3โรคที่เกิดจากการสูบบุหรี่ การควบคุมบุหรี่ในสถานพยาบาลทำไม?โรคที่เกิดจากการสูบบุหรี่มะเร็งLungLarynxEsophagusBladderKidney and UreterPancreasOral pharynxStrokeCoronary heart diseaseAortic aneurysmAtherosclerotic peripheral vascular diseaseChronic obstructive pulmonary disease (COPD)โรคเรื้อรังCigarette smoking is a cause of several groups of diseases: cancers of a number of organs, cardiovascular disease, chronic lung diseases, and peptic ulcer disease.1 These diseases occur not only at the sites contacted directly by tobacco smoke, the mouth, throat and lungs, but also at sites reached by tobacco smoke components and metabolites, such as the heart, blood vessels, kidney and bladder. These diseases reflect carcinogenesis, atherogenesis, and chronic lung inflammation, the latter probably arises through unfavorable balances of oxidants versus antioxidants and proteolytic versus anti-proteolytic factors. Many of the diseases causally linked to smoking are shown in the figure.The following table gives key conclusions of reports of the US Surgeon General, and the International Agency for Research on Cancer (IARC).2–4 Additionally, smoking during pregnancy has adverse effects on pregnancy outcome.3References:1. Baron JA & Rohan TE. Tobacco. In Cancer Epidemiology and Prevention. 2nd edn 1996; pp. 269–289. Edited by D Schottenfeld & JF Fraumeni Jr. New York: Oxford University Press.2. US Department of Health, Education and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington, DC: US Government Printing Office; 1964.3. US Department of Health and Human Services. Reducing the health consequences of smoking. 25 years of progress. A Report of the Surgeon General. Washington, DC: US Government Printing Office; 1989.4. International Agency for Research on Cancer. Tobacco Smoking, vol. 38 of IARC monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. World Health Organization; 1986.
4ประวัติศาสตร์ที่สำคัญ การควบคุมบุหรี่ในสถานพยาบาลทำไม?ประวัติศาสตร์ที่สำคัญ1954: Richard Doll and Bradford Hill’s study of British doctors published in the British Medical Journal1962: Royal College of Physicians Report1964: First Surgeon General’s Report on tobacco and health1981: First major study on passive smoking and lung cancer by Takeshi Hirayama (Japan)In 1951, Richard Doll and Bradford Hill initiated the now renowned prospective cohort study of British physicians. The population included 40,000 physicians, mostly men. In a 1954 report on the initial findings, Doll and Hill found that the physicians who were mild smokers were seven times more likely to die of lung cancer than non-smokers and for ‘immoderate’ smokers, the risk was 24 times greater.1 These results were published with the title ‘The Mortality of Doctors in Relation to their Smoking Habits’ in the British Medical Journal.By the late 1950s and early 1960s, the mounting evidence on the health effects of smoking received formal review and evaluation by government committees. In the United Kingdom, the 1962 report of the Royal College of Physicians concluded that smoking was a cause of lung cancer and bronchitis and a contributing factor to coronary heart disease.2 In the US, the 1964 report of the Advisory Committee to the Surgeon General concluded that smoking was a cause of lung cancer in men and of chronic bronchitis.3The Royal College of Physicians report received massive publicity. Its main recommendations were: restrictions of tobacco advertising, increased taxation on cigarettes, more restrictions on the sale of cigarettes to children and smoking in public places, and more information on the tar and nicotine content of cigarettes. For the first time in a decade, cigarettes sales fell.4In 1981, Professor Takeshi Hirayama published a prospective cohort study of 91,540 non-smoking Japanese women whose husbands were smokers. The non-smoking wives were followed for mortality, including lung cancer mortality, for 14 years. Risk of lung cancer was examined in relation to the level of smoking by the spouse with the finding of a statistically significant exposure-response relationship. This was the first study to assess the possible importance of passive smoking as one of the causal factors for lung cancer.5References:1. Doll R, Hill AB. The mortality of doctors in relation to their smoking habits: a preliminary report.British Medical Journal 1954; 1:1451–1455.2. Royal College of Physicians of London. Smoking and Health London: Pitman Medical.3. US Department of Health, Education and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington DC: US Government Printing Office; 1964.4. Action on smoking and health (ASH). Key dates in the history of anti-tobacco campaigning. Available at: (accessed June 2000).5. Hirayama T. Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan. British Medical Journal (Clinical Research Edition) 1981 January 17; 282:183–185.Photo Source:Provided by JM Samet.Slide Source:Borio G. Tobacco Timeline Available at: (accessed June 2000).Surgeon General Luther Terry holding the 1964 ReportBorio G. Tobacco Timeline. 1998