Updated Review of Major Cancer Risk Factors and Screening Test Use in the United States in 2018 and 2019, with a Focus on Smoking Cessation.

Cancer prevention and early detection efforts are central to reducing cancer burden. Herein, we present estimates of cancer risk factors and screening tests in 2018 and 2019 among US adults, with a focus on smoking cessation. Cigarette smoking reached a historic low in 2019 (14.2%) partly because 61.7% (54.9 million) of all persons who had ever smoked had quit. Yet, the quit ratio was <45% among lower-income, uninsured, and Medicaid-insured persons, and was <55% among Black, American Indian/Alaska Native, lower-educated, lesbian, gay or bisexual, and recent immigrant persons, and in 12 of 17 Southern states. Obesity levels remain high (2017-2018: 42.4%) and were disproportionately higher among Black (56.9%) and Hispanic (43.7%) women. HPV vaccination in adolescents 13 to 17 years remains underutilized and over 40% were not up-to-date in 2019. Cancer screening prevalence was suboptimal in 2018 (colorectal cancer ≥50 years: 65.6%; breast ≥45 years: 63.2%; cervical 21-65 years: 83.7%), especially among uninsured adults (colorectal: 29.8%; breast: 31.1%). This snapshot of cancer prevention and early detection measures was mixed, and substantial racial/ethnic and socioeconomic disparities persisted. However, gains could be accelerated with targeted interventions to increase smoking cessation in under-resourced populations, stem the obesity epidemic, and improve screening and HPV vaccination coverage.

Twenty-year health and economic impact of reducing cigarette use: Minnesota 1998-2017.

BACKGROUND: Adult smoking prevalence in Minnesota fell from 21.8% in 1997 to 15.2% in 2016. This reduction improved heart and lung health, prevented cancers, extended life and reduced healthcare costs, but quantifying these benefits is difficult. METHODS: 1.3 million individuals were simulated in a tobacco policy model to estimate the gains to Minnesotans from 1998 to 2017 in health, medical spending reductions and productivity gains due to reduced cigarette smoking. A constant prevalence scenario was created to simulate the tobacco harms that would have occurred had smoking prevalence stayed at 1997 levels. Those harms were compared with tobacco harms from a scenario of actual smoking prevalence in Minnesota from 1998 to 2017. RESULTS: The simulation model predicts that reducing cigarette smoking from 1998 to 2017 has prevented 4560 cancers, 31 691 hospitalisations for cardiovascular disease and diabetes, 12 881 respiratory disease hospitalisations and 4118 smoking-attributable deaths. Minnesotans spent an estimated $2.7 billion less in medical care and gained $2.4 billion in paid and unpaid productivity, inflation adjusted to 2017 US$. In sensitivity analysis, medical care savings ranged from $1.7 to $3.6 billion. CONCLUSIONS: Minnesota's investment in comprehensive tobacco control measures has driven down smoking rates, saved billions in medical care and productivity costs and prevented tobacco related diseases of its residents. The simulation method employed in this study can be adapted to other geographies and time periods to bring to light the invisible gains of tobacco control.

[Interventions for smoking cessation in 2018]. / Les outils du sevrage tabagique en 2018.

Smoking cessation treatments have been proved effective to stop smoking. For pharmacological treatments, nicotine replacement therapies (NRT) as well as bupropion allow to increase 6 month-abstinence rates by more than 80% in comparison with placebo while varenicline prescription doubles success rates in the same conditions. These results mean that for 10 smokers who quit with placebo, 18 are expected to quit with NRT or bupropion and 28 are expected to quit with varenicline. Varenicline is 50% more effective than nicotine patch and 70% more effective than nicotine gum. Nevertheless, a combination including NRT patch and oral nicotine forms is as effective as varenicline, thus leading to encourage the prescription of a combination NRT when NRT are chosen. For these three pharmacological treatments, cardiovascular as well as neuropsychiatric tolerance were not found statistically different from placebo in randomized controlled trials. Yet, bupropion prescription leads to an increasing risk of seizure (1/1000 to 1/1500). For behavioral treatment, motivational interviewing as well as cognitive behavior therapies are been proven to be effective to stop smoking but few smokers have access to this treatment. Smoking cessation mobile application and smartphone application seem to be promising in terms of effectiveness and might be useful to reach more smokers.

History and the future: Looking back to look forward?

History is often dismissed as of little utility in the analysis of policy. This paper provides a justification for its use as evidence. It surveys the rise of the use of history, including public history and history and policy. It looks at two issues which draw on the author's own work: the relationship between regulation and culture for smoking and alcohol; and the response to electronic cigarettes in the light of smoking and public health history. It analyses what history can contribute. Responses are time dependent and change is an essential parameter in understanding policy. Historical research can challenge stereotypes, for example that prohibition was abandoned because it 'failed'. It also forms the bedrock of historical interpretation, which is mutable and often misunderstood outside the profession. History provides policy analysis rather than policy prescription and is a challenging approach, not just a convenient support for established positions. The paper concludes that history is far from moribund as a policy science.

History of Cardiothoracic Surgery at Washington University in Saint Louis.

The Division of Cardiothoracic Surgery at Washington University evolved a century ago to address what many considered to be the last surgical frontier, diseases of the chest. In addition, as one of the first training programs in thoracic surgery, Washington University has been responsible for educating more thoracic surgeons than nearly any other program in the world. Beginning with Evarts A. Graham and continuing through to Ralph J. Damiano Jr., the leaders of the division have had a profound impact on the field of cardiothoracic surgery.

[The "modernization" of health education in both German states between 1949 and 1975. The example of smoking]. / Die "Modernisierung" der GesundheitsaufkIärung in beiden deutschen Staaten zwischen 1949 und 1975. Das Beispiel Rauchen.

Using the example of smoking, this article scrutinizes the notions of order, educational conduct and images of subjects in the health education of both German states between 1949 and the mid 70s. Drawing on archival sources, publications and educational media from both health ministries, the Deutsches Hygiene-Museum and the Bundeszentrale für gesundheitliche Aufklärung I reconstruct the organizational, conceptual and medial shift of health education from "citizenship" to a technology of communication and public relation, needing "scientification" in the 1960s. New epidemiological evidence fostered the belief in an efficacious prevention of manly coded and with smoking associated cardio-vascular diseases by forming healthy behavior. This went hand in hand with the increase of state responsibility for the health of its citizens and the import of new knowledge stemming from social research and new methodological expertise from advertising. At the same time the ideal of a comprehensible citizen shifted into a "socialist personality" that was to be shaped by a hierarchical and consistent education in the German Democratic Republic. In the Federal Republic of Germany the general principle of the self-determined citizen unfolded the antagonism of health education between individual emancipation and imposition.

Did we finally slay the evil dragon of cigarette smoking in the late 20th century?: unfortunately, the answer is no - the dragon is still alive and well in the 21st century and living in the third world. Shame on us!

If cigarettes were introduced as a new consumer product today, it is unlikely they would receive government regulatory approval. Cigarettes have proven biologic toxicities (carcinogenesis, atherogenesis, teratogenesis) and well-established causal links to human disease. Things were very different in 1913 when the R. J. Reynolds Tobacco Company introduced the first modern cigarette, the iconic Camel. By the early 1950s, definitive scientific reports linked cigarettes and human disease, but it was more than a half century later (2006) that cigarette manufacturers were found guilty by a federal court of deceptive product marketing regarding the health hazards of tobacco use. In the United States, cigarette smoking remains a major but slowly declining problem. But in developing countries, cigarette use is expanding tremendously. In global terms, the epidemic of smoking-caused disease is projected to increase rapidly in coming decades, not decline. Society may have begun to slowly win the smoking battle in the developed world, but we are resoundingly losing the global war on smoking. All is not lost! There is some good news! The 2003 Framework Convention on Tobacco Control, supported strongly by the American College of Chest Physicians, is the first global public health treaty of the new millennium. Many developed societies have begun planning to rid their countries of cigarettes in what is called the Endgame Strategy, and now is the time for the international medical community to help change tobacco policy to a worldwide endgame approach to rid all humanity of smoking-related diseases.

Health improvement in Poland is contingent on continued extensive tobacco control measures.

Tobacco smoking is a major avoidable single cause of premature mortality in Poland. Almost one in three Polish males do not live to 65 years of age, and almost half of this premature mortality can be traced back to the much higher smoking prevalence in Poland than in Western Europe--every third Polish male and every fourth Polish female smokes daily. However, the current health situation in Poland is much better than two decades ago when the country entered a period of political and economic upheaval. In the early 1990s, the state of health of the Polish population was catastrophic and its tobacco consumption levels the highest in the world. In the early 1990s, the probability of a 15-year-old Polish boy living to the age of 60 was not just twice lower than in Western Europe, but also lower than in China or India. The health policy of limiting the health consequences of smoking conducted by the European Union and, in the last two decades, by the Polish parliament and government, helped to stop this health catastrophe. In Poland, cigarette consumption has decreased by 30% since 1990, as did lung cancer mortality among males. Despite this progress, tobacco smoking remains the most serious health problem in Poland. Therefore, comprehensive tobacco control policy should not only be continued, but expanded and accelerated. The EU Tobacco Products Directive proposes a package of actions for reducing tobacco-related health harm in Europe. The Directive proposal is rational, science-and-evidence based, and grounded on the best practice examples from other countries. Both the Polish tobacco control law and the WHO Framework Convention on Tobacco Control (FCTC), ratified by Poland in 2006, oblige our country to support tobacco control, including all the initiatives taken by the European Union.

Large-scale unassisted smoking cessation over 50 years: lessons from history for endgame planning in tobacco control.

In the 50 years since the twentieth century's smoking epidemic began to decline from the beginning of the 1960s, hundreds of millions of smokers around the world have stopped smoking permanently. Overwhelmingly, most stopped without any formal assistance in the form of medication or professional assistance, including many millions of former heavy smokers. Nascent discussion about national and global tobacco endgame scenarios is dominated by an assumption that transitioning from cigarettes to alternative forms of potent, consumer-acceptable forms of nicotine will be essential to the success of endgames. This appears to uncritically assume (1) the hardening hypothesis: that as smoking prevalence moves toward and below 10%, the remaining smokers will be mostly deeply addicted, and will be largely unable to stop smoking unless they are able to move to other forms of 'clean' nicotine addiction such as e-cigarettes and more potent forms of nicotine replacement; and (2) an overly medicalised view of smoking cessation that sees unassisted cessation as both inefficient and inhumane. In this paper, we question these assumptions. We also note that some vanguard nations which continue to experience declining smoking prevalence have long banned smokeless tobacco and non-therapeutic forms of nicotine delivery. We argue that there are potentially risky consequences of unravelling such bans when history suggests that large-scale cessation is demonstrably possible.