127, 128, Gender factors, 233, 321, 597 129, 204, 205, 206, 228 see also Pregnancy; Reproductive and drug treatments, 29-30, 205, 226-228; see developmental effects also “nicotine replacement...” infra adolescents, 74, 172, 543, 545, 552 bupropion, 123-124, 172, 552-553 sexual behavior, 44-46, 50, 51 investigational new drug, 122, 215 advertising, 74 filters, 128 cancer, 389, 416, 418, 419, 421, 424, 426, labeling, 27, 122, 123, 128, 227 436 litigation, 21, 30, 124, 127-128, 204, 227, breast, 385, 395, 598 228, 604 endometrial, 368, 421-422 marketing, 128, 205 lung, 24, 401, 402-403, 404-406, 410, processing of tobacco, 128 411, 412, 413, 598, 599 nicotine levels, 29, 30 cardiovascular disease, 168, 472, 473, nicotine replacement products, viii, 29, 477, 481, 482 91, 95-96, 123-124, 172, 204-205, chronic obstructive pulmonary (COPD), 552-553 500, 509, 512, 514, 515, 516 outline of drug approval process, 122- clonidine treatments, 108 123 contraceptives, 45, 477, 481, 544, 597 PREPs, 15, 122-124, 129-130, 141, 181, dermatologic conditions, 566 204-205, 206, 209, 221, 226-227 dose-response relationship, 164 see also “nicotine replacement environmental tobacco smoke (ETS), products” supra 424, 544, 545, 548, 551, 599 surveillance, 181 inflammatory bowel disease, 561-562 tobacco, 27, 124-130, 204, 205, 227, 228, low-yield products, 74, 404-405 604 menthol cigarettes, 87 Food, Drug and Cosmetic Act, 30, 122, 124, nicotine replacement therapy, 267-268 125-126, 128, 204, 205, 206, 214 oropharyngeal disease, 416 Forced expiratory volume (FEV), 156, 171, osteoporosis, 565 338, 343, 503, 506, 508-509, 514- prevalence of smoking, 22, 74, 87, 404 515, 516, 520, 523, 532-533 renal disease, 568 Framework Convention on Tobacco respiratory diseases, 416, 520 Control, 25 chronic obstructive pulmonary Free radicals, 91, 253, 378, 389, 485, 486, (COPD), 500, 509, 512, 514, 515, 506, 561, 566, 572 516 FTC, see Federal Trade Commission lung cancer, 24, 401, 402-403, 404- Funding, 49, 215, 218, 229 406, 410, 411, 412, 413, 598, 599 rheumatoid arthritis, 562 risk assessment, general, 67, 145, 164, G 168 sexual behavior, 44-46, 50, 51 Gallup Organization, 68, 70 smokeless tobacco use, 93 Gastrointestinal tract surveillance, 187 carcinogens, general, 372 Genetic factors, 310 Crohn’s disease, 561-562 see also Cancer and carcinogens; DNA; esophageal cancer, 1, 23, 24, 232, 372, Gender factors; Mutagenesis and 377, 425, 429, 597 mutagens; Reproductive and inflammatory bowel disease, 174, 302, developmental effects 560, 561-562, 574

INDEX 621 addiction, predisposition to, 161, 256, pregnant smokers, 546, 549 347-348 Hepatic system, 109, 248, 250, 269 animal models, 165 cancer, 376, 377, 378, 385, 386, 420, 430 cardiovascular disease, 478, 490, 492 Heterocyclic amines, 148, 288, 374, 377, 379 chromosomes, 152, 293, 313, 314, 333, Heterozygosity, loss of (LOH), 152, 313, 334-335, 340, 341, 342, 346, 368, 314, 334, 340, 342, 391, 393, 414- 369, 372, 389, 391, 393, 406, 414- 415, 419, 435 415, 417, 419, 420, 435, 545 Hispanics, 321, 406, 543, 603 loss of heterozygosity, 152, 313, 314, Historical perspectives, vii, 1, 2, 21-22, 23, 334, 340, 342, 391, 393, 414-415, 26-27, 60-81, 89-91, 573, 593-605 419, 435 alcohol abuse reduction, 47 cytochrome P-450, 109, 152, 248, 269, asthma, 519, 520, 521 298, 323, 327, 334, 342, 375, 377, cancer risk, general, 21-26 (passim), 367, 378, 385, 409, 417, 421, 570 594, 595, 597, 598, 600, 604 nicotine metabolism, 252, 270-271 FDA approval of over-the-counter nicotine replacement therapy, 270 drugs, 123 nonneoplastic respiratory disease, 170, filtered cigarettes, 379, 594, 595, 601 501-502 label warnings, 219, 595, 599 oncogenes, 294, 341-342, 371, 389, 391, nicotine pharmacology, 243, 593-595, 393 597 polymorphisms, 252, 256, 314, 315, 345, nicotine replacement products, 113, 599, 346, 347, 405-406, 409, 478, 526 601 RNA, 152, 153, 299, 314, 334, 353, 389 nonneoplastic respiratory diseases, 500, tobacco, genetically altered, 189 506, 598, 599 toxic effects, susceptibility, ix, 6, 13, 145, regulation of tobacco industry, 124-130, 153, 164, 166, 192, 233, 344-347, 595-604 390, 408-409, 416, 429, 436, 478, Surgeon General’s reports, 21-26 490, 508 (passim), 69, 125, 379, 380-381, transgenic animals, 298-299, 385, 391 513, 595-603 (passim) tumor suppressor genes (including surveillance, 181 p53), 155, 336, 341-342, 343, 371- tar content of cigarettes, 379 372, 375, 376, 391-392, 393-394, HIV, see AIDS 405, 409, 415, 417, 418-419, 420, Home factors, see Family/home factors 421, 428-429, 435 Homocysteine, 483, 491 Genomics, 12-13, 154, 342, 370-371, 393, Hormonal effects, 179, 255, 268, 405, 406, 490, 492, 503 544, 551 GlaxoWellcome Pharmaceutical, 585 adrenal, 105, 107, 108, 109, 110, 244, 245, Glycerin, 86, 94 252, 253, 480, 549 Growing Up Tobacco Free, 211, 219 androgens, 422 Gum, see Chewing gum estrogen, 346, 405, 422, 566 fertility, 544 progesterone, 405 H Host susceptibility, ix, 6, 13, 145, 153, 164, 166, 192, 233, 344-347, 390, 408- Health insurance discounts, 598 409, 416, 429, 436, 478, 490, 508 Heart disease, see Coronary heart disease; Human Genome Project, 503 Cardiovascular disease Hypertension, 252, 319, 477, 479, 481, 547, Hemoglobin, 156, 294, 314, 324, 338, 396, 548, 568 398, 481, 561 antihypertensive drugs, 107, 108-109 adducts, 313, 330, 332, 333, 376, 378, clonidine, 4, 108-109, 124 398, 399, 429 preeclampsia, 268, 560, 572

622 INDEX I anti-inflammatory agents, 123, 561 carcinogenesis, 394, 416 Immune system, 24, 149, 182, 254, 269, 270, cardiovascular disease, 168, 252, 253, 270, 291, 296-298, 563, 597 291, 482-483, 485, 490, 491, 492 see also Infectious diseases; gingivitis, 563-564 Inflammation pelvic inflammatory disease, 544-545 AIDS, 23, 44, 45, 48, 52, 53 placental, 546 antibodies, 107-108, 330-331 respiratory, 12, 13, 95, 113, 149, 156, diabetes, 174, 482, 548, 567 170-171, 295, 298, 302, 338, 343- leukocytes, 314, 492, 506-507, 527 344, 395, 502, 505, 506, 507, 516- leukotrines, 156, 344, 388, 519-520, 563 518, 527, 531, 533 lymphocytes, 156, 296-297, 314, 338, 346, asthma, 170, 500-501, 518-525, 527, 376, 399, 417, 436, 518, 519 530-531, 551 macrophages, 293, 296, 297, 344, 484, Inflammatory bowel disease, 174, 302, 560, 506, 517, 518, 526, 561 561-562, 574 neutrophils, 156, 338, 344, 485, 508, 517, Influenza, 297, 502, 526, 530 518, 561 Information dissemination, see Advertising; nonneoplastic respiratory disease, 526, Labeling; Marketing; Public 527 education particulates, 297-298 Inhalation depth and retention, 210, 219, preeclampsia, 572 252, 322 rheumatoid arthritis, 174, 562 cancer, 390, 392, 395, 420, 426 susceptibility to toxic effects, ix, 6, 13, cardiovascular disease, 471, 473 145, 153, 164, 166, 192, 233, 344- compensatory smoking, 2, 26, 67, 88, 347 285, 322 Immunoglobulin, 296, 519, 526, 527, 562 menthol cigarettes, 73, 86 Incidence of disease, general, vii, viii, 14, Inhalers, see Oral/nasal sprays 66, 596 Innovative products, see Potential reduced- see also Epidemiology; Risk assessment; exposure products (PREPs); Surveillance Technological innovation cancer, 367, 384, 392, 410, 411, 415, 418 International Agency for Research on cardiovascular disease, 167, 470, 471, Cancer (IARC), 293, 374 472, 473, 479, 487 International Diagnostic Code, 257, 258-259 nonneoplastic respiratory diseases, 500, International perspectives 518, 519, 526 addiction, 261 PREPs, 5-6, 193 bidis, 83 Infectious diseases cancer, 88-89, 407-408, 418, 423, 424, 425 AIDS, 23, 44, 45, 48, 52, 53 environmental tobacco smoke (ETS), animal models, 296-297 423, 424 bladder, 418 filters, 286 intrautrine, 547 label warnings, 219 oral, 563 oropharyngeal disease, 415, 416 placental, 546 prevalence of tobacco use, 23, 88-89 respiratory, 170, 296, 297, 354, 500-501, smokeless tobacco, 93, 300, 426-428 502, 506, 508, 516, 525-531, 532, snus, 4, 14, 167, 204, 270, 300, 301, 546, 547, 551 302, 427, 428, 434 influenza, 297, 502, 526, 530 smoker knowledge of toxins, 72-73 pneumonia, 501, 502, 526, 527-528, International Standards Organization, 87, 529, 530, 551 283 tuberculosis, 501, 526, 528 International Workshop on Genotoxicity Inflammations, 144, 162, 169, 291, 338-339 Test Procedures, 292

INDEX 623 Internet fire-safe cigarettes, 87, 571, 604 cigarette-like products, 94 Food, Drug and Cosmetic Act, 30, 122, marketing of tobacco, 190 124, 125-126, 128, 204, 205, 206, smoke yields, 92 214 Investigational New Drug, 122, 215 label warnings, 216-217, 219-221 In vitro assays, 160, 215, 291-292 minors, sales of tobacco to, 120, 125, cancer, 154, 165, 367, 376, 383-384, 385, 202, 604 391-392, 432 Public Health Cigarette Smoking Act, cardiovascular disease, 168, 480 125 PREPs, 12, 34, 144, 148-149, 151, 152, public smoking restrictions, 120, 206, 154, 156, 158, 160, 168, 208, 212, 225, 597, 599, 600, 601 215, 303, 350, 351 state tobacco laws, 125, 207, 571, 584, cancer, 154, 167, 367, 383-384, 385, 601, 604 432 surveillance, 188, 197 tobacco products regulation, committee recommendation, 204, 205 J Toxic Substances Control Act, 125 see also Regulatory issues Japan, 88-89, 261, 286, 342, 409 Leptin, 268, 378-379 Leukocytes, 314, 492, 506-507, 527 Leukoplakia, 415, 427, 429, 563 K Leukotrines, 156, 344, 388, 519-520, 563 Kidneys, see Renal disease Life expectancy, 23 Kreteks, 83, 321 Light cigarettes, see Low-yield products Lipids and lipoproteins, 12, 154, 169, 243, 253, 314, 330-331, 336-337, 343, L 378-379, 471, 479, 482, 485, 486, 491-492 Labeling, 7, 10, 17, 29, 203, 206, 207, 208, leukotrines, 156, 344, 388, 519-520, 563 211, 213, 216-221, 222, 229, 232 Litigation definition of cigarette, 27 additives, 90-91 FDA criteria, 27, 122, 123, 128, 227 FDA jurisdiction, 21, 30, 124, 127-128, health warnings, 125, 215-216, 219-221, 204, 227, 228, 604 595, 599 smoke yield assessment, 211 historical perspective, 219, 595, 599 tobacco companies, litigation against, nicotine replacement products, 123 126, 595, 601-604 Legal issues, 207 Liver, see Hepatic system see also Litigation; Regulatory issues Lorillard Tobacco Company, 184, 584 Legislation Loss of heterozygosity, see Heterozygosity, advertising, bans on, 120, 125, 597, 602 loss of automobile safety belts, 42, 43 Low-yield products, 4, 27, 28, 73-76, 89-90, Cigarette Labeling and Advertising Act, 95, 116, 205, 319, 432, 532, 533, 125 584 committee recommendations, 204, 205, see also Black vs blond tobacco; Filters; 227, 228 Ventilation Comprehensive Smokeless Tobacco advertising, 26, 56, 61-66, 72, 73, 76 Health Education Act, 125 bladder cancer, 421 Consumer Product Safety Act, 125 cardiovascular disease, 471, 477 Controlled Substances Act, 123, 125 chronic obstructive pulmonary disease Federal Cigarette Labeling and (COPD), 517-518 Advertising Act, 595

624 INDEX compensatory smoking, 2, 26, 67, 88, regulatory issues, 30, 91, 124, 125-126, 121, 164, 219, 266, 285, 322, 380, 127, 128, 129, 204, 205, 206, 209- 402, 403, 405, 477, 517 210, 214, 225, 228 gender factors, 74, 404-405 Memory, 254, 319, 564 historical perspectives, 3, 60, 61-66, 72- Men, see Gender factors 73, 121, 596-604 (passim) Menthol-containing cigarettes, 62, 64, 72, lung cancer risk, 399-404 73, 77, 86-87, 98, 183, 319, 406- nitrosamines, 377 407, 438, 439 oropharyngeal disease, 416 African Americans, 72, 73, 86, 406-407 relapse into smoking, 75 Methadone, 42, 48, 49-50, 51, 52, 55, 114-115 risk assessment, 143, 145, 164, 399-400 Methodology, see Research methodology risk perception, 66-67, 68-71, 76-77 Methoxsalen, 110 Lung Health Study, 232, 471, 505, 514-515, Military personnel, 70, 76, 398 532 Minority groups, see Race/ethnicity Lungs, see Respiratory system Mitochondria, 154, 314, 336-337, 341, 394 Lymphocytes, 156, 296-297, 314, 338, 346, Modified tobacco products, viii, ix-x, 2, 8, 376, 399, 417, 436, 518, 519 17, 52, 231, 303, 596 see also Additives; Low-yield products; Potential reduced-exposure M products (PREPs); Technological innovation Macrophages, 293, 296, 297, 344, 484, 506, committee charge and methodology, 3- 517, 518, 526, 561 4, 205, 206 Magnesium nitrate, 90-91 genetically altered, 189 Males, see Gender factors regulatory issues, 8, 10-11, 205, 206, 207, Marketing, viii, 7, 8, 10, 30, 31, 32, 64, 74, 209 237, 240 Molecular biology, 207, 298-299 see also Advertising; Federal Trade see also Biomarkers; Genetic factors; Commission; Labeling; Pharmacology; Receptors; Packaging Toxicology FDA regulation, 128, 205 cytochrome P-450, 109, 152, 248, 269, historical perspectives, 60-66 298, 323, 327, 334, 342, 375, 377, postmarket surveillance, x, 182, 184, 378, 385, 409, 417, 421, 570 189, 190, 203, 207, 208, 213, 221- lipids, 12, 154, 169, 314, 330, 336-337, 222, 270 343, 379, 471, 479, 482, 485, 486, regulation, general, 207, 208, 213, 215, 491-492 216-221, 222-223, 228, 229, 232 oropharyngeal disease, 417 premarket testing/approval, x, 8, proteomics, 12-13, 152, 314, 334, 353, 129, 213-215, 217, 223, 224, 227- 389, 492 228 Monitoring the Future, 185-187, 320-321 Mass media, 188, 190 Mortality, 201, 434, 595, 598 see also Advertising auto accidents, 42, 43 Mecamylamine, 107, 124, 266 bladder cancer, 418, 419 Medical Device Amendments of 1976, 124 cancer, 392, 398, 400, 411-414, 415, 418, Medical devices, 111 419, 426, 434 see also Oral/nasal sprays cardiovascular disease, 470, 472, 473, birth control, 45 477, 487 burning temperature, 95 chronic obstructive pulmonary (COPD), computerized, 118 505, 508, 509, 512, 513-514 PREP defined, 3, 28, 205 cigar smokers, 426

INDEX 625 committee charge, 4, 31 National Center for Environmental Health, dementia risk assessment and, 564 184, 185 drug treatment to reduce, 111, 112-113 National Committee for Clinical fetal, 543, 545, 552, 596 Laboratory Standards, 349 fires caused by smoking, 571 National Health and Nutrition harm reduction defined, 2, 25, 40 Examination Survey (NHANES), historical perspectives, vii, 2, 23 184-185, 190, 320-321, 413, 422, international perspectives, 23, 25 565 low-yield products, 2, 400 National Health Interview Survey, 69, 185- lung cancer, 392, 398, 411-414 187, 320-321, 544 nonneoplastic respiratory disease, 170, National Highway Traffic Safety 505, 508, 509, 512, 513-514, 528, Administration, 42, 44 530 National Household Survey on Drug oropharyngeal cancer, 415 Abuse, 50, 92-93, 185-187, 260, registries, 321 261 regulatory issues, 213, 215, 220 National Institutes of Health, 301 sudden infant death syndrome, 173, National Cancer Institute, 185, 211, 596 268, 543, 546, 549, 552, 596 National Institute for Environmental surveillance, 194 Health Sciences, 604 Musculoskeletal effects, see Orthopedic National Survey of Family Growth, 187 effects; Rheumatoid arthritis National Toxicology Program, 53, 384 Mutagenesis and mutagens, 144, 148, 154, National Vital Statistics System, 188 292, 367-370, 371, 373-379, 380, National Youth Tobacco Survey, 185-187 384, 429-430 Native Americans, see American Indians see also Cancer and carcinogens Neurological diseases biomarkers, 313, 314, 323, 326, 327, 334, dementia, 174, 254, 564-565 340-342, 345, 346-347, 353 depression, 104, 174, 186, 256-257, 347, defined, 368 568-569 DNA adducts, 153, 292, 293, 313, 314, antidepressants, 105-106, 115-116, 327-335 (passim), 341, 346, 348, 254, 256, 570 353, 368-370 (passim), 372, 375- Parkinson’s disease, 162, 270, 347, 571- 378 (passim), 385-390 (passim), 572 399, 405, 409, 417, 420-424 schizophrenia, 162, 174, 244, 257, 268- (passim), 429, 435, 492 269, 347, 568 particulates, 148, 374, 436 Neurotransmitters, 105, 134, 161, 244, 245, teratogenic, 545, 554-555 255, 256, 519, 550-551, 571 transgenic animals, 298-299, 385, 391 see also Receptors tumor suppressor genes (including acetylcholine (Ach), 161, 244-245, 252, p53), 155, 336, 341-342, 343, 371- 254, 266, 269, 347, 568 372, 375, 376, 391-392, 393-394, dopamine, 105, 109, 110, 244, 245, 256, 405, 409, 415, 417, 418-419, 420, 257, 266, 347-348, 551, 568, 571, 421, 428-429, 435 572 serotonin, 105, 109, 244, 347, 478, 551 Neutrophils, 156, 338, 344, 485, 508, 517, N 518, 561 New products, see Potential reduced- Naloxone, 108 exposure products (PREPs); Naltrexone, 108 Technological innovation Nasal sprays, see Oral/nasal sprays New Zealand, 261 National Cancer Institute, 185, 211, 596 NEXT, 29, 91

626 INDEX Nicorette, 97, 123, 129 Nicotine replacement therapy (NRT), viii, Nicotine, vii, 25, 26, 28-29, 66, 67, 597 1, 3, 4, 29, 51-53, 95-104, 110-115, see also Addiction; Filters; Low-yield 161-162, 231, 233-234, 254, 263, products; Nicotine replacement 269, 270-271, 325, 326, 430, 533, therapy; Pharmacology; Potential 552-553, 554-555 reduced-exposure products see also Chewing gum; Oral/nasal (PREPs); Ventilation sprays; Patches antagonists, 4, 106-108, 110, 116, 244 addiction, 161 antibodies, 107-108 behavioral therapy and, 96, 115 antidepressants, 105 cardiovascular disease, 98-99, 112, 115, biomarkers, 323, 324-325, 326, 347 252-253, 471 see also Cotinine clinical trials, 96, 101-103, 113-115, 533 plasma markers, 99, 113, 250, 293 cost of, 101-102, 129, 554-555 body weight, 126, 158-159, 162, 255, 267, dose-response relationship, 255-256, 270, 568-569 264, 266 carcinogenesis, 167, 402, 403, 405 doses per day, 98, 105-106, 113, 248 cardiovascular disease, 168, 470-471 gastrointestinal system, 267, 270 nicotine replacement therapy (NRT), gender factors, 267-268 98-99, 112, 115, 252-253, 471 genetic factors, 270 cigarette-like products, 94, 95 historical perspectives, 113, 599, 601 cognitive effects, 254, 255, 259, 270, labeling, 123 564 relapse into smoking, 101, 111, 115 compensatory smoking, 2, 26, 67, 88, reproductive and developmental 121, 164, 219, 266, 285, 322, 380, effects, 112, 116, 172-173, 267, 402, 403, 405, 477, 517 552-553, 554-555 definitional issues, 27, 126 research methodology, 101-103 dementia, 564 research recommendations, 269-271 gender factors, 74 risk perception, 110-111, 112 marketing factors, 61 time factors, mecamylamine, 107, 124, 266 blood concentrations, 99-101, 103 metabolism, 109, 110, 116, 162, 248-252, FDA approval, 123 256, 269, 313, 422 long-term use, 115, 121 processing of tobacco, 85 Nicotrol Nasal Spray, 97, 124, 129 public understanding of content, 60 Nitrosamines, 4, 67, 86, 87, 91-92, 93, 148, regulatory issues, 10, 207, 210, 211-212 151, 210, 215, 294, 300, 301, 319, receptors, 550, 564, 568 326-327, 328, 348, 373-374, 376- drug treatments, 97, 103, 105, 106- 377, 379, 380, 403, 405, 429-430, 107, 110 603, 604 genetic predisposition to smoking, environmental tobacco smoke, 424 347-348 racial/ethnic differences, 406, 407 pharmacology, 161, 245, 252, 254, smokeless tobacco, 4, 93, 428, 429 255, 257 Nonneoplastic respiratory diseases, 170- reproductive and developmental 171, 500-542 effects, 172, 545, 550, 552, 554- see also Chronic obstructive pulmonary 555, 572 disease smoker knowledge of, 72-73 asthma, 170, 500-501, 518-525, 527, 530- surveillance, 184, 189 531, 551 yield assessment, 88, 90, 184, 207, 210, biomarkers, general, 170-171, 501-503, 211-212, 317-319, 373 506, 507, 512, 517, 527, 531, 532 urine, 503, 506, 523, 524, 525, 529, 531

INDEX 627 bronchi, 24, 156, 500, 505, 514, 520, 522, rheumatoid arthritis, 174, 562 526, 551 Over-the-counter drugs, 31, 94, 96, 97, 102, bronchitis, 21, 295, 338, 502, 503, 505, 110, 120, 263 510, 525, 529, 551 FDA approval process, 123 epithelium, 298, 375, 376, 393 children, 500, 501, 506, 508, 510-511, 518-526 (passim), 528-530, 551 P clinical research, 13, 171, 511-512, 514, 518, 522, 523-525, 529, 530, 532- Packaging, 27, 30-31, 70, 77, 124 see also Labeling 533 cotinine, 517, 523, 525, 526, 529, 530, 532 Palladium, 90-91 dose-response relationship, 170, 171, 510- Pancreatic cancer, 372 Paper, 27, 85, 87, 88, 89, 91, 92, 128, 287, 514, 521, 523, 527-528, 531, 532 environmental tobacco smoke (ETS), 500, 571, 604 509-511, 521-522, 528-530, 531, 551 see also Ventilation cigarette defined, 82, 83 genetic factors, 170, 501-502 historical perspectives, 500, 506, 598, 599 regulatory issues, 210, 224, 225 immune system, 526, 527 ventilation, 26, 71, 87, 88, 89, 90, 121, 211, 286, 287, 317, 380, 399, 595, incidence, 500, 518, 519, 526 infections, 170, 296, 297, 354, 500-501, 597 502, 506, 508, 516, 525-530, 532, Parental factors, see Family/home factors Parkinson’s disease, 162, 270, 347, 571-572 546, 547 children, 501, 506, 526, 528-529, 551 Particulates, viii, 284-285, 286-287, 322 influenza, 297, 502, 526, 530 see also Aerosols carcinogens and mutagens, 148, 374, 436 pneumonia, 501, 502, 526, 527-528, 529, 530, 551 free radicals, 378 surrogate markers, 507, 512 immune response, 297-298 smoke yields, 87 tuberculosis, 501, 526, 528 sputum, 12, 193-194, 313, 353-354, 391, Passive smoking, see Environmental 435, 437, 503, 505, 514, 515 tobacco smoke Patches, vii, 3, 4, 29, 96, 97, 98, 99, 100, 101, Nortriptyline, 4, 104, 106, 124 Nurses’ Health Study, 168, 487, 567 103, 104, 112, 113, 601 clonidine, 108 mecamylamine, 107 O pharmacokinetics, 246 Peptic ulcers, 175, 560-561, 573 Occupational factors, see Workplace Periodontal disease, see Oropharyngeal Ocular disease, 174, 193, 565-566 disease Oncogenes, 294, 341-342, 371, 389, 391, 393 Pharmaceutical products, see Chewing Oral/nasal sprays, vii, 4, 94, 97-101, 103, gum; Drug treatment; Oral/nasal 124, 266 sprays; Nicotine replacement Oropharyngeal disease, 174, 563-564, 574 therapy; Psychotrophic drugs; see also Smokeless tobacco Patches biomarkers, 156, 333, 338-339, 342 Pharmacology, 101, 161-163, 215, 243-282, cancer, 23, 167, 301, 333, 342, 368, 372, 570, 583, 593 415-418, 425, 427-429, 597 see also Addiction; Receptors gingivitis, 563-564 alcohol, 253, 570 gum bleeding, 156, 338, 563 animal models, 244, 253, 258, 268 oral clefts, 549-550 cardiovascular effects, 471 Orthopedic effects, 565 cotinine, 248, 249, 250, 265 osteoporosis, 158, 174, 176, 193, 338-339, historical perspectives, 243, 593-595, 597 565, 574 regulatory issues, 126, 127

628 INDEX risk assessment, 161-163 biomarkers, 142, 144, 145, 150-161, 162- withdrawal, 161, 244, 245, 254-260 163, 165, 237, 309-317, 323-352, (passim), 263-267 (passim) 388, 435-436, 553 Philip Morris, 184, 584 committee charge and methodology, 3- Accord, 4, 65, 95, 603 5, 31-32, 33, 34, 142, 202-203, 205, NEXT, 29, 91 237 Pipe smoking, 85, 321, 473, 508, 597 currently available and novel, 91-95 Placental complications, 268, 545-547, 552 definitional issues, 3, 28, 205 Plasma markers, 325, 480 dose-response relationship, 14, 15, 33, cotinine, 348 34, 140, 141, 144-147, 152, 154, leptin, 268, 378-379 156, 158, 159, 160, 167, 237-238, nicotine, 99, 113, 250, 293 271, 310, 312, 325, 326, 352, 381, Platelet activation, 12, 156, 157, 168, 169, 395-396 252, 253, 296, 337-339, 343, 354, epidemiology, 6, 7, 8, 10, 13-14, 141, 142, 479, 480, 481, 483-486, 490-491, 147, 153, 160, 165, 193, 195, 197, 492, 493, 561 203, 206, 208, 221, 222, 229, 232, Pneumonia, 501, 502, 526, 527-528, 529, 530, 236, 238, 437-438, 584 551 FDA actions, 15, 122-124, 129-130, 141, Policy, general, 7, 9, 38-39, 41-42, 51-56, 181, 204-205, 206, 209, 221, 226- 119-122, 176, 201-230 227 see also Automobile safety; Regulatory Federal Trade Commission (FTC), 2, 15, issues 26, 61, 67, 207, 210, 221, 227, 350 alcohol and drug abuse, 39-40, 46-50, historical perspectives, 24, 26, 55, 60-81, 51, 52, 53, 55, 56, 601 88-91 automobile safety, vii, 41-44, 50, 52, 53, incidence of disease, 5-6, 193 56 in vitro assays, 12, 34, 144, 148-149, 151, surveillance, 197 152, 154, 156, 158, 160, 168, 208, taxation, 119, 128, 202, 596, 603 212, 215, 303, 350, 351 teen sexual behavior, 44 cancer, 154, 167, 367, 383-384, 385, Political factors, 22 432 Polycyclic aromatic hydrocarbons (PAHs), lung cancer, 294-295, 395-399, 407-409 86, 148, 149, 295, 322, 326-327, marketing, 61-66 328-331, 333, 348, 374, 375-376, other harm reduction intervention 377, 379, 391-392, 418, 570 compared, 50-53 Polymer chain reaction, 340, 391 policy, general, 202-204 Polymorphisms, 252, 256, 314, 315, 345, postmarket surveillance, x, 182, 184, 346, 347, 405-406, 409, 478, 526 189, 190, 203, 207, 208, 213, 221- Potential reduced-exposure products 222, 270 (PREPs), 2, 3-17 (passim), 21, 53, pregnant women, 173-174, 552-553, 554- 231, 232-240, 273, 574 555 see also Drug treatment; Filters; Low- prevalence of use, 67 yield products; Modified tobacco product descriptions, 82-140 products; Nicotine replacement regulation, 5, 6, 7-11, 30-32, 33, 122-124, therapy; Ventilation 129-130, 147, 202-229 (passim), additives, 144, 149, 165, 212 234-235, 236, 238 age factors, 76, 161, 164, 319, 321, 331 relapse into smoking, 75, 101, 111, 115, animal models, 144, 145, 147, 148-149, 141, 146 162, 163, 165, 208, 212-213, 303, risk assessment, general, 140-179 350, 351, 384-386 (passim) behavioral effects of availability, 7, 73- risk thresholds, 9, 164, 167, 222-224, 76, 185, 197, 315 225-226, 431, 439, 480, 481, 487

INDEX 629 risk perception, 26, 68-69, 77, 78 teenage, 44, 172, 543, 545, 552 smokeless tobacco, 93 surveillance, 187-188, 191, 193 Surgeon General’s reports, 24 teratogenic effects, 545, 554-555 surveillance, x, xi, 7-8, 10, 13-14, 147, Pregnancy Risk Assessment Monitoring 162, 176, 181, 182, 183, 185, 189, System, 187-188 203, 208, 221-222, 225, 236, 237, Premarket notification/testing/approval, 238, 269, 270, 573, 574 x, 8, 129, 213-215, 217, 223-224, time requirements for evaluation, 5, 227-228 141, 146, 147, 232, 320 Premier, 4, 93, 94, 600 toxicology, 144, 145, 147-150, 204-205, PREPs, see Potential reduced-exposure 207, 208-209, 212-213, 228, 292, products 302-303 President’s Cancer Committee, 211 Preeclampsia, 268, 560, 572 Prevalence, 195, 262, 594, 603 Pregnancy, 53-54, 543-555 see also Incidence see also Reproductive and adolescents, 1, 22, 38, 319 developmental effects birthweight, low, 11, 23, 24, 149, 172, alcohol use, 172, 545, 547 173-174, 188, 193, 212, 267, 340- animal models, 13, 298 341, 344, 529, 543, 547-549, 550, biomarkers, 174, 191, 545, 548, 553, 570, 551, 552, 554, 596 572 cigar smoking, 425 birthweight, 11, 23, 24, 149, 172, 173- gender factors, 22, 74, 87, 404 174, 188, 193, 212, 267, 340-341, harm reduction defined, 40 344, 529, 543, 547-549, 550, 551, orthopedic effects, 565 552, 554, 596 PREP use, 67 bupropion, 172, 174, 552-553, 554 respiratory infections, 529 carbon monoxide, 172, 173-174, 549, smokeless tobacco use, 92-93, 427 550, 552, 554 smoking, general, viii, 1, 22, 23, 25, 74, cohort studies, 173, 547 189, 191, 197, 414 contraceptives, 45, 477, 481, 544, 597 antidepressants, 106 cotinine, 545, 548, 553, 572 international perspectives, 23, 88-89 diet, 547 nicotine replacement drugs, clinical drug treatments, 116 trials, 102-103 environmental tobacco smoke (ETS), pregnant women, 543-544 544, 545, 548, 549, 551 Processing of tobacco, 66, 82, 84-87, 89, 90- fetal lung development, 149, 298, 511, 91, 299-300, 597 551 see also Additives hemoglobin, 546, 549 blending, viii, 26, 82, 85, 87, 94, 128, 209, nicotine, 172, 545, 550, 552, 554-555, 572 287 nicotine replacement therapy (NRT), curing, 8, 82, 83, 84, 91, 128, 189, 209, 112, 116, 172-173, 267, 552-553, 300 554-555 FDA regulation, 128 placental complications, 268, 545-547, regulation recommendations, 209 552 surveillance, 189 preeclampsia, 268, 560, 572 Proteomics, 12-13, 152, 314, 334, 353, 389, PREPs, 173-174, 552-553, 554-555 492 preterm delivery, 172, 543, 546-547, 552, Psychological factors, 118 596 see also Attitudes and beliefs; Behavioral regulatory issues, 10-11, 208, 222 effects of tobacco use; Behavioral smokeless tobacco, 301-302, 551-552 treatments; Dementia; spontaneous abortion, 11, 24, 268, 545, Depression; Schizophrenia 554, 596 addiction, 41, 118, 161, 254, 256-257, 259

630 INDEX adolescents, 74 dopamine, 256, 266, 347-348 anxiety, 109 estrogen, 394, 405 depression, 104, 174, 186, 256-257, 347, nicotinic, 550, 564, 568 568-569 drug treatments, 97, 103, 105, 106- antidepressants, 105-106, 115-116, 107, 110 254, 256, 570 genetic predispositions for smoking, menthol cigarettes, 73 347-348 nicotine mood enhancement, 245, 254 pharmacology, 161, 245, 252, 254, nicotine replacement therapy, 255, 257 addiction, 161 progesterone, 405 surveillance, 186 Red Book, 14, 15, 33, 34, 141 Psychotrophic drugs, vii, 268-269 Regulatory issues, x, 6, 30-31, 201-229, 584 FDA attempt to regulate tobacco, 126 see also Enforcement; Federal Trade Public education, x, 9, 203-204, 236, 603 Commission; Food and Drug see also Internet; Schools Administration; Labeling; committee charge, 4-5 Legislation; Standards consumer information, 7, 231, 240 additives, 128, 149, 209, 210, 212, 224- see also Labeling 225 regulatory framework, 204, 205, 225, advertising, 7, 10, 120, 125-126, 127, 128, 229 141, 203, 206, 207, 208, 211, 216- surveillance, 188 221, 222, 229, 232, 595, 597, 602, Public Health Cigarette Smoking Act, 125 603 Public Health Service, 102, 103, 109, 595 animal models, 10, 208, 212-213, 215 Public health, general, 4, 5, 6, 7, 14, 16, 25, automobile safety, vii, 41-44, 50, 52, 53, 31, 33, 141, 142, 202, 235-237 56 see also Cessation programs; biomarkers, 10, 11-12, 207-208, 211, 220, Epidemiology; Fires; Policy, 348-349 general; Surveillance carbon monoxide, 210, 218 restrictions on public smoking, 120, 206, carcinogens, 10, 208, 215 225, 597, 599, 600, 601 clinical trials, 122, 208, 209, 212, 213, Pulmonary system, see Respiratory system 215, 227, 229 committee charge and methodology, 4, 5, 31-32, 34, 202-203 R consumer information, general, 204, 205, 225, 229 Race/ethnicity, 73, 86, 233, 321, 543, 548 conventional tobacco, 124-130, 207, 209- see also specific groups 229 (passim), 234-235 birthweight, 548 definitional issues, 11, 27-28, 30, 124, cancer, 406-408, 416, 436 126, 205, 225-226 dementia, 564 enforcement, 11, 30, 40, 43-44, 48, 120, dose-response relationship, 164, 407 125, 196, 207, 209, 226, 238, 239 metabolic processes, 250, 270-271, 389 epidemiology, 8, 10-11, 129, 203, 206, nitrosamines, 406, 407 207, 208, 221, 222, 229 oropharyngeal disease, 416 exposure, general, 10, 204, 207-208, 215 pregnant smokers, 543, 553 filters, 128, 210, 225 prevalence of smoking, 22, 24 historical perspectives, 124-130, 595-604 Surgeon General’s reports, 24, 125, 603 marketing, 207, 208, 213, 215, 216-221, Radon, 195, 298, 408 222-223, 228, 229, 232 Receptors, 108, 244, 482, 485-486, 550-551, see also “advertising” supra; Labeling 564, 568 postmarket surveillance, x, 182, 184, see also Neurotransmitters 189, 190, 203, 207, 208, 213, 221- 222, 270

INDEX 631 premarket testing/approval, x, 8, behavioral/cognitive disorders, 268, 129, 213-215, 217, 223, 224, 227- 550-551 228 biomarkers, 174, 191, 545, 548, 553, 570, medical devices, 30, 91, 124, 125-126, 572 127, 128, 129, 204, 205, 206, 209- serum, 548, 553, 570, 572 210, 214, 225, 228 urine, 545, 548, 553 modified tobacco products, 8, 10-11, birthweight, 11, 23, 24, 149, 172, 173- 205, 206, 207, 209 174, 188, 193, 212, 267, 340-341, mortality, 213, 215, 220 344, 529, 543, 547-549, 550, 551, nicotine, 10, 207, 210, 211-212 552, 554, 596 paper, 210, 224, 225 carbon monoxide, 172, 173-174, 549, pharmacology, 126, 127 550, 552, 554 PREPs, 5, 6, 7-11, 30-32, 33, 122-124, cervical cancer, 24 129-130, 147, 202-229 (passim), clinical research, 173-174, 547, 548, 554 234-235, 236, 238 cognitive and behavioral disorders, 268, principles, 10-11, 17 550-551 processing of tobacco, 189, 209 congenital malformations, 268, 545, 549- public smoking restrictions, 120, 206, 550 225, 597, 599, 600, 601 contraceptives, 45, 477, 481, 544, 597 reproductive and developmental environmental tobacco smoke (ETS), effects, 10-11, 208, 222 544, 545, 548, 549, 551 respiratory effects, 10, 208, 215, 222 fertility, 173, 267, 544-545 smokeless tobacco products, 126, 128, 209 menstrual cycle, 267 surveillance, 183, 184, 188, 189, 190, 197, nicotine, 172, 545, 550, 552, 554-555, 572 203, 204, 208, 221-222, 225 nicotine replacement therapy (NRT), taxation, 119, 128, 202, 596, 603 112, 116, 172-173, 267, 552-553, toxicology, 9, 10-11, 128, 204-205, 207, 554-555 212-213, 222, 224-225, 228 pelvic inflammatory disease, 544-545 yield assessment, 183, 184, 207-208, 210- PREP risk assessment, 172-174, 552-553, 212, 219 554-555 smoking machines, 2, 3, 26-27, 87-88, regulatory issues, 10-11, 208, 222 90, 210-211, 226, 283-284, 317-319, research recommendations, 553-555 350, 352, 373, 380, 395, 404 smokeless tobacco, 551-552 Relapse, 5, 40, 141, 262 sudden infant death syndrome, 173, alcohol abuse, 47 268, 543, 546, 549, 552, 596 depression and, 104 surveillance, 187-188, 193 drug treatment and, 111 teratogenic, 545, 554-555 low-yield cigarettes, 75 Research methodology, 55-56, 121-122, 438- nicotine replacement products, 101, 111, 439 115 see also Animal models; Biomarkers; PREP risk assessment, 75, 101, 111, 115, Clinical research; Cohort studies; 141, 146 Epidemiology; Internet; In vitro risk perception and, 41 assays; Surveillance substance abusers, 49 addiction measures/models, 257-267 Renal disease, 481, 567-568 asthma studies, 520, 521 Reproductive and developmental effects, 4, carcinogenesis, 378, 379-394, 410, 434-439 24, 172-174, 268, 298, 302, 543- committee study at hand, 3-5, 16, 31-35, 559, 598, 601 142 see also Age factors; Genetic factors; dementia, 564-565 Pregnancy exposure, 309-366 animal models, 13, 298 see also “smoke yields” infra

632 INDEX forced expiratory volume (FEV), 156, lung cancer, 24, 401, 402-403, 404- 171, 338, 343, 503, 506, 508-509, 406, 410, 411, 412, 413, 598, 599 514-515, 516, 520, 523, 532-533 inflammation, 12, 13, 95, 113, 149, 156, free radical carcinogens, 378 170-171, 295, 298, 302, 338, 343- health impact research, 66-67 344, 395, 502, 505, 506, 507, 516- nicotine metabolism, 252 518, 527, 531, 533 nicotine replacement drugs, 101-103 asthma, 170, 500-501, 518-525, 527, Parkinson’s disease, 572 530-531, 551 quitting smoking, 76 lung cancer, viii, 21, 23, 24, 66, 67, 86, respiratory infections, 529-530 89, 149, 166-167, 192, 193, 215, risk perception, 68 293-295, 296-297, 302, 333, 342, smoking machines, 2, 3, 26-27, 87-88, 90, 355, 368, 372 210-211, 226, 283-284, 317-319, nicotine pharmacology, 244-245, 246 350, 352, 373, 380, 395, 404 regulatory issues, 10, 208, 215, 222 Research recommendations, 7-17, 33-35, 77- Rheumatoid arthritis, 174, 562 78, 203, 206-207, 232-233, 239-240, Risk assessment, general, ix-x, 14, 15, 33-35, 573-574 66-67, 239-240 biomarkers, 352-355, 438, 491 see also Biomarkers; Dose-response cancer, 434-439 relationship; Epidemiology; cardiovascular, 491-493 Exposure; Surveillance; specific nicotine replacement therapy, 269-271 diseases and anatomical systems nonneoplastic respiratory diseases, 532- age factors, 67, 145, 186, 321 533 committee charge, 3-4 reproductive and developmental definitional issues, 28 effects, 553-555 exposure-to-adverse effect, time, ix, 140, smokeless tobacco, 301-302 145, 166, 511, 530 toxicology, 301-303 filters, 143, 164, 168, 399-400, 402-404 Respiratory system, 4, 156, 285-286, 343 gender factors, 67, 145, 164, 168 see also Nonneoplastic respiratory genetic predisposition to toxic effects, diseases ix, 6, 13, 145, 153, 164, 166, 192, bronchi, 24, 156, 500, 505, 514, 520, 522, 233, 344-347, 390, 408-409, 416, 526, 551 429, 436, 478, 490, 508 bronchitis, 21, 295, 338, 502, 503, 505, low-yield products, 143, 145, 164, 399- 510, 525, 529, 551 400 cancer and carcinogenesis, 285, 298, modified tobacco products, viii 375, 376, 391, 392, 393, 437, 518 pharmacology, 161-163 epithelium, 298, 375, 376, 393 PREPs, 140-179 (passim) bronchoalveolar lavage, 13, 156, 295, risk thresholds, 9, 164, 167, 222-224, 338-339, 343-344, 437, 517 225-226, 431, 439, 480, 481, 487 bronchoscopy, 157, 171, 339, 392, 502- tobacco, 141-144 503, 517, 531 Risk characterization, general, 14, 33-34, epithelial function, 500, 519, 525-526 140, 237-238, 239 bronchial, 298, 375, 376, 393 Risk perception, 2, 6, 8, 10, 26, 28, 40-41, 42- forced expiratory volume (FEV), 156, 43, 67-73, 76-77, 185-188 (passim), 171, 338, 343, 503, 506, 508-509, 212, 434, 584 514-515, 516, 520, 523, 532-533 addiction, 68 gender factors, 416, 520 additives, 72-74, 77 chronic obstructive pulmonary adolescents, 41, 68, 72, 73-74, 112, 185 (COPD), 500, 509, 512, 514, 515, carbon monoxide, 72-73 516 international perspectives, 72-73 low-yield products, 66-67, 68-71, 76-77

INDEX 633 negative attitudes toward unsafe Smokeless tobacco products, 83, 85, 92-95, behavior, general, 43 99, 101, 149, 167, 255, 426-429, nicotine replacement products, 110-111, 563, 598, 600 112 see also Chewing tobacco; Snuff R.J. Reynolds, 184, 585, 594, 595, 597, 600 addiction, 266 Eclipse, 4, 65, 94-95, 129, 215, 517-518, additives, 299-300 602 adolescents, 302 Premier, 4, 93, 94, 600 advertising, 93 Winston, 72, 91 age factors, 93, 302 RNA, 152, 153, 299, 314, 334, 353, 389 cancer, 4, 93, 300-301, 426-429 epidemiology, 301 international perspectives, 93, 300, 426- S 428 snus, 4, 14, 167, 204, 270, 300, 301, Saliva, 209, 267, 300, 311, 323, 325, 422, 428, 302, 427, 428, 434 523, 525 nitrosamines Schizophrenia, 162, 174, 244, 257, 268-269, oral disease, 167, 563 347, 568 prevalence of use, 92-93, 427 Schools regulation of, 126, 128, 209 impacts of smoking on performance, research recommendations, 301-302 187 toxicology, 299-302 prevention/cessation programs, 24, 120, use surveys, 321 598, 601 Smoking machines (Federal Trade teen sexual behavior, 44-45 Commission), 2, 3, 26-27, 87-88, Youth Risk Behavior Survey, 93, 185- 90, 210-211, 226, 283-284, 317-319, 187, 261, 320-321 350, 352, 373, 380, 395, 404 Secondary smoke, see Environmental Smoking topography, 151, 182, 322, 323, 349, tobacco smoke 352, 399, 405, 406, 407-408, 437 Serotonin, 105, 109, 244, 347, 478, 551 see also Inhalation depth and Sertraline, 105 topography Serum markers, 157, 174, 184-185, 187, 190, compensatory smoking, 2, 26, 67, 88, 300, 313, 314, 321, 323, 330, 335, 121, 164, 219, 266, 285, 322, 380, 339, 353 402, 403, 405, 477, 517 cancer, 333, 422 Snuff, 83-84, 92-93, 100, 300, 301, 427, 593 cholesterol levels, 289, 296, 477, 482 DNA adducts, 332 diabetes, 567 snus, 4, 14, 167, 204, 270, 300, 301, 302, environmental tobacco smoke, 348, 422 427, 428, 434 nonneoplastic respiratory diseases, 506, Socioeconomic factors 517, 527, 532 asthma, 519 reproductive and developmental educational attainment, 390, 425, 530, effects, 548, 553, 570, 572 543, 547, 564 Sex differences, see Gender factors lung cancer, 407, 414 Sexual behavior, adolescents, 44-46, 50, 51 pregnant smokers, 543, 547 pregnancy, 44, 172, 543, 545, 552 Spontaneous abortions, 11, 24, 268, 545, Sidestream smoke, see Environmental 554, 596 tobacco smoke Sprays, see Oral/nasal sprays Skeletal system, see Orthopedic effects Sputum, 12, 193-194, 313, 353-354, 391, 435, Skin diseases, see Dermatologic diseases 437, 503, 505, 514, 515 Skin patches, see Patches Standards, 11, 17, 30-31, 209, 225-226 Sleep disturbance, 105, 106, 254, 255 see also Definitional issues; Regulatory Smith Kline Beecham, 585 issues

634 INDEX addiction, 255, 257-262 (passim), 265 behavioral effects of smoking, 183, 185- additives, 224-225 188, 191-192, 195, 197 biomarkers, 348-349 carbon monoxide, 184 Diagnostic and Statistical Manual of clinical research and, 183, 193, 197 Mental Disorders (DSM), 255, cost of, 181, 195 257, 258-259, 260-262 cotinine, 184-185, 187 fire-safe cigarettes, 87, 571 defined, 180, 181, 194 International Diagnostic Code, 257, 258- dependence potential, 269 259 environmental tobacco smoke (ETS), 194 International Standards Organization, FDA, 181 87, 283 Federal Trade Commission (FTC), 183, medical devices, 124, 228 184, 189, 190 pregnant women, clinical guidelines, 172 filters, 183, 189 risk thresholds, 9, 164, 167, 222-224, 225- gender factors, 187 226, 431, 439, 480, 481, 487 national surveillance system, general, 8, smoke yields, 87-88, 210-212, 283-284 181, 207 smoking machines, 2, 3, 26-27, 87-88, pregnant women, 174, 553 90, 210-211, 226, 283-284, 317-319, postmarket surveillance, x, 182, 184, 350, 352, 373, 380, 395, 404 189, 190, 203, 207, 208, 213, 221- tobacco industry regulation, 128, 204 222, 270 Star Scientific (Star Tobacco), 91-92, 585, PREPs, x, xi, 7-8, 10, 13-14, 147, 162, 176, 603, 604 181, 182, 183, 185, 189, 203, 208, Advance, 4, 92 221-222, 225, 236, 237, 238, 269, Stroke, 24, 168, 470, 473, 476, 487, 489, 600 270, 573, 574 Sudden infant death syndrome, 173, 268, regulatory issues, 183, 184, 188, 189, 190, 543, 546, 549, 552, 596 197, 203, 204, 208, 221-222, 225 Surgeon General, 21-26 (passim), 69, 125, time factors, 181, 194 379, 380-381, 513, 595-603 yield assessments, 182, 183, 184 (passim) Sweden, 4, 14, 93, 167, 204, 270, 300, 301, Surgery, 438 302, 427, 428, 434, 548 cardiovascular, 473, 476 Synergistic effects, 298, 342, 378, 387, 390, inflammatory bowel disease, 561-562 570 lung cancer, 395 see also Air pollutants Surgical wounds, see Wound healing alcohol and tobacco, 342, 415-416, 418, Surrogate markers, 6, 11-12, 16, 31, 147, 426, 428 153, 235, 270, 310, 314, 335, 339 asbestos, 89, 298, 408, 501, 599 cancer, 166, 327, 330, 435-436 bladder cancer, 420 cardiovascular disease, 168, 483-486, 490 chronic obstructive pulmonary disease nonneoplastic respiratory disease, 507, (COPD), 508-509 512 cardiovascular disease, 477-478 regulatory issues, 220 drug interactions, 122, 269, 570 Surveillance, 10, 17, 176, 180-200, 203, 208, lung cancer, 408-409 232, 573, 574 oropharyngeal disease, 415-416, 418 see also Centers for Disease Control and pregnancy, 545 Prevention; Epidemiology additives, 189, 196 adolescents, 185, 192 T age factors, 185, 186, 191, 192, 194, 321 Tar, 2, 11, 24, 26, 66, 67, 70-71, 184, 584 attitudes and beliefs, 8, 10, 185-188 (passim), 192, 196, 197 see also Filters; Low-yield products; Potential reduced-exposure products (PREPs); Ventilation

INDEX 635 carcinogenesis, 373-374, 399-404, 407 nicotine replacement drugs, cigarette-like products, 94 blood concentrations, 99-101, 103 marketing factors, 61, 65 FDA approval, 123 public understanding of content, 60 long-term use, 115, 121 yield assessment, 87, 90, 91, 92, 94, 184, population surveys, 320 210, 211-212, 317-319, 373-374, PREP evaluation, 5, 141, 146, 147, 232, 399-401, 407 320 Taxation, 119, 128, 202, 596, 603 reproductive effects, T cells, see Lymphocytes time to conception, 544 Technological innovations surveillance, 181, 194 see Drug treatments; Filters; Fire-safe thrombosis bleeding, 154, 336 cigarettes; Modified tobacco withdrawal symptoms, 255 products; Potential reduced- wound healing, 174, 175, 194, 561, 573 exposure products (PREPs); Tobacco Testing Laboratory, 600 Ventilation Toluene, 89, 148, 290, 374 automobile safety, 41, 42, 43 Toxicology, 26-28, 34, 121, 129, 147-148, FTC smoking machine, 2, 3, 26-27, 87- 283-308, 553, 583 88, 90, 210-211, 226, 283-284, 317- see also Animal models; Biomarkers; 319, 350, 352, 373, 380, 395, 404 Carbon monoxide; Dose- processing of tobacco, 66 response relationship; Exposure; Teenagers, see Adolescents Synergistic effects; Tar; Yield Temperature factors, viii, 95, 210, 284 assessment definition of cigarette, 27 advertising and, 66 Teratogenic effects, 545, 554-555 arsenic, 72, 148, 184, 374 Thrombosis, 154, 157, 336-337, 339, 356, asbestos, 89, 298, 408, 501, 599 481, 485-486, 491, 493 cyanide, 72, 89, 291, 324-325, 401, 549, Time factors 561, 572 addiction, 255-256, 260, 262, 263-264 environmental tobacco smoke, 283, 285, adverse effects of treatment, 121 287, 289-290 behavioral treatments, 117-118 filters, 284, 287 biomarkers, half-life, 152, 154, 156, 157, genetic susceptibilities, ix, 6, 13, 145, 158, 250, 297, 316, 323, 324, 328, 153, 164, 166, 192, 233, 344-347, 333, 376, 422 390, 408-409, 416, 429, 436, 478, burn rate, 87 490, 508 chronic obstructive pulmonary (COPD), nicotine-derived, 28-29, 86, 94-95, 111- 503, 511-512 112, 173-174, 207, 270, 429-430, committee charge, 4 554 dose-response assessment, 140, 141 reproductive and developmental duration of smoking, lifetime, 67, 76, effects, 172, 545, 550, 552, 554- 151, 168, 390, 395, 396-397, 401, 555, 572 402, 404, 419, 420, 471, 493, 508, PREP risk assessment, 144, 145, 147-150, 566, 572 204-205, 207, 208-209, 212-213, duration of smoking cessation, 75, 115, 228, 292, 302-303 186, 409-415, 419, 438, 470, 473, processing of tobacco, 85, 128 475, 476, 487, 490, 562 regulatory issues, 9, 10-11, 128, 204-205, see also Relapse 207, 212-213, 222, 224-225, 228 exposure-to-adverse effect, ix, 140, 145, research recommendations, 301-303 166, 511, 530 susceptibility to toxic effects, ix, 6, 13, 145, FDA approval for medical devices, 124 153, 164, 166, 192, 233, 344-347 legislation, 221 smoker knowledge of, 72-73, 77 nicotine pharmacology, 246, 250, 251, 255-256

636 INDEX smoking machines, 2, 3, 26-27, 87-88, 90, Withdrawal symptoms, 405, 569 210-211, 226, 283-284, 317-319, drug treatments, 96, 101, 104-114 350, 352, 373, 380, 395, 404 (passim), 123 standards, 204, 283-284 nicotine pharmacology, 161, 244, 245, Toxic Substances Control Act, 125 254-260 (passim), 263-267 True, 26, 64 (passim) Tuberculosis, 501, 526, 528 Women, see Gender factors Women’s Health Study, 544 Workplace U occupational toxins, 33, 140, 151, 164, 166, 180, 195, 298, 329, 332, 350, Ulcers, see Peptic ulcers 375, 377, 390, 408, 419, 420, 431, Urine biomarkers, 12, 106, 109, 156, 157, 433, 508, 599 171, 190, 250, 252, 295, 312, 313, smoking restrictions, 119-120, 422 314, 325, 326, 336-337, 339, 343, World Bank, 23 346 World Health Organization, 23, 25, 258, 470 cancer, 326, 353-354, 376, 378, 407, 420- World Wide Web, see Internet 421, 422, 424, 429, 435, 437 Wound healing, 174, 175, 194, 561, 573 cardiovascular disease, 485, 486 environmental tobacco smoke, 323, 348 nonneoplastic respiratory diseases, 503, Y 506, 523, 524, 525, 529, 531 reproductive and developmental Yield assessment, 70-71, 87-88, 90, 92, 234, effects, 174, 545, 548, 553, 548 284 see also Low-yield products carbon monoxide, 87, 88, 90, 92, 94, 95, V 184, 210 nitrosamines, 376 Vapors, 27, 87, 88, 92, 94, 148, 284, 374 particulates, 87 Vascular activation, 12, 157, 169, 269, 337, regulatory issues, 183, 184, 207-208, 210- 480, 490-491, 493 212, 219 Vascular disease, see Cardiovascular disease; smoking machines, 2, 3, 26-27, 87-88, 90, Extracardiac vascular disease 210-211, 226, 283-284, 317-319, Ventilation 350, 352, 373, 380, 395, 404 asthma, 522 surveillance, 182, 183, 184 chronic obstructive pulmonary (COPD), tar, 87, 90, 91, 92, 94, 184, 210, 211-212, 503, 510 317-319, 373-374, 399-401, 407 cigarette paper, 26, 71, 87, 88, 89, 90, Youth Risk Behavior Survey, 93, 185-187, 121, 211, 286, 287, 317, 380, 399, 261, 320-321 595, 597 respiratory infections, 526 Visual impairments, see Ocular disease Z Vitamin C, 486 Volatile organic compounds, 89, 148, 374 Zyban, 30, 104, 123-124 see also Bupropion W Weight, see Birthweight; Body weight White persons, see Caucasians

Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Get This Book
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Despite overwhelming evidence of tobacco's harmful effects and pressure from anti-smoking advocates, current surveys show that about one-quarter of all adults in the United States are smokers. This audience is the target for a wave of tobacco products and pharmaceuticals that claim to preserve tobacco pleasure while reducing its toxic effects.

Clearing the Smoke addresses the problems in evaluating whether such products actually do reduce the health risks of tobacco use. Within the context of regulating such products, the committee explores key questions:

  • Does the use of such products decrease exposure to harmful substances in tobacco?
  • Is decreased exposure associated with decreased harm to health?
  • Are there surrogate indicators of harm that could be measured quickly enough for regulation of these products?
  • What are the public health implications?

This book looks at the types of products that could reduce harm and reviews the available evidence for their impact on various forms of cancer and other major ailments. It also recommends approaches to governing these products and tracking their public health effects.

With an attitude of healthy skepticism, Clearing the Smoke will be important to health policy makers, public health officials, medical practitioners, manufacturers and marketers of "reduced-harm" tobacco products, and anyone trying to sort through product claims.

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