Workshop Summary

INTRODUCTION

Tobacco use is the leading cause of preventable death in the United States, causing more than 440,000 deaths annually and resulting in $193 billion in health-related economic losses each year—$96 billion in direct medical costs and $97 billion in lost productivity (CDC, 2008). Since the first U.S. Surgeon General’s report on smoking in 1964, more than 29 Surgeon General’s reports, drawing on data from thousands of studies, have documented “the overwhelming and conclusive biologic, epidemiologic, behavioral, and pharmacologic evidence that tobacco use is deadly” (HHS, 2010b, p. iii). This evidence base links tobacco use to the development of multiple types of cancer1 and other life-threatening conditions, including cardiovascular and respiratory diseases (HHS, 2004). Smoking accounts for at least 30 percent of all cancer deaths, and 80 percent of lung cancer deaths (ACS, 2012). Despite widespread agreement on the dangers of tobacco use and considerable success in reducing tobacco use prevalence from more than 40 percent at the time of the 1964 Surgeon General’s report to less than 20 percent today, recent progress in reducing tobacco use has slowed. An estimated 18.9 percent of U.S. adults (45.3 million) smoke cigarettes, nearly

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1 Smoking heightens the risk of up to 18 different types of cancers, including head and neck cancers, leukemia, and cancers of the esophagus, bladder, pancreas, kidney, liver, stomach, colorectum, cervix, uterus, and ovaries (ACS, 2012; HHS, 2004; Secretan et al., 2009).



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Workshop Summary INTRODUCTION Tobacco use is the leading cause of preventable death in the United States, causing more than 440,000 deaths annually and resulting in $193 billion in health-related economic losses each year—$96 billion in direct medical costs and $97 billion in lost productivity (CDC, 2008). Since the first U.S. Surgeon General’s report on smoking in 1964, more than 29 Surgeon General’s reports, drawing on data from thousands of studies, have documented “the overwhelming and conclusive biologic, epidemiologic, behavioral, and pharmacologic evidence that tobacco use is deadly” (HHS, 2010b, p. iii). This evidence base links tobacco use to the development of multiple types of cancer1 and other life-threatening conditions, including cardiovascular and respiratory diseases (HHS, 2004). Smoking accounts for at least 30 percent of all cancer deaths, and 80 percent of lung cancer deaths (ACS, 2012). Despite widespread agreement on the dangers of tobacco use and considerable success in reducing tobacco use prevalence from more than 40 percent at the time of the 1964 Surgeon General’s report to less than 20 percent today, recent progress in reducing tobacco use has slowed. An esti- mated 18.9 percent of U.S. adults (45.3 million) smoke cigarettes, nearly 1 Smoking heightens the risk of up to 18 different types of cancers, including head and neck cancers, leukemia, and cancers of the esophagus, bladder, pancreas, kidney, liver, stom- ach, colorectum, cervix, uterus, and ovaries (ACS, 2012; HHS, 2004; Secretan et al., 2009). 1

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2 REDUCING TOBACCO-RELATED CANCER INCIDENCE AND MORTALITY one in four high school seniors smoke, and 13 percent of high school males use smokeless tobacco products (CDC, 2012b,g; HHS, 2012). In recognition that progress in combating cancer will not be fully achieved without addressing the tobacco problem, the National Cancer Policy Forum of the Institute of Medicine (IOM) convened a public work- shop, Reducing Tobacco-Related Cancer Incidence and Mortality, June 11–12, 2012, in Washington, DC.2 In opening remarks to the workshop participants, planning committee chair Roy Herbst, professor of medicine and of pharmacology and chief of medical oncology at Yale Cancer Center and Smilow Cancer Hospital, described the goals of the workshop, which were to examine the current obstacles to tobacco control and to discuss potential policy, outreach, and treatment strategies that could overcome these obstacles and reduce tobacco-related cancer incidence and mortality. Experts explored a number of topics, including •  he changing demographics of tobacco users and the changing pat- t terns of tobacco product use; •  he influence of tobacco use on cancer incidence and cancer treat- t ment outcomes; • tobacco dependence and cessation programs; • federal- and state-level laws and regulations to curtail tobacco use; • tobacco control education, messaging, and advocacy; • financial and legal challenges to tobacco control efforts; and •  esearch and infrastructure needs to support tobacco control strate- r gies, reduce tobacco-related cancer incidence, and improve cancer patient outcomes. During the workshop, individual workshop participants raised a num- ber of potential action items to reduce tobacco use and the associated health consequences, including the higher rates of cancer incidence and mortal- ity, as well as suggestions to improve tobacco control policy, research, and advocacy. These suggestions focused on a number of key audiences, includ- 2 This workshop was organized by an independent planning committee whose role was limited to the identification of topics and speakers. This workshop summary was prepared by the rapporteurs as a factual summary of the presentations and discussions that took place at the workshop. Statements, recommendations, and opinions expressed are those of indi- vidual presenters and participants, are not necessarily endorsed or verified by the Institute of Medicine or the National Cancer Policy Forum, and should not be construed as reflecting any group consensus.

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WORKSHOP SUMMARY 3 ing the general public, cancer patients, clinicians, policy makers, advocacy groups, health researchers, and insurers. An overview of key discussion points raised by individual presenters is provided below. The workshop agenda, statement of task, and speaker biographies are in Appendixes A and B. The speakers’ presentations (PDF and audio files) have been archived at www.iom.edu/Activities/Disease/NCPF/2012- JUN-11.aspx. Overview of Key Points Highlighted by Individual Participants Clinicians can improve their patients’ health by •  ecognizing and treating nicotine dependence as a serious R chronic medical problem. • ncorporating tobacco assessment and cessation support I as a standard part of clinical care for all patients. •  iscussing the immediate and long-term cardiovascular, D pulmonary, cancer, and other related health benefits associ- ated with tobacco cessation at every patient encounter. •  ecommending and/or providing evidence-based tobacco R cessation therapy, including counseling and medication, for all patients who use tobacco. •  roviding consistent and repeated counseling for tobacco P cessation at every patient encounter. Cancer care could be improved by •  ccurately identifying tobacco use in cancer patients during A and following cancer treatment using structured tobacco assessments and/or biochemical confirmation methods. • ncorporating the treatment of tobacco dependence into the I standard of care for all cancer patients who use tobacco products, to improve treatment outcomes and reduce treat- ment complications and toxicity. •  nsuring that all institutions that treat cancer patients have E evidence-based tobacco cessation programs as a require- ment for accreditation. •  andating dedicated cessation support as a standard M requirement for National Cancer Institute (NCI) Cancer Center Designation.

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4 REDUCING TOBACCO-RELATED CANCER INCIDENCE AND MORTALITY Tobacco cessation therapy could be advanced and made more accessible by •  andating tobacco assessment and cessation referrals for M payment incentives or as a condition of reimbursement for standard medical procedures. •  nsuring tobacco cessation programs have adequate E resources to achieve their missions. •  nsuring all insurance plans provide coverage for evidence- E based tobacco cessation therapy. •  tandardizing electronic medical record fields to document S tobacco use status, cessation referrals, and cessation therapy. •  nsuring all tobacco cessation therapy is personalized to E prioritize patient preferences and needs. •  raining health care professionals in evidence-based T tobacco cessation therapy and encouraging use of available cessation resources. •  nhancing referral programs and other partnerships between E clinicians/health systems and cessation therapy providers in the public health sector (e.g., state quitlines). Tobacco control policy and advocacy could be improved by •  oordinating institutional, local, and national tobacco control C efforts and oversight. •  nsuring tobacco control programs have sufficient resources E and funding to achieve their missions. •  ngaging clinicians and clinician societies to join with the E public health community to advance tobacco control efforts. •  nticipating legal challenges from the tobacco industry, and A ensuring that communities have the financial resources to defend them. •  ligning policies and advocacy efforts with the trends of A tobacco product use, including dual use of noncombustible and combustible products, and the use of new tobacco products. Reductions in tobacco use could be facilitated by •  sing Food and Drug Administration (FDA) regulatory U authority to reduce the amount of nicotine in tobacco prod- ucts to nonaddicting levels so that consumers who wish to discontinue use can do so easily.

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WORKSHOP SUMMARY 5 •  ssessing and communicating the relative health risks of A new, combined, and alternative tobacco products in a rigor- ous, evidence-based manner with FDA oversight, so con- sumers can make informed decisions about the products they use. •  dvancing effective policies and advocacy efforts such as A taxes, smoke-free laws, and media campaigns. • ncreasing referrals from clinicians/health systems to public I health cessation resources such as quitlines. Health research could be improved and the evidence base could be expanded by • ncluding measures to assess tobacco use and cessation in I all cancer clinical trials. •  rioritizing behavioral and social science research on P tobacco use and cessation in conjunction with other health research efforts. •  valuating communication strategies to determine the most E effective ways to inform the public about the risks of tobacco use and to encourage quit attempts. •  onducting research to maximize the impact of FDA over- C sight, such as informing product standards (e.g., with regard to nicotine). •  ssessing the roles that may be played by evidence-based A and emerging technologies such as cell phone apps and video games in reducing tobacco use, facilitating cessation, and enhancing cancer care. CHANGING DEMOGRAPHICS OF TOBACCO USE Several speakers noted that the average person who smokes today tends to have a different educational and economic background from the typical person who smoked decades ago, when cigarette smoking was more popular, with fewer known risks. People who smoke now tend to have a lower economic and educational status than those who do not smoke, according to Kenneth Warner, the Avedis Donabedian Distinguished University Professor of Public Health at the University of Michigan School of Public Health. He noted that less than 10 percent of college graduates smoke, while those with a high school diploma/GED or less have a smoking

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6 REDUCING TOBACCO-RELATED CANCER INCIDENCE AND MORTALITY prevalence of 27 to 28 percent. In some blue-collar occupations, smoking prevalence is around 30 percent (CDC, 2011a). Michele Bloch, acting chief of the Tobacco Control Research Branch at NCI, also stressed that many people who smoke today “live in communities where smoking is normative, and we haven’t done enough to think about how to reach folks that live in [that] environment.” Otis Brawley, chief medical and scientific officer and executive vice president of the American Cancer Society, cautioned against viewing smoking as a racial disparities issue, and instead emphasized that smoking is a socioeconomic and educa- tion issue. Brawley noted that some surveys have shown that black high school students have a lower prevalence of tobacco use compared with white students (CDC, 2012b). “I tend to focus … on the fact that this is a problem [and] that everybody needs to stop smoking. This is not just a black problem or a white problem,” he said. “It is an American problem.” In addition, some studies indicate that individuals with mental illness and/or substance abuse are twice as likely to smoke compared to the gen- eral population, and consume nearly half of the cigarettes smoked in the United States (Lasser et al., 2000). Warner noted that about 60 percent of schizophrenic patients smoke—three times the national average (McClave et al., 2010). This high rate of tobacco use has led some to suggest that these individuals may be self-medicating with tobacco, and led to a suggestion by Brawley for mental health and tobacco control advocates to join together to tackle this issue of severe addiction coupled with a high prevalence of mental illness or substance abuse. Warner also noted that “there is a raging debate about whether many [of the people who smoke today] are hardcore smokers—people who can’t quit or never will quit. That is a very different image [than] smoking as a freely chosen adult pleasure.” Some have contended this could explain, in part, why the decline in smoking prevalence has slowed almost to the point of stagnation. However, others disagree with the premise that people who smoke today are more hard core, noting that many people who currently smoke consume fewer cigarettes and smoke far less regularly. Jamie Ostroff, attending psychologist, director of the Tobacco Cessa- tion Program for Memorial Hospital, and chief of the Behavioral Sciences Service at the Memorial Sloan-Kettering Cancer Center, emphasized recent studies suggest that evidence-based approaches to tobacco cessation are also safe and effective for people with mental illness or substance abuse disorders (Fiore et al., 2008; Williams and Ziedonis, 2004). Michael Fiore, professor of medicine and director of the University of Wisconsin Center for Tobacco

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WORKSHOP SUMMARY 7 Research and Intervention, noted that a bigger challenge is getting health care professionals to overcome their reluctance to treat their psychiatric patients’ tobacco dependence because of unwarranted concern that such treatment will worsen their underlying psychiatric condition. Several speakers and attendees also pointed out the heightened prevalence of tobacco use in the military compared to the overall civilian population, with nearly a third of military personnel reporting they have smoked in the past 30 days and 14 percent reporting smokeless tobacco use (TRICARE, 2009). According to a Centers for Disease Control and Prevention (CDC) study, close to 45 percent of U.S. service members deployed to Iraq and Afghanistan smoke, roughly double the rate of non- military Americans (CDC, 2012e). Warner pointed out that cigarettes are sold at a discount rate on military installations (IOM, 2009a). Brawley added that his impression from interactions with military personnel is that the military medical officers would like to ban cigarette sales from military bases and would like to have the ability to order soldiers not to smoke. But some battle frontline officers argue this is an imposition on the American soldier who is exposed to combat and other stressful conditions. However, Brawley noted that smoking is no longer allowed on submarines, and Fiore added that all basic training facilities must be smoke free (IOM, 2009a; Shanker, 2010). Richard Hurt, professor of medicine and director of the Nicotine Dependence Center at the Mayo Clinic, suggested that the issue of banning smoking in military facilities should be extended not only to active duty facilities but also to those operated by the U.S. Department of Veterans Affairs (VA). Fiore concurred, noting that the smoking rate of veterans from the Gulf War is higher than that of the same soldiers prior to going to battle (Bastian and Sherman, 2010; Brown, 2009; IOM, 2009a). “This is an important consideration—these soldiers are surviving [the battlefield] only to return with this enormous risk to their future health,” Fiore said. He also called attention to the recent report by the IOM on tobacco use in the military and the challenges tied to this issue (IOM, 2009a). Several speakers addressed the current smoking behavior of youth. Terry Pechacek, associate director for science in the Office on Smoking and Health at CDC, pointed out that after years of sustained progress in reducing smoking in youth, the decline in smoking appears to be slowing for cigarette use, and is at a standstill for smokeless tobacco, since about 2003 (HHS, 2012). There was a 40 percent decline in youth smoking between 1997 and 2003, but only about half as much of a decline in youth

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8 REDUCING TOBACCO-RELATED CANCER INCIDENCE AND MORTALITY smoking between 2003 and 2011 (see Figure 1). Pechacek stressed that there are now 3 million more youth and young adults in the United States who smoke than there would have been if progress from 1999 to 2003 in preventing smoking initiation had been sustained (HHS, 2012). Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids, blamed this on a lack of a substantial price increase in cigarettes since 2003. McGoldrick and Tim McAfee, director of the Office of Smoking and Health at CDC, emphasized that although cigarette smoking is still declin- ing slowly among youth (as shown in Figure 1), other tobacco product use is up (see section on Changing Patterns of Tobacco Use), so the progress in stemming overall use of tobacco products may be overestimated. “The [tobacco industry] is getting all the replacement smokers that it needs,” Pechacek said. “Since the birth cohort of about 1980, we have not really been cutting down the number of smokers being fed into the epidemic.” While the percentage of young people who start smoking has decreased and is lower than it would have been had tobacco control mea- sures not been adopted, when one includes the use of cigars, the progress made in stemming smoking initiation is even less. 100 Total White 80 Black Hispanic 60 Percent 40 20 0 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 Year FIGURE 1  Percentage of high school students who reported current cigarette use, 1991 to 2011. For all high school students, cigarette smoking increased from 1991 to 1997 and decreased from 1997 to 2011. The rate of decline in smoking has slowed down from 2003 to 2011 compared to 1997 to 2003. Figure 1.eps NOTE: Current cigarette use is defined as smoking at least 1 day during the 30 days prior to the survey. SOURCES: Pechacek presentation (June 11, 2012); CDC (2012f ).

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WORKSHOP SUMMARY 9 Pechacek noted that the 2012 Surgeon General’s report Preventing Tobacco Use Among Youth and Young Adults stated that prevention efforts must focus on adolescents and young adults through age 25, because data indicate that few start smoking after age 25, whereas nearly 9 out of 10 who smoke start by age 18, and 99 percent start by age 26 (HHS, 2012). Progression from occasional to daily smoking almost always occurs by age 26 (HHS, 2012). However, David Abrams, executive director of the Schro- eder Institute for Tobacco Research and Policy Studies at Legacy, said that among a young adult cohort they have been studying, 32 percent of people who have ever used tobacco reported initiation of use after age 18 and 39 percent of people who regularly use tobacco reported progressing to regular use during young adulthood (Rath et al., 2012). Pechacek pointed out that although around 20 percent of the general population smokes, recent data from the 2011 Youth Risk Behavior Sur- vey found about 40 percent of young adults have tried smoking (CDC, 2012d). “We are underestimating the burden of smoking that is being passed forward into the future if we focus only on the current 20 percent prevalence,” said Pechacek. He added that under current tobacco exposure patterns, about two-thirds of preventable cancers in children born today will not be averted. Abrams also stressed the need to focus on the smoking behavior of young adults “because they are the pattern of use of the future.” Legacy found that 30 percent of 18- to 34-year-olds are dual cigarette and other tobacco product users (Rath et al., 2012). “That is of huge concern,” he said. There has also been a slowing of progress in reducing the use of tobacco products in older adults, Pechacek noted. He pointed out that the projected prevalence of smoking for 2020, based on current smoking patterns, will be around 17 percent (CDC, 2011d). Howard Koh, assistant secretary for health at the U.S. Department of Health and Human Services (HHS), noted that the perception among too many is that “the tobacco problem has been solved and it is time to move on to something else. But it is time to accelerate and reinvigorate our efforts and reaffirm that tobacco use is the premier public health challenge of our time.” Michael Cummings, professor and codirector of the Tobacco Policy and Control Program at the Medical University of South Carolina’s Hollings Cancer Center, added, “The time to act is sooner rather than later. If the population ceased smok- ing, this would be tantamount to an effective vaccine against a third of all cancers.” McGoldrick stated it more bluntly: “The goal is to have fewer dead people—this is the bottom line.”

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10 REDUCING TOBACCO-RELATED CANCER INCIDENCE AND MORTALITY CHANGING PATTERNS OF TOBACCO USE Although tobacco use has been a common practice for centuries, the development of the modern cigarette in the early part of the 20th century made it easier to inhale tobacco smoke and is driving the current epidemic of smoking, Pechacek noted. Introduction of the cigarette also drove down the use of other less inhalable forms of tobacco smoking, including pipe and cigar smoking (see Figure 2). Although the cigarette is the most prominent tobacco product cur- rently on the market, several speakers pointed out that the use of different types of tobacco products have increased in recent years. These products include cigars, a type of smokeless tobacco called snus, spit tobacco, dissolv- able tobacco products, and the e-cigarette, which is a device that resembles a cigarette and converts a nicotine-laden liquid into vapor. Often noncombustible tobacco products are viewed as being less hazardous to health than combustible ones, but that thinking may be mis- guided, according to Pechacek. The use of noncombustible tobacco prod- ucts is often in addition to cigarette or cigar smoking and not instead of such smoking. He reported that a current survey indicates that nearly 40 percent 16 Cigarettes Cigars Pipe/Roll your own Chewing Snuff 14 Pounds of Tobacco per Adult 12 10 8 6 4 2 0 1880 1885 1890 1895 1900 1905 1910 1915 1920 1925 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 Year FIGURE 2  Trends in per capita consumption of various tobacco products—United States, 1880–2005. Figure 2.eps SOURCES: Pechacek presentation (June 11, 2012); adapted from Giovino (2007). Reprinted with permission from Elsevier.

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WORKSHOP SUMMARY 11 of all smokeless tobacco users also use cigarettes.3 Among youth and young adults, the reported dual use of cigarettes and smokeless tobacco is even greater; nearly 60 percent among 18- to 25-year-olds and 48 percent among 12- to 17-year-olds. Many “smokeless tobacco users are smoking cigarettes,” Pechacek stressed. “We are not saying that noncombustible sources don’t have a role, but watch out because noncombustible tobacco products are adding on to, rather than replacing, cigarette smoking.” Pechacek noted that cigar smoking is assumed to be less dangerous than cigarette smoking because it is often not inhaled, but this may not be the case for current or former cigarette smokers who do inhale cigar smoke. Studies have shown that former cigarette smokers who switched to cigars had potentially higher levels of exposure to toxic chemicals and risk of disease than people who smoke cigarettes (NCI, 2012a). McAfee added that the increased consumption of cigars seen in the past few years is being influenced strongly by the growing availability of cigars that are only slightly larger than cigarettes, with their weight adjusted in order to be eligible for preferential tax treatment (CDC, 2012a). He added that these cigars appear to be used functionally more like cigarettes than traditional large cigars. Another factor that may be contributing to cigarette-like cigar uptake is differential FDA regulatory authority for cigars versus cigarettes. Margaret Foti, chief executive officer of the American Association for Cancer Research (AACR), stressed that the use of the hookah pipe is also increasing in the United States, and that 1 hour of using a hookah pipe can equate to inhaling 100 to 200 times the volume of smoke inhaled from a single cigarette (CDC, 2011b). Brawley agreed that the use of hookah is growing, especially on college campuses, and its use should be addressed. Pechacek confirmed that the prevalence of hookah smoking is growing rapidly, and public health officials need to pay attention to the problem. Several speakers emphasized the need to increase national surveillance for all forms of tobacco use, with emphasis on the need to assess the effects of combined tobacco product use. Warner added that the University of Michi- gan’s Monitoring the Future study, which traces use of drugs by children, is now tracking the use of hookah. McAfee discussed the emergence of new noncombustible products, such as refrigerated snus and dissolvables in tablet or stick form that have been introduced in the United States during the past 5 years, as well as the availability of e-cigarettes. Some of these products are being marketed as 3 National Survey on Drug Use and Health, 2010 (unpublished data).

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76 REDUCING TOBACCO-RELATED CANCER INCIDENCE AND MORTALITY Bastian, L. A., and S. E. Sherman. 2010. Effects of the wars on smoking among veterans. Journal of General Internal Medicine 25(2):102-103. Bauer, J. E., A. Hyland, Q. Li, C. Steger, and K. M. Cummings. 2005. A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use. American Journal of Public Health 95(6):1024-1029. Bayer, R., L. Gostin, and D. Marcus-Toll. 2012. Repackaging cigarettes—will the courts thwart the FDA? New England Journal of Medicine 367(22):2065-2067. Boorjian, S., J. E. Cowan, B. R. Konety, J. DuChane, A. Tewari, P. R. Carroll, C. J. Kane, and Cancer of the Prostate Strategic Urologic Research Endeavor Investigators. 2007. Bladder cancer incidence and risk factors in men with prostate cancer: Results from Cancer of the Prostate Strategic Urologic Research Endeavor. Journal of Urology 177(3):883-887. Breast Cancer Trialists Group. 1998. Polychemotherapy for early breast cancer: An overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group. Lancet 352(9132):930-942. Brody, A. L., M. A. Mandelkern, E. D. London, R. E. Olmstead, J. Farahi, D. Scheibal, J. Jou, V. Allen, E. Tiongson, S. I. Chefer, A. O. Koren, and A. G. Mukhin. 2006. Cigarette smoking saturates brain α4 β2 nicotinic acetylcholine receptors. Archives of General Psychiatry 63(8):907-915. Browman, G. P., G. Wong, I. Hodson, J. Sathya, R. Russell, L. McAlpine, P. Skingley, and M. N. Levine. 1993. Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. New England Journal of Medicine 328(3):159-163. Brown, D. W. 2009. Smoking prevalence among US veterans. Journal of General Internal Medicine 25(2):147-149. California State Board of Equalization. 2012. Annual report 2010-2011: Appendix. http:// www.boe.ca.gov/annual/2010-11/appendix.html (accessed September 4, 2012). California Tobacco Control Program. 2010. Two decades of the California Tobacco Control Program: California Tobacco Survey, 1990-2008. http://www.cdph.ca.gov/programs/ tobacco/Documents/CDPH_CTS2008%20summary%20report_final.pdf (accessed September 4, 2012). Callinan, J. E., A. Clarke, K. Doherty, and C. Kelleher. 2010. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption (review). Cochrane Database of Systematic Reviews 14(4):CD005992. Campaign for Tobacco-Free Kids. 2012a. The impact of the new FDA tobacco law on state tobacco control efforts. http://www.tobaccofreekids.org/research/factsheets/pdf/0360.pdf (accessed September 7, 2012). Campaign for Tobacco-Free Kids. 2012b. Spending vs. tobacco company marketing. http://www.tobaccofreekids.org/content/what_we_do/state_local_issues/settlement/ FY2012/10_State_Tobacco_Prevention_Spending_vs_Tob_Co._Marketing.pdf (accessed September 10, 2012). Campaign for Tobacco-Free Kids. 2012c. Enforcing laws prohibiting cigarette sales to kids reduces youth smoking. http://www.tobaccofreekids.org/research/factsheets/pdf/0049. pdf (accessed September 10, 2012). Campaign for Tobacco-Free Kids. 2012d. Trends in state tobacco prevention spending vs. state tobacco revenues. http://www.tobaccofreekids.org/research/factsheets/pdf/0220.pdf (accessed September 11, 2012).

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78 REDUCING TOBACCO-RELATED CANCER INCIDENCE AND MORTALITY Chapple, A., S. Ziebland, and A. McPherson. 2004. Stigma, shame, and blame experienced by patients with lung cancer: Qualitative study. British Medical Journal 328(7454):1470. Cleveland Clinic. 2012a. A message about smoking. http://my.clevelandclinic.org/tobacco/a_ message_about_smoking.aspx (accessed September 10, 2012). Cleveland Clinic. 2012b. New nonsmoking hiring policy at Cleveland Clinic. http:// my.clevelandclinic.org/Documents/Urology/Non-Smoking_Hiring_Statement.pdf (accessed September 10, 2012). CMS (Centers for Medicare & Medicaid Services). 2011. Essential health benefits bulletin. Center for Consumer Information and Insurance Oversight. http://cciio.cgov/resources/ files/Files2/12162011/essential_health_benefits_bulletin.pdf (accessed September 7, 2012). CMS. 2012. Smoking & tobacco use cessation (counseling to stop smoking or using tobacco products). http://www.medicare.gov/coverage/smoking-and-tobacco-use-cessation.html (accessed September 7, 2012). Conroy, M. B., N. E. Majchrzak, C. B. Silverman, Y. Chang, S. Regan, L. I. Schneider, and N. A. Rigotti. 2005. Measuring provider adherence to tobacco treatment guidelines: A comparison of electronic medical record review, patient survey, and provider survey. Nicotine and Tobacco Research 7(S1):S35-S43. Cooley, M. E., L. Sarna, J. Kotlerman, J. M. Lukanich, M. Jaklitsch, S. B. Green, and R. Bueno. 2009. Smoking cessation is challenging even for patients recovering from lung cancer surgery with curative intent. Lung Cancer 66(2):218-225. CTIA. 2011. CTIA—the Wireless Association semi-annual survey reveals historical wireless trend. http://www.ctia.org/media/press/body.cfm/prid/2133 (accessed September 4, 2012). Dennis, B. 2013. Government quits legal battle over graphic cigarette warnings. http://articles. washingtonpost.com/2013-03-19/national/37845669_1_cigarette-makers-tobacco- companies-confusion-or-deception (accessed April 4, 2013). Dobbins, M., K. DeCorby, S. Manske, E. Goldblatt. 2008. Effective practices for school- based tobacco use prevention. Preventive Medicine 46(4):289-297. Dooren, J. C. 2012. Court strikes graphic cigarette labels. http://online.wsj.com/article/SB10 000872396390444358404577609242156512180.html (accessed October 6, 2012). Duffy, S. A., D. L. Ronis, M. Valenstein, M. T. Lambert, K. E. Fowler, L. Gregory, C. Bishop, L. L. Myers, F. C. Blow, and J. E. Terrell. 2006. A tailored smoking, alcohol, and depression intervention for head and neck cancer patients. Cancer Epidemiology, Biomarkers & Prevention 15(11):2203-2208. Emery, S., Y. Kim, Y. K. Choi, G. Szczyka, M. Wakefield, and F. J. Chaloupka. 2011. The effects of smoking-related television advertising on smoking and intentions to quit among adults in the United States: 1999-2007. American Journal of Public Health 102(4):751-757. European Commission. 2009. Survey on tobacco: Analytical report. http://ec.europa.eu/ public_opinion/flash/fl_253_en.pdf (accessed September 5, 2012). Farrelly, M. C., K. C. Davis, M. L. Haviland, P. Messeri, and C. G. Healton. 2005. Evidence of a dose—response relationship between “truth” antismoking ads and youth smoking prevalence. American Journal of Public Health 95(3):425-431. Farrelly, M. C., J. Nonnemaker, K. C. Davis, and A. Hussin. 2009. The influence of the national truth campaign on smoking initiation. American Journal of Preventive Medicine 6(5):379-384.

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80 REDUCING TOBACCO-RELATED CANCER INCIDENCE AND MORTALITY Goodall, C., and O. Appiah. 2008. Adolescents’ perceptions of Canadian cigarette package warning labels: Investigating the effects of message framing. Health Communication 23(2):117-127. Gray, L., and L. Lewis. 2009. Educational technology in public school districts: Fall 2008 (NCES 2010-003). Washington, DC: National Center for Education Statistics (accessed September 21, 2012). Grimshaw, G.M., and A. Stanton. 2006. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews Oct 18(4):CD003289. Gritz, E. R., C. Dresler, and L. Sarna. 2005. Smoking, the missing drug interaction in clinical trials: Ignoring the obvious. Cancer Epidemiology, Biomarkers & Prevention 14(10):2287-2293. Gritz, E. R., C. Y. Lam, D. J. Vidrine, and M. C. Fingeret (Eds.). 2011. Cancer prevention: Tobacco dependence and its treatment. In Cancer: Principles & practice of oncology, edited by V. T. DeVita, T. S. Lawrence, and S. A. Rosenberg. Philadelphia, PA: Wolters Kluwer Lippincott Williams & Wilkins. Hackshaw, A. K., M. R. Law, and N. J. Wald. 1997. The accumulated evidence on lung cancer and environmental tobacco smoke. British Medical Journal 315(7114):980-988. Hahn, E. J., M. K. Rayens, C. Hopenhayn, and W. J. Christian. 2006. Perceived risk and interest in screening for lung cancer among current and former smokers. Research in Nursing and Health 29(4):359-370. Hammond, D. 2011. Health warning messages on tobacco products: A review. Tobacco Control 20:327-337. Hammond, D., G. T. Fong, A. McNeill, R. Borland, and K. M. Cummings. 2006. Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: Findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control 15(Suppl III):iii19-iii25. Herbst, R. S., D. Prager, R. Hermann, L. Fehrenbacher, B. E. Johnson, A. Sandler, M. G. Kris, H. T. Tran, P. Klein, X. Li, D. Ramies, D. H. Johnson, and V. A. Miller. 2005. TRIBUTE: A phase III trial of erlotinib hydrochloride (OSI-774) combined with carboplatin and paclitaxel chemotherapy in advanced non-small-cell lung cancer. Journal of Clinical Oncology 23(25):5892-5899. Herbst, R. S., J. V. Heymach, and S. M. Lippman. 2008. Molecular origins of lung cancer. New England Journal of Medicine 359(13):1367-1380. HHS (U.S. Department of Health and Human Services). 2004. The health consequences of smoking: A report of the Surgeon General. Atlanta, GA: Office on Smoking and Health. HHS. 2008. Helping smokers quit: A guide for clinicians. http://www.ahrq.gov/clinic/tobacco/ clinhlpsmksqt.pdf (accessed September 12, 2012). HHS. 2010a. Ending the tobacco epidemic: A tobacco control strategic action plan for the U.S. Department of Health and Human Services. Washington, DC: Office of the Assistant Secretary for Health. HHS. 2010b. How tobacco smoke causes disease: The biology and behavioral basis for smoking- attributable disease. A Report of the Surgeon General. Atlanta, GA: Office on Smoking and Health. HHS. 2012. Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: Office on Smoking and Health.

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