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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.
×

Index

A

Abortion,

see Spontaneous abortions

Accidents

automobile, 42–44 (passim), 46, 50, 56

fires, vii, 570–571

Accord, 4, 65, 95, 603

Acetylcholine (Ach), 161, 244–245, 252, 254, 266, 269, 347, 568

Action on Smoking and Health, 126

Activated charcoal filters,

see Charcoal filters

Added ingredients,

see Additives

Addiction, vii, 1, 5, 25, 28, 29, 35, 40, 41, 161, 162, 201, 601

see also Alcohol and drug abuse;

Relapse

adolescents, 261

advertising and, 66

African Americans, 407

dose-response relationship, 255–256, 264, 266

FDA attempt to regulate tobacco, 126, 127, 129, 258, 604

genetic predisposition to, 161, 256, 347–348

nicotine pharmacology, 161, 243, 244, 245, 248, 254–260 (passim), 263–267 (passim)

psychological and behavioral aspects, 41, 118, 161, 254, 256–257, 259

risk perception, 68

Surgeon General’s report, 24, 600

withdrawal, 405, 569

drug treatments, 96, 101, 104–114 (passim), 123

nicotine pharmacology, 161, 244, 245, 248, 254–260 (passim), 263–267 (passim)

Additives, 82, 86, 90–91, 432, 571, 598, 601

advertising, 72, 73–74

animal models, 90–91, 149

blending processes, viii, 26, 82, 85, 87, 94, 128, 209, 287

FDA regulation, 128, 224

menthol, 62, 64, 72, 73, 77, 86–87, 98, 183, 319, 406–407, 438, 439

PREP risk assessment, 144, 149, 165, 212

regulation, 128, 149, 209, 210, 212, 224–225

risk perception, 72–74, 77

smokeless tobacco, 299–300

surveillance, 189, 196

Adolescents, 67, 235, 320–321, 602

see also Schools

addiction, 261

drug treatments, 112, 116

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.
×

gender factors, 74, 172, 543, 545, 552

sexual behavior, 44–46, 50, 51

National Youth Tobacco Survey, 185–187

pregnancy, 44, 172, 543, 545, 552

prevalence of tobacco use, 1, 22, 38, 319

risk perception, 41, 68, 72, 73–74, 112, 185

sexual behavior, 44–46, 50, 51;

see also “pregnancy” supra

smokeless tobacco, 302

state laws banning sales to, 120, 125, 202, 604

Surgeon General’s reports, 24, 125, 598, 601

surveillance, 185, 192

Youth Risk Behavior Survey, 93, 185–187, 261, 320–321

Adrenal hormones, 105, 107, 108, 109, 110, 244, 245, 252, 253, 480, 549

Adult Use of Tobacco Surveys (AUTS), 69, 76

Advance, 4, 92

Advertising, 7, 8, 26, 32, 72, 86

see also Labeling;

Marketing

additives, 72, 73–74

antismoking, 125

bans on, 120, 125, 597, 602

children and adolescents, 24

cigarette-like products, 94

historical perspectives, 60–66, 72–73, 74, 76, 120, 125–126, 595, 597, 602, 603

regulation of, 7, 10, 120, 125–126, 127, 128, 141, 203, 206, 207, 208, 211, 216–221, 222, 229, 232, 595, 597, 602, 603

smokeless tobacco, 93

Aerosols, viii, 284–285

cigarette-like products, 93–94

nicotine inhalers, 97–98

African Americans, 321, 603

birthweight, 548

cancer, 406–407, 416

mentholated cigarettes, 72, 73, 86, 406–407

nicotine metabolism, 250

Age factors

see also Adolescents;

Birthweight;

Children;

Reproductive and developmental effects

addiction, 261

body weight, 569

cancer, 389, 390, 405, 410–413, 420, 421, 424, 425

cardiovascular disease, 472, 473, 474–475, 482

chronic obstructive pulmonary (COPD), 503, 508, 509–511, 513, 515

dementia, 564

dose-response relationship, 164

environmental tobacco smoke (ETS), 424, 509–511

influenza and pneumonia, 526

initiation of smoking, 73–74, 185, 191, 319, 331, 381, 395, 405, 425, 508, 543, 601

nicotine metabolism, 250

ocular disease, 566

orthopedic disease, 565

PREPs, 76, 161, 164, 319, 321, 331

reproductive and developmental effects, 547

teenage pregnancy, 44, 172, 543, 545, 552

risk assessment, general, 67, 145, 186, 321

smokeless tobacco use, 93, 302

surveillance, 185, 186, 191, 192, 194, 321

Agency for Healthcare Research and Quality, 172

AIDS, 23, 44, 45, 48, 52, 53

Air pollutants, 44, 54, 225, 296, 333, 390, 505, 508–509, 519

occupational toxins, 33, 140, 151, 164, 166, 180, 195, 298, 329, 332, 350, 375, 377, 390, 408, 419, 420, 431, 433, 508, 599

Alcohol and drug abuse

auto accidents, 42, 43, 44, 46, 50, 56

behavioral treatments, 118–119

dementia, 564

measures of, 255, 257–266 (passim)

methadone, 42, 48, 49–50, 51, 52, 55, 114

naltrexone, 108

National Household Survey on Drug Abuse, 50, 92–93, 185–187, 260, 261

oropharyngeal disease, 415–416, 418

pharmacodynamics, 253, 570

policy, 39–40, 46–50, 51, 52, 53, 55, 56, 601

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.
×

pregnant women, 172, 545, 547

psychological mechanisms, 41

relapse, 47, 49

surveillance, 195

synergistic effects, 342, 415–416, 418, 426, 428

Alzheimer’s disease, 254, 564–565

American Cancer Society

Cancer Prevention Study (CPS) I/II, 67, 75, 76, 167, 170, 400, 487, 512–513, 530, 531

American Indians, 22, 543, 603

American Legacy Foundation Survey, 320–321

Aneurysms, 470, 481, 491

Animal models, 12–13, 15, 17, 34, 141, 149, 175, 287, 291, 293

addiction, 258, 263–264, 265–266

additives, 90–91, 149

cardiovascular disease, 149, 479, 486

cancer, 13, 293–295, 367, 374, 376, 383, 384–387, 422, 429, 432–433, 434, 435

cost of, 383

DNA adducts, 327, 385–387

dose-response relationship, 16, 145, 163, 165

fetal lung development, 511

infectious diseases, 296–297

nicotine antibodies, 107–108

nicotine pharmacology, 244, 253, 258, 268

PREP risk assessment, 144, 145, 147, 148–149, 162, 163, 165, 208, 212–213, 303, 350, 351, 384–386

regulatory principles, 10, 208, 212–213, 215

reproductive and developmental effects, 550

transgenic animals, 298–299, 385, 391

Antagonists, 4, 106–108, 110, 116, 244

mecamylamine, 107, 124, 266

Antibodies, 107–108, 297, 330–331

lymphocytes, 156, 296–297, 314, 338, 346, 376, 399, 417, 436, 518, 519

Antidepressants, 4, 104–106

see also Bupropion;

Zyban

nortriptyline, 4, 104, 106, 124

Aromatic amines, 148, 374, 377–378, 379, 420–421

Arsenic, 72, 148, 184, 374

Arthritis,

see Rheumatoid arthritis

Asbestos, 89, 298, 408, 501, 599

Asians/Pacific Islanders, 22, 250, 406, 407, 543, 603

Japanese, 88–89, 261, 286, 342, 409

Asthma, 170, 500–501, 518–525, 527, 530–531, 551

Atherosclerosis, 157, 162, 169, 253, 270, 296, 313, 332, 339, 343, 471, 472, 476–477, 479–483 (passim), 485, 490, 492, 493

Attitudes and beliefs, 54

see also Depression;

Risk perception

desire to cease smoking, 22, 71, 74–76, 78, 122, 186, 476, 512, 514, 515

negative opinion of tobacco use, 124–125, 187, 319

pregnant women, 187–188

public understanding of PREP content, 60

surveillance of, 8, 10, 185–188 (passim), 192, 196, 197

toward unsafe behavior, negative attitudes, 43

Automobile safety, vii

regulation, 41–44, 50, 52, 53, 56

AUTS,

see Adult Use of Tobacco Surveys

B

Behavioral effects of tobacco use, 3, 118, 389

see also Inhalation depth and intensity;

Smoking topography

addiction, 41, 118, 161, 254, 256–257, 259

childhood cognitive/behavioral disorders, 268, 550

cigarettes smoked per day, 22, 74, 88–89, 102, 113, 115, 119, 120, 151, 163, 164, 167, 170, 173, 300, 319, 343, 349, 375, 391, 392, 395, 396, 398–399, 401, 404, 412, 419, 437, 474, 487, 488, 489, 512, 513–514, 515, 516, 530

compensatory smoking, 2, 26, 67, 88, 121, 164, 219, 266, 285, 322, 380, 402, 403, 405, 477, 517

desire to cease smoking, 22, 71, 74–76, 78, 186, 476, 512, 514, 515

PREPs, 7, 73–76, 185, 197, 315

surveillance, 183, 185–188, 191–192, 195, 197

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.
×

Behavioral Risk Factor Surveillance System, 185–187, 320–321, 543

Behavioral treatments, 116–119, 121, 532

drug treatment, general, and, 118–119

nicotine replacement products and, 96, 115

Beliefs,

see Attitudes and beliefs

Benzene, 89, 95, 148, 287, 290, 374, 379

Benzo[a]pyrene (BaP), 86, 87, 94, 148, 319, 373–374, 375–376, 380, 391–392, 407, 544

Bidis, 82, 83, 321

Biologically effective dose, 150, 160, 309–315 (passim), 326–333, 348, 350, 351, 353

cancer, 151, 166, 313, 327–330, 332–333, 380, 381, 388, 433, 435, 437

defined, 150, 311, 388

Biomarkers, 11–12, 13, 16, 121, 142, 144, 145, 149–150, 162–163, 240, 309–317, 323–366

see also Cotinine;

In vitro assays;

Plasma markers;

Serum markers;

Surrogate markers;

Urine biomarkers

biologically effective dose, 150, 151, 160, 166, 309–315 (passim), 326–333, 348, 350, 351, 353, 380, 381, 388, 433, 435, 437

biopsies, 311, 323, 341, 414, 417, 437, 518

bronchoalveolar lavage, 13, 156, 295, 338–339, 343–344, 437, 517

carbon monoxide as, 313, 323, 324–325, 330–331

carcinogenesis, general, 150–151, 153, 154, 163–167 (passim), 333, 380, 381, 388, 422, 424, 433, 435–436, 437

see also “mutagenesis” infra

cotinine, 407, 422, 424, 429

DNA adducts, 153, 292, 293, 313, 314, 327–335 (passim), 341, 346, 348, 353, 368–370 (passim), 375–378 (passim), 385–390 (passim), 399, 405, 409, 417, 420–424 (passim), 429, 435, 492

serum, 333, 422

surrogate markers, 166, 327, 330, 435–436

urine, 326, 353–354, 376, 378, 407, 420–421, 422, 424, 429, 435, 437

cardiovascular disease, 12, 154, 156, 168, 169, 253, 313, 332, 336–337, 339, 343, 354, 483–486, 490–491

surrogate markers, 168, 483–486, 490

chronic obstructive pulmonary disease (COPD), 170, 502

cohort studies, 352–353, 354, 438

cost of techniques, 153, 315, 318, 322

definitional issues, 150, 311

environmental tobacco smoke (ETS), 317, 323, 329, 348, 422, 436, 491

enzymatic processes, 314, 327, 334, 342, 345–346, 389

epidemiology and, 142, 160, 161, 309, 339, 438

exposure, 145, 150–161, 237, 309–317, 323–355, 396–397

internal exposure, 150, 151, 160, 163–164, 309, 323, 349, 350, 351, 388, 396, 431, 435, 437

half-life, 152, 154, 156, 157, 158, 250, 297, 316, 323, 324, 328, 333, 376, 422

internal exposure, 150, 151, 160, 163–164, 309, 323, 349, 350, 351–352, 388, 396, 431, 435, 437

lipids, 12, 154, 169, 243, 253, 314, 330–331, 336–337, 343, 378–379, 471, 479, 482, 485, 486, 491–492

leukotrines, 156, 344, 388, 519–520, 563

mutagenesis, 313, 314, 323, 326, 327, 334, 340–342, 345, 346–347, 353;

see also “carcinogenesis” supra

nicotine, 323, 324–325, 326, 347

see also Cotinine

plasma markers, 99, 113, 250, 293

nonneoplastic respiratory disease, 170–171, 501–503, 506, 507, 512, 517, 527, 531, 532

urine, 503, 506, 523, 524, 525, 529, 531

oropharyngeal disease, 156, 333, 342, 338–339

platelet activation, 12, 156, 157, 168, 169, 252, 253, 296, 337–339, 343, 354, 479, 480, 481, 483–486, 490, 491, 492, 493, 561

PREP risk assessment, 142, 144, 145, 150–161, 162–163, 165, 237, 309–317, 323–352, 388, 435–436, 553

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.
×

regulatory issues, 10, 11–12, 207–208, 211, 220, 348–349

reproductive and developmental effects, 174, 191, 545, 548, 553, 570, 572

research recommendations, 352–355, 438, 491

saliva, 209, 267, 300, 311, 323, 325, 422, 428, 523, 525

standards, 348–349

surveillance, 182, 184–185, 190–191, 196

vascular activation, 12, 157, 169, 337, 490–491

Biopsies, 311, 323, 341, 414, 417, 437, 518

Birthweight, 11, 23, 24, 149, 172, 173–174, 188, 193, 212, 267, 340–341, 344, 529, 543, 547–549, 550, 551, 552, 554, 596

Black persons,

see African Americans

Black vs blond tobacco

bladder cancer, 419

hemoglobin adducts, 332

lung cancer, 401–402

oropharnygeal cancer, 416

Bladder cancer, 24, 333, 355, 368, 377–378, 380, 388, 390, 418–421, 428

Blending processes, viii, 26, 82, 85, 87, 94, 128, 209, 287

see also Black vs blond tobacco

Blond tobacco,

see Black vs blond tobacco

Blood pressure, 154, 336–337, 343, 479, 482, 491

hypertension, 252, 319, 477, 479, 481, 547, 548, 568

antihypertensive drugs, 4, 107, 108–109, 124

preeclampsia, 268, 560, 572

low, 107, 109, 252, 268, 269

Body weight, 340–341, 343, 344, 422, 482, 565, 569–570

age factors, 569

birthweight, 11, 23, 24, 149, 172, 173–174, 188, 193, 212, 267, 340–341, 344, 529, 543, 547–549, 550, 551, 552, 554, 596

nicotine effects, 126, 158–159, 162, 255, 267, 270, 568–569

ventilation and, 286

Bone,

see Orthopedic effects

Bradford Hill criteria, 381, 382

Breast cancer, 385, 395, 598

British American Tobacco Company, 65

Bronchi, 24, 156, 500, 505, 514, 520, 522, 526, 551

bronchitis, 21, 295, 338, 502, 503, 505, 510, 525, 529, 551

cancer and carcinogenesis, 285, 298, 375, 376, 391, 392, 393, 437, 518

epithelium, 298, 375, 376, 393

Bronchoalveolar lavage, 13, 156, 295, 338–339, 343–344, 437, 517

Bronchoscopy, 157, 171, 339, 392, 502–503, 517, 531

Brown & Williamson, 21, 61, 92, 184, 204, 228, 584, 601

Bupropion, 4, 98, 104, 105–106, 115, 231, 233–234, 347

see also Zyban

FDA actions, 123–124, 172, 552–553

pregnant women, 172, 174, 552–553, 554

Zyban, 30, 104, 123–124

Buspirone, 109

C

Canada, 219

Cancer and carcinogens, 1, 4, 23, 147–148, 163–167, 174, 367–469

additives, 90–91

adenocarcinomas (AD), 392, 393, 404

African Americans, 406–407, 416

age factors, 389, 390, 405, 410–413, 420, 421, 424, 425

animal models, 13, 293–295, 367, 374, 376, 383, 384–387, 422, 429, 432–433, 434, 435

aromatic amines, 148, 374, 377–378, 379, 420–421

benzene, 89, 95, 148, 287, 290, 374, 379

benzo[a]pyrene (BaP), 86, 87, 94, 148, 319, 373–374, 375–376, 380, 391–392, 407, 544

biologically effective dose, 151, 166, 313, 327–330, 332–333, 380, 381, 388, 433, 435, 437

biomarkers, 150–151, 153, 154, 163–167 (passim), 333, 380, 381, 388, 422, 424, 433, 435–436, 437

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.
×

adducts, 153, 292, 293, 313, 314, 327–335 (passim), 341, 346, 348, 353, 368–370 (passim), 375–378 (passim), 386–390 (passim), 399, 405, 409, 417, 420–424 (passim), 429, 435, 492

cotinine, 407, 422, 424, 429

serum, 333, 422

surrogate markers, 166, 327, 330, 435–436

urine, 326, 353–354, 376, 378, 407, 420–421, 422, 424, 429, 435, 437

biopsies, 311, 323, 341, 414, 417, 437, 518

bladder, 24, 333, 355, 368, 377–378, 380, 388, 390, 418–421, 428

breast, 385, 395, 598

bronchial, 285, 298, 375, 376, 391, 392, 393, 437, 518

carbon monoxide, 294, 407

cervical, 24

clinical research, 165, 383, 414, 433, 437

cohort studies, 377, 395, 396–397, 400–403, 405, 411–413, 420

colonic, 394

definition of carcinogen, 368

dietary factors, 164, 166, 375, 376, 390, 404, 406, 408, 409, 414, 431, 433

dose-response relationship, 163–165, 167, 334–340, 381, 395–397, 415, 416, 419, 421, 431;

see also “biologically effective dose” supra

endometrial, 368, 421–422

environmental tobacco smoke, 53, 390, 396, 398, 408, 422–424, 434, 439, 604

enzymatic processes, 368, 369, 370, 376, 377, 389, 394, 433, 436

epidemiology, 165, 166, 367, 383, 418, 420, 424

epithelial cells, 375, 376, 393, 394, 416, 420–421

esophagus, 1, 23, 24, 232, 372, 377, 425, 429, 597

exposure, 383–384, 390, 395–397, 398–399, 401, 404, 412, 419, 420, 437;

see also “dose-response relationship” supra

filtered cigarettes, 91, 164, 332, 399–400, 402–404, 405, 416, 419–420, 431

gender factors, 389, 416, 418, 419, 421, 424, 426, 436

breast, 385, 395, 598

endometrial, 368, 421–422

lung, 24, 401, 402–403, 404–406, 410, 411, 412, 413, 598, 599

head and neck, 195, 301, 372, 427, 428

historical perspectives, 21–26 (passim), 367, 594, 595, 597, 598, 600, 604;

see also Surgeon General

incidence, 367, 384, 392, 410, 411, 415, 418

inflammation, 394, 416

inhalation depth and retention, 390, 392, 395, 420, 426

international perspectives, 88–89, 407–408, 418, 423, 424, 425

in vitro assays, 154, 165, 367, 376, 383–384, 385, 391–392, 432

large-cell carcinomas, 392, 393

liver, 376, 377, 378, 385, 386, 420, 430

low-yield products, general, 399–404

lung, viii, 21, 23, 24, 66, 67, 86, 88–89, 149, 166–167, 192, 193, 215, 293–295, 296–297, 302, 333, 342, 355, 368, 372, 385, 386, 388, 390, 391–415, 423, 425, 426, 431, 598

cohort studies, 395, 396–397, 400–403, 405, 411–413

mortality, 392, 398, 411–414

metastasis, 297, 395, 418, 501

mortality, 392, 398, 400, 411–414, 415, 418, 419, 426, 434

nicotine as carcinogen, 167, 402, 403, 405

nitrosamines, 4, 67, 86, 87, 91–92, 93, 148, 151, 210, 215, 294, 300, 301, 319, 326–327, 328, 348, 373–374, 376–377, 379, 380, 403, 405, 429–430, 603, 604

environmental tobacco smoke, 424

racial/ethnic differences, 406, 407

smokeless tobacco, 4, 93, 428, 429

oncogenes, 294, 341–342, 371, 389, 391, 393

oropharyngeal, 23, 167, 301, 333, 342, 368, 372, 415–418, 425, 427–429, 597

pancreatic, 372

particulates, 148, 374, 436

polycyclic aromatic hydrocarbons (PAHs), 86, 148, 149, 295, 322, 326–327, 328–331, 333, 348, 374, 375–376, 377, 379, 391–392, 418, 570

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.
×

PREP risk assessment, 3, 150–151, 153, 154, 163–167, 208, 218, 222, 373, 374–375, 379–392, 421, 430–439

in vitro assays, 154, 167, 367, 383–384, 385

low-yield products, general, 399–404

lung cancer, 294–295, 395–399, 407–409

see also “biomarkers” supra

processing of tobacco, 85

race/ethnicity, 406–408, 416, 436

regulatory issues, 10, 208, 215

research methodology, 378, 379–394, 410, 434–439

research recommendations, 434–439

serum markers, 333, 422

small-cell lung carcinomas (SCLC), 392, 393–394, 395, 402, 404

smokeless tobacco, 4, 93, 300–301, 426–429

socioeconomic factors, 407, 414;

see also “race/ethnicity” supra

squamous cell carcinomas (SCC), 67, 299, 301, 372, 392, 393, 404, 415, 418

surrogate markers, 166, 327, 330, 435–436

tar, 373–374, 399–404, 407

tumor suppressor genes (including p53), 155, 336, 341–342, 343, 371–372, 375, 376, 391–392, 393–394, 405, 409, 415, 417, 418–419, 420, 421, 428–429, 435

urine biomarkers, 326, 353–354, 376, 378, 407, 420–421, 422, 424, 429, 435, 437

volatile organic compounds, 89, 148, 374

Cancer Prevention Study (CPS) I/II, 67, 75, 76, 167, 170, 400, 487, 512–513, 530, 531

Carbon monoxide, 2, 24, 26, 86, 288, 517, 570, 597

see also Potential reduced-exposure products (PREPs)

behavioral treatments and reduction of, 117

as biomarker, 313, 323, 324–325, 330–331

cancer, 294, 407

cardiovascular disease, 168, 481, 487

cigarette-like products, 94, 95

drug treatments and reduction of, 110, 113, 114

regulatory issues, 210, 218

reproductive and developmental effects, 172, 173–174, 549, 550, 552, 554

smoker knowledge of, 72–73

surveillance, 184

yield assessments, 87, 88, 90, 92, 94, 95, 184, 210

Carcinogens,

see Cancer and carcinogens

Cardiovascular disease, 4, 24, 252–253, 302, 470–499

see also Blood pressure;

Extracardiac vascular disease

age factors, 472, 473, 474–475, 482

aneurysms, 470, 481, 491

animal models, 149, 479, 486

atherosclerosis, 157, 162, 169, 253, 270, 296, 313, 332, 339, 343, 471, 472, 476–477, 479–483 (passim), 485, 490, 492, 493

biomarkers, 12, 154, 156, 168, 313, 332, 336–337, 339, 343, 354

cholesterol levels, 289, 296, 477, 482

cotinine, 168, 487

platelet activation, 12, 156, 157, 168, 169, 252, 253, 296, 337–339, 343, 354, 479, 480, 481, 483–486, 490–491, 492, 493, 561

surrogate markers, 168, 483–486, 490

urine, 485, 486

carbon monoxide, 168, 481, 487

children, 482, 493

cholesterol levels, 289, 296, 477, 482

clinical research, 168, 169–170, 212, 491

coronary heart disease, viii, 1, 21, 23, 67, 157, 195, 208, 212, 222, 252–253, 347, 470, 471–481, 483, 487, 488, 505, 599

cotinine, 168, 487

dose-response relationship, 167–168, 169, 471, 472, 473, 477, 483, 486–487

endothelial function, 479, 480, 481, 484–485, 486, 490, 491, 492

environmental tobacco smoke (ETS), 169, 470, 478, 491

enzymatic processes, 478, 484, 487

epidemiology, 471, 472, 473, 477

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.
×

exposure, 474, 477;

see also “dose-response relationship” supra

filtered cigarettes, 168

gender factors, 168, 472, 473, 477, 481, 482

genetic factors, 478, 490, 492

incidence, 167, 470, 471, 472, 473, 479, 487

inflammation, 168, 252, 253, 270, 291, 482–483, 485, 490, 491, 492

in vitro assays, 168, 480

lipids and lipoproteins, 12, 154, 169, 253, 314, 330, 336–337, 343, 471, 479, 482, 485, 486, 491–492

low-yield products, 471, 477

mortality, 470, 472, 473, 477, 487

nicotine, 168, 470–471

nicotine replacement therapy (NRT), 98–99, 112, 115, 252–253, 471

platelet activation, 12, 156, 157, 168, 169, 252, 253, 296, 337–339, 343, 354, 479, 480, 481, 483–486, 490–491, 492, 493, 561

pregnant smokers, children of, 545, 548, 552

regulatory issues, 10, 208, 212

research recommendations, 491–493

risk assessment, 149, 154, 162, 167–170, 174, 208, 212, 222, 470–499, 598, 599

risk perception, 68

stroke, 24, 168, 470, 473, 476, 487, 489, 600

surgery, 473, 476

surrogate markers, 168, 483–486, 490

surveillance, 188, 193, 195

synergistic effects of toxins, 477–478

thrombosis, 154, 157, 336–337, 339, 356, 481, 485–486, 491

urine biomarkers, 485, 486

vascular activation, 12, 157, 169, 337, 490–491, 493

Caucasians, 73, 86, 250, 406, 407, 416, 513, 543, 548

Cell cultures,

see In vitro assay

Centers for Disease Control and Prevention (CDC), 207, 221

smokeless tobacco, 93

surveillance, general, 180, 184, 185

Youth Risk Behavior Survey, 93, 185–187, 261, 320–321

Cerebrovascular disease,

see Stroke

Cessation programs, vii, x, 24, 41, 116–119, 352

see also Behavioral treatments;

Chewing gum;

Drug treatments Oral/nasal sprays;

Patches;

Psychotrophic drugs;

School-based prevention/cessation programs

Charcoal filters, 88, 89, 92, 94, 286, 287, 406, 603

Chewing gum, vii, 4, 5, 14, 91, 96, 98, 99, 101, 103, 113–114, 115, 129, 253, 266–267, 599

cardiovascular disease, 471

Nicorete, 97, 123, 129

Chewing tobacco, 83, 84, 247–248, 426, 428

Children, 320–321

see also Adolescents;

Birthweight;

Reproductive and developmental disorders;

Schools

advertising, 24

asthma, 501, 518–525 (passim), 530, 551

cardiovascular disease, 482, 493

cognitive deficits, 268, 550–551

environmental tobacco smoke, 286, 348, 422, 500, 510–511, 521, 522–525, 528–530, 549;

see also Family/home factors

nonneoplastic respiratory diseases, 500, 501, 506, 508, 510–511, 518–526 (passim), 528–530, 551

prevalence of tobacco use, 1

respiratory infections, 501, 506, 526, 528–529, 551

sales of tobacco to, 120, 125, 202, 604

Cholesterol levels, 289, 296, 477, 482

Chromosomes, 152, 293, 313, 314, 333, 334–335, 340, 341, 342, 346, 368, 369, 372, 389, 391, 393, 406, 414–415, 417, 419, 420, 435, 545

see also Mutagenesis and mutagens

loss of heterozygosity, 152, 313, 314, 334, 340, 342, 391, 393, 414–415, 419, 435

Chronic obstructive pulmonary disease (COPD), 1, 21, 23, 149, 174, 302, 500, 503–518, 520, 527, 530–531, 532, 584, 598, 599

age factors, 503, 508, 509–511, 513, 515

animal studies, 13, 295

biomarkers, 170, 502

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.
×

bronchitis, 21, 295, 338, 502, 503, 505, 510, 525, 529, 551

clinical studies, 13, 171

definition of, 503

epidemiology, 503–505, 509, 512

gender factors, 500, 509, 512, 514, 515, 516

mortality, 505, 508, 509, 512, 513–514

Surgeon General’s report, 24

synergistic effects of toxins, 508–509

time factors, 503, 511–512

ventilation, 503, 510

Cigarette Labeling and Advertising Act, 125

Cigars, viii, 82, 83, 85, 243–244, 425–426, 473, 508, 597

Clinical research, 7, 13, 16, 17, 34, 115–116, 147, 175–176, 232, 238, 352, 584

see also Biomarkers

addiction, 263, 264–266

behavioral treatments, 116–118

body weight, 570

cancer, 165, 383, 414, 433, 437

cardiovascular disease, 168, 169–170, 212, 491

clonidine, 108–109

cytochrome P-450, 109–110

depression, 569

antidepressants, 105–106, 115–116

FDA drug approval criteria, 122, 215, 227

nicotine antagonists, 107

nicotine replacement products, 96, 101–103, 113–115, 533

nonneoplastic respiratory disease, 13, 171, 511–512, 514, 518, 522, 523–525, 529, 530, 532–533

regulatory issues, 122, 208, 209, 212, 213, 215, 227, 229

reproductive and developmental effects, 173–174, 547, 548, 554

subjects unwilling/unable to quit, 122

surveillance and, 183, 193, 197

tobacco industry product testing, 128

Clonidine, 4, 108–109, 124

Coalition on Smoking and Health, 126

Cognitive effects

aging, 162

dementia, 174, 254, 564–565

developmental disorders, 268, 550–551

memory, 254, 319, 564

nicotine, 254, 255, 259, 270, 564

Cohort studies, 174, 193, 196, 437–438, 482, 548, 567

biomarkers, 352–353, 354, 438

bladder cancer, 377, 420

chronic obstructive pulmonary disease (COPD), 511

diabetes, 567

lung cancer, 395, 396–397, 400–403, 405, 411–413

pregnant women, 173, 547

College of American Pathologists, 349

Colon

cancer, 394

inflammatory bowel disease, 174, 302, 560, 561–562, 574

Combustion, viii, 3, 4, 66, 210, 598

cigarette-like products, 93

fires and fire-safe cigarettes, 87, 571, 604

measurement, 284

nicotine pharmacology, 243

surveillance, 184

temperature factors, viii, 27, 210, 284

Compensatory smoking, 2, 26, 67, 88, 121, 164, 219, 266, 285, 322, 380, 402, 403, 405, 477, 517

Comprehensive Smokeless Tobacco Health Education Act, 125

Comprehensive Smoking Health Education Act, 125

Consumer Product Safety Act, 125

Contraceptives

devices, 45

oral, 477, 481, 544, 597

Controlled Substances Act, 123, 125

COPD,

see Chronic obstructive pulmonary disease

Coronary heart disease, viii, 1, 21, 23, 67, 157, 195, 208, 212, 222, 252–253, 347, 470, 471–481, 483, 487, 488, 505, 599

Coronary vascular disease,

see Cardiovascular disease

Cost factors, monetary, 383

aggregating harm, 55

animal models, 383

auto accidents, 44

biomarkers, 153, 315, 318, 322

cigarettes, 119, 129, 187, 262

taxation, 119, 128, 202, 596, 603

drug treatments, 110

funding, 49, 215, 218, 229

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.
×

health insurance discounts, 598

in vitro studies, 149

nicotine replacement products, 101–102, 129, 554–555

surveillance, 181, 195

Cotinine, 174, 184–185, 187, 293, 321, 323, 324, 325, 326, 348, 353

carcinogenesis, 407, 422, 424, 429

cardiovascular disease, 168, 487

drug treatments, 109–110, 114

nonneoplastic respiratory disease, 517, 523, 525, 526, 529, 530, 532

pharmacology of, 248, 249, 250, 265

pregnancy, 545, 548, 553, 572

surveillance, 184–185, 187

Court cases,

see Litigation

Crohn’s disease, 561–562, 574

Curing of tobacco, 8, 82, 83, 84, 91, 128, 189, 209, 299–300

Current Population Survey, 185–187

Cyanide, 72, 89, 291, 324–325, 401, 549, 561, 572

Cytochrome P-450, 109, 152, 248, 269, 298, 323, 327, 334, 342, 375, 377, 378, 385, 409, 417, 421, 570

D

Definitional issues, 27–28

see also Standards

biomarkers assessment, 150, 311

carcinogen, 368

chronic obstructive pulmonary (COPD), 503

cigar, 83

cigarette, 27, 82, 83

Diagnostic and Statistical Manual of Mental Disorders (DSM), 255, 257, 258–259, 260–262

exposure, 1, 27–28, 311

harm reduction, 2, 25, 38–40

hazard identification, 33–34

mutagen, 368

nicotine, 27, 126

PREPs, 3, 28, 205

regulatory, 11, 27–28, 30, 124, 126, 205, 225–226

safer cigarette, 2, 25

surveillance, 180, 181, 194

tobacco constituent, 368

Dementia, 174

Alzheimer’s disease, 254, 564–565

Demographic factors,

see Age factors;

Educational attainment;

Genderfactors;

Military personnel;

Race/ethnicity;

Socioeconomic status

Department of Justice, 603

Depression, 104, 174, 186, 256–257, 347, 568–569

antidepressants, 105–106, 115–116, 254, 256, 570

Dermatologic diseases, 158, 174, 193–194, 246, 301, 338–339, 385, 566

Developmental disorders,

see Reproductive and developmental disorders

Devices,

see Medical devices

Diabetes, 174, 482, 548, 567

Diagnostic and Statistical Manual of Mental Disorders (DSM), 255, 257, 258–259, 260–262

Dietary factors, 89, 151, 175, 206, 294, 296, 325, 329, 333, 508, 573

cancer, 164, 166, 375, 376, 390, 404, 406, 408, 409, 414, 431, 433

pregnancy, 547

DNA, 291–292, 294, 299, 313, 314–315, 342–343, 344–347, 353, 368–370, 372, 384, 385, 486, 492

adducts, 153, 292, 293, 313, 327–335 (passim), 341, 346, 348, 353, 368–370 (passim), 372, 375–378 (passim), 385–390 (passim), 398–399, 405, 409, 417, 420–424 (passim), 429, 435, 492

chromosomes, 152, 293, 313, 314, 333, 334–335, 340, 341, 342, 346, 368, 369, 372, 389, 391, 393, 406, 414–415, 417, 419, 420, 435, 545

loss of heterozygosity, 152, 313, 314, 334, 340, 342, 391, 393, 414–415, 419, 435

repair, 152, 315, 326, 332, 334, 342–347 (passim), 369–370, 372, 376, 377, 378, 388, 389, 390, 394, 399, 409 478

Dopamine, 105, 109, 110, 244, 245, 256, 257, 266, 347–348, 551, 568, 571, 572

Dose-response relationship, viii, ix, 9, 11, 14, 15, 16, 33, 34, 316, 326–333, 343

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.
×

see also Biologically effective dose;

Exposure

addiction, 255–256, 264, 266

age factors, 164

alcohol use, 415, 416

animal models, 16, 145, 163, 165

antidepressants, 105–106

cancer, 163–165, 167, 334–340, 381, 395–397, 415, 416, 419, 421, 431

cardiovascular disease, 167–168, 169, 471, 472, 473, 477, 483, 486–487

dermatologic conditions, 566

environmental tobacco smoke (ETS), 423–424, 436

exposure-to-adverse effect, ix, 140, 145, 166, 511, 530

gender factors, 164

historical perspectives, 23

nicotine replacement doses per day, 255–256, 264, 266

nonneoplastic respiratory disease, 170, 171, 510–514, 521, 523, 527–528, 531, 532

ocular disease, 565

oropharyngeal disease, 415

Parkinson’s disease, 571–572

PREP risk assessment, 14, 15, 33, 34, 140, 141, 144–147, 152, 154, 156, 158, 159, 160, 167, 237–238, 271, 310, 312, 325, 326, 352, 381, 395–396

race/ethnicity, 164, 407

renal disease, 567–568

rheumatoid arthritis, 562

reproductive and developmental effects, 172–173, 544, 545, 546, 548, 550, 554–555

time factors, ix, 140, 141, 145, 511

Drug abuse,

see also Alcohol and drug abuse;

Addiction

Drug interactions, 122, 269, 570

Drug treatments, 2, 9, 17, 25, 29–30, 82, 95–116, 121

see also Chewing gum;

Medical devices;

Nicotine replacement therapy;

Oral/nasal sprays;

Psychotrophic drugs;

Patches

adolescents, 112, 116

antagonists, 4, 106–108, 110, 116, 244

mecamylamine, 107, 124, 266

antidepressants, 4, 104, 106, 124;

see also Bupropion

antihypertensive drugs, 107, 108–109

clonidine, 4, 108–109, 124

behavioral therapy and, 96, 115, 118–119

carbon monoxide, reduction of, 110, 113, 114

cardiovascular disease and, 110, 113, 114

committee charge, 3–4, 31–32, 33, 34, 142, 202–203, 205

cost of, 110

cotinine, 109–110, 114

definitional issues, 27, 28

Food and Drug Administration, 29–30, 205, 226–228

bupropion, 123–124, 172, 552–553

Investigational New Drug, 122, 215

historical perspectives, 95

mortality reduction, 111, 112–113

nicotine receptors, 97, 103, 105, 106–107, 110

over-the-counter drugs, 31, 94, 96, 97, 102, 110, 120, 123, 263

pregnant women, 116

relapse into smoking, 111

withdrawal, 96, 101, 104–114 (passim), 123

DSM,

see Diagnostic and Statistical Manual of Mental Disorders

Dye exclusion tests, 292

E

Eclampsia,

see Preeclampsia

Eclipse, 4, 65, 94–95, 129, 215, 517–518, 602

Economic factors,

see Cost and cost-benefit factors;

Funding;

Socioeconomic status;

Taxation

Education,

see Labeling;

Public education

Educational attainment, 390, 425, 530, 543, 547, 564

Emphysema,

see Chronic obstructive pulmonary disease

Employment factors,

see Workplace

Endometrial cancer, 368, 421–422

Endothelial function, 161–162, 168, 169, 302, 354

cardiovascular disease, 479, 480, 481, 484–485, 486, 490, 491, 492

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.
×

nicotine pharmacology, 252, 253, 268, 270

reproductive and developmental effects, 546, 548, 572

Enforcement, 11, 30, 40, 43–44, 48, 120, 125, 196, 207, 209, 226, 238, 239

Environmental interventions, 119–121, 256

public smoking restrictions, 120, 206, 225, 597, 599, 600, 601

workplace restrictions, 119–120, 422

Environmental tobacco smoke (ETS), vii, 5, 25, 35, 51, 53–54, 147–148, 201, 597, 604

age factors, 424, 509–511;

see also “children” infra

asthma, 521–522

biomarkers, 317, 323, 329, 348, 422, 436, 491

cancer, 53, 390, 396, 398, 408, 422–424, 434, 439, 604

cardiovascular disease, 169, 470, 478, 491

children, 286, 348, 422, 500, 510–511, 521, 522–525, 528–530, 549;

see also “family…” and “reproductive…” infra

cigarette-like products, 94

dose-response relationship, 423–424, 436

epidemiology, 424, 509–510, 521

family/home factors, 120, 186, 319, 422, 510, 521, 523, 525, 528, 544, 597

gender factors, 424, 544, 545, 548, 551, 599

infants, 549

international perspectives, 423, 424

nitrosamines, 424

nonneoplastic respiratory diseases, 500, 509–511, 521–522, 528–530, 531, 551

regulatory factors, 225;

see also Environmental interventions

reproductive and developmental effects, 544, 545, 548, 549, 551

Surgeon General’s report, 24, 597, 600

surveillance, 194

toxicology, 283, 285, 287, 289–290

Enzymatic processes, 84, 152, 166, 253, 292, 505, 571, 570

biomarkers, 314, 327, 334, 342, 345–346, 389

carcinogenesis, 368, 369, 370, 376, 377, 389, 394, 433, 436

cardiovascular disease, 478, 484, 487

cytochrome P-450, 109, 152, 248, 269, 298, 323, 327, 334, 342, 375, 377, 378, 385, 409, 417, 421, 570

mitochondria, 154, 314, 336–337, 341, 394

Epidemiology, 15, 16, 17, 23, 26, 33, 34, 183, 193, 195, 197, 202, 594

see also Cohort studies;

Mortality;

Surveillance

asthma, 518–519, 520, 521

biomarkers and, 142, 160, 161, 309, 339, 438

cancer, 165, 166, 367, 383, 418, 420, 424

cardiovascular disease, 471, 472, 473, 477

chronic obstructive pulmonary (COPD), 503–505, 509, 512

dose-response assessments, 140

environmental tobacco smoke (ETS), 424, 509–510, 521

orthopedic effects, 565

PREPs, 6, 7, 8, 10, 13–14, 141, 142, 147, 153, 160, 165, 193, 195, 197, 203, 206, 208, 221, 222, 229, 232, 236, 238, 437–438, 584

regulatory issues, 8, 10–11, 129, 203, 206, 207, 208, 221, 222, 229

smokeless tobacco, 301

Epithelial cells, 244–245, 295, 313, 316, 563

bladder cancer, 420–421

bronchial, 298, 375, 376, 393

cancer, 375, 376, 393, 394, 416, 420–421

respiratory system, other than bronchi, 500, 519, 525–526

wound healing, 561

Erectile dysfunction, 545

Esophageal cancer, 1, 23, 24, 232, 372, 377, 425, 429, 597

Estrogen, 346, 405, 422, 566

Ethnicity,

see Race/ethnicity

ETS,

see Environmental tobacco smoke

Exposure, viii, 31, 33–34, 140, 141, 143, 145, 232, 583

see also Dose-response relationship;

Environmental interventions;

Environmental tobacco smoke;

Inhalation depth and retention;

Potential reduced-exposure products (PREPs);

Yield assessment

biomarkers, 145, 150–161, 237, 309–317, 323–355, 396–397

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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internal exposure, 150, 151, 160, 163–164, 309, 323, 349, 350, 351, 388, 396, 431, 435, 437

cancer risk, 383–384, 390, 395–397, 398–399, 401, 404, 412, 419, 420, 437

cardiovascular disease, 474, 477

cigarettes smoked per day, 22, 74, 88–89, 102, 113, 115, 119, 120, 151, 163, 164, 167, 170, 173, 300, 319, 343, 349, 375, 391, 392, 395, 396, 398–399, 401, 404, 412, 419, 437, 474, 487, 488, 489, 512, 513–514, 515, 516, 530

compensatory smoking, 2, 26, 67, 88, 121, 164, 219, 266, 285, 322, 380, 402, 403, 405, 477, 517

definitional issues, 2, 27–28, 311

duration of smoking, 67, 76, 151, 168, 390, 395, 396–397, 401, 402, 404, 419, 420, 471, 493, 508, 566, 572

duration of smoking cessation, 75, 115, 186, 409–415, 419, 438, 470, 473, 475, 476, 487, 490, 562

exposure-to-adverse effect, ix, 140, 145, 166, 511, 530

historical perspectives, vii, 26–27

nicotine replacement doses per day, 98, 105–106, 113, 248

PREPs, 31, 33, 34, 140, 141, 143, 145, 148, 150–161, 191, 237–238, 309, 310, 311, 323, 349, 350, 351

regulatory principles, 10, 204, 207–208, 215

research methodology, 309–366

snuff, daily consumption, 300

surveillance, 191

Extracardiac vascular disease, 470, 481, 545, 552, 561, 563, 565

placental, 545

stroke, 24, 168, 470, 473, 476, 487, 489, 600

Eyes,

see Ocular disease

F

Fagerström Tolerance Questionnaire, 260

Family/home factors, 120, 186, 319, 422, 510, 521, 523, 525, 528, 544, 597

see also Genetic factors

FDA,

see Food and Drug Administration

Federal Cigarette Labeling and Advertising Act, 595

Federal Communications Commission, 125

Federal government

see also Legislation;

Regulatory issues;

specific departments and agencies

funding, 49, 215, 218, 229

national surveillance system, 8, 181, 207

national tobacco control program, 7, 35, 202, 206–207, 229, 232

Federal Trade Commission (FTC), 15, 30, 67, 207, 210, 600

marketing, 61, 211, 213

PREPs, 2, 15, 26, 61, 67, 207, 210, 221, 227, 350

smoking machines, 2, 3, 26–27, 87–88, 90, 210–211, 226, 283–284, 317–319, 350, 352, 373, 380, 395, 404

surveillance, 183, 184, 189, 190

Females,

see Gender factors

Fertility, 173, 544–545

Fetal lung development, 149, 298, 511, 551

FEV,

see Forced expiratory volume

Fibers, 89, 94, 165, 189, 225

Fibroblasts, 561, 563

Filters, 2, 26, 52, 56, 60, 64, 82, 88, 89–90, 91, 92, 121

see also Ventilation

cancer risk, 91, 164, 332, 399–400, 402–404, 405, 416, 419–420, 431

cardiovascular disease, 168

charcoal, 88, 89, 92, 94, 286, 287, 406, 603

cigars, 83

DNA adducts, 332

FDA regulation, 128

historical perspectives, 379, 594, 595, 601

international perspectives, 286

oropharyngeal disease, 416

regulatory issues, 128, 210, 225

risk assessment, 143, 164, 168, 399–400, 402–404

surveillance, 183, 189

toxicological measures, 284, 287

ventilation, 26, 71, 87, 88, 89, 90, 121, 211, 286, 287, 317, 380, 399, 597

Fires, vii, 570–571

Fire Safe Act, 87, 571

Fire-safe cigarettes, 87, 571, 604

Food and Drug Administration (FDA), 30, 207

addiction, 126, 127, 129, 258, 604

additives, 128, 224

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.
×

bupropion, 123–124, 172, 552–553

clinical trial criteria, 122, 215, 227

committee charge, 3–4, 41, 205

definition of cigarette, 27, 126

devices, 30, 91, 124, 125–126, 127, 128, 129, 204, 205, 206, 228

drug treatments, 29–30, 205, 226–228;

see also “nicotine replacement…” infra

bupropion, 123–124, 172, 552–553

investigational new drug, 122, 215

filters, 128

labeling, 27, 122, 123, 128, 227

litigation, 21, 30, 124, 127–128, 204, 227, 228, 604

marketing, 128, 205

processing of tobacco, 128

nicotine levels, 29, 30

nicotine replacement products, viii, 29, 91, 95–96, 123–124, 172, 204–205, 552–553

outline of drug approval process, 122–123

PREPs, 15, 122–124, 129–130, 141, 181, 204–205, 206, 209, 221, 226–227

see also “nicotine replacement products” supra

surveillance, 181

tobacco, 27, 124–130, 204, 205, 227, 228, 604

Food, Drug and Cosmetic Act, 30, 122, 124, 125–126, 128, 204, 205, 206, 214

Forced expiratory volume (FEV), 156, 171, 338, 343, 503, 506, 508–509, 514–515, 516, 520, 523, 532–533

Framework Convention on Tobacco Control, 25

Free radicals, 91, 253, 378, 389, 485, 486, 506, 561, 566, 572

FTC,

see Federal Trade Commission

Funding, 49, 215, 218, 229

G

Gallup Organization, 68, 70

Gastrointestinal tract

carcinogens, general, 372

Crohn’s disease, 561–562

esophageal cancer, 1, 23, 24, 232, 372, 377, 425, 429, 597

inflammatory bowel disease, 174, 302, 560, 561–562, 574

nicotine pharmacokinetics, 247–248

nicotine replacement therapy (NRT), 267, 270

peptic ulcers, 175, 560–561, 573

Gender factors, 233, 321, 597

see also Pregnancy;

Reproductive and developmental effects

adolescents, 74, 172, 543, 545, 552

sexual behavior, 44–46, 50, 51

advertising, 74

cancer, 389, 416, 418, 419, 421, 424, 426, 436

breast, 385, 395, 598

endometrial, 368, 421–422

lung, 24, 401, 402–403, 404–406, 410, 411, 412, 413, 598, 599

cardiovascular disease, 168, 472, 473, 477, 481, 482

chronic obstructive pulmonary (COPD), 500, 509, 512, 514, 515, 516

clonidine treatments, 108

contraceptives, 45, 477, 481, 544, 597

dermatologic conditions, 566

dose-response relationship, 164

environmental tobacco smoke (ETS), 424, 544, 545, 548, 551, 599

inflammatory bowel disease, 561–562

low-yield products, 74, 404–405

menthol cigarettes, 87

nicotine replacement therapy, 267–268

oropharyngeal disease, 416

osteoporosis, 565

prevalence of smoking, 22, 74, 87, 404

renal disease, 568

respiratory diseases, 416, 520

chronic obstructive pulmonary (COPD), 500, 509, 512, 514, 515, 516

lung cancer, 24, 401, 402–403, 404–406, 410, 411, 412, 413, 598, 599

rheumatoid arthritis, 562

risk assessment, general, 67, 145, 164, 168

sexual behavior, 44–46, 50, 51

smokeless tobacco use, 93

surveillance, 187

Genetic factors, 310

see also Cancer and carcinogens;

DNA;

Gender factors;

Mutagenesis and mutagens;

Reproductive and developmental effects

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.
×

addiction, predisposition to, 161, 256, 347–348

animal models, 165

cardiovascular disease, 478, 490, 492

chromosomes, 152, 293, 313, 314, 333, 334–335, 340, 341, 342, 346, 368, 369, 372, 389, 391, 393, 406, 414–415, 417, 419, 420, 435, 545

loss of heterozygosity, 152, 313, 314, 334, 340, 342, 391, 393, 414–415, 419, 435

cytochrome P-450, 109, 152, 248, 269, 298, 323, 327, 334, 342, 375, 377, 378, 385, 409, 417, 421, 570

nicotine metabolism, 252, 270–271

nicotine replacement therapy, 270

nonneoplastic respiratory disease, 170, 501–502

oncogenes, 294, 341–342, 371, 389, 391, 393

polymorphisms, 252, 256, 314, 315, 345, 346, 347, 405–406, 409, 478, 526

RNA, 152, 153, 299, 314, 334, 353, 389

tobacco, genetically altered, 189

toxic effects, susceptibility, ix, 6, 13, 145, 153, 164, 166, 192, 233, 344–347, 390, 408–409, 416, 429, 436, 478, 490, 508

transgenic animals, 298–299, 385, 391

tumor suppressor genes (including p53), 155, 336, 341–342, 343, 371–372, 375, 376, 391–392, 393–394, 405, 409, 415, 417, 418–419, 420, 421, 428–429, 435

Genomics, 12–13, 154, 342, 370–371, 393, 490, 492, 503

GlaxoWellcome Pharmaceutical, 585

Glycerin, 86, 94

Growing Up Tobacco Free, 211, 219

Gum,

see Chewing gum

H

Health insurance discounts, 598

Heart disease,

see Coronary heart disease;

Cardiovascular disease

Hemoglobin, 156, 294, 314, 324, 338, 396, 398, 481, 561

adducts, 313, 330, 332, 333, 376, 378, 398, 399, 429

pregnant smokers, 546, 549

Hepatic system, 109, 248, 250, 269

cancer, 376, 377, 378, 385, 386, 420, 430

Heterocyclic amines, 148, 288, 374, 377, 379

Heterozygosity, loss of (LOH), 152, 313, 314, 334, 340, 342, 391, 393, 414–415, 419, 435

Hispanics, 321, 406, 543, 603

Historical perspectives, vii, 1, 2, 21–22, 23, 26–27, 60–81, 89–91, 573, 593–605

alcohol abuse reduction, 47

asthma, 519, 520, 521

cancer risk, general, 21–26 (passim), 367, 594, 595, 597, 598, 600, 604

FDA approval of over-the-counter drugs, 123

filtered cigarettes, 379, 594, 595, 601

label warnings, 219, 595, 599

nicotine pharmacology, 243, 593–595, 597

nicotine replacement products, 113, 599, 601

nonneoplastic respiratory diseases, 500, 506, 598, 599

regulation of tobacco industry, 124–130, 595–604

Surgeon General’s reports, 21–26 (passim), 69, 125, 379, 380–381, 513, 595–603 (passim)

surveillance, 181

tar content of cigarettes, 379

HIV,

see AIDS

Home factors,

see Family/home factors

Homocysteine, 483, 491

Hormonal effects, 179, 255, 268, 405, 406, 544, 551

adrenal, 105, 107, 108, 109, 110, 244, 245, 252, 253, 480, 549

androgens, 422

estrogen, 346, 405, 422, 566

fertility, 544

progesterone, 405

Host susceptibility, ix, 6, 13, 145, 153, 164, 166, 192, 233, 344–347, 390, 408–409, 416, 429, 436, 478, 490, 508

Human Genome Project, 503

Hypertension, 252, 319, 477, 479, 481, 547, 548, 568

antihypertensive drugs, 107, 108–109

clonidine, 4, 108–109, 124

preeclampsia, 268, 560, 572

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.
×

I

Immune system, 24, 149, 182, 254, 269, 270, 291, 296–298, 563, 597

see also Infectious diseases;

Inflammation

AIDS, 23, 44, 45, 48, 52, 53

antibodies, 107–108, 330–331

diabetes, 174, 482, 548, 567

leukocytes, 314, 492, 506–507, 527

leukotrines, 156, 344, 388, 519–520, 563

lymphocytes, 156, 296–297, 314, 338, 346, 376, 399, 417, 436, 518, 519

macrophages, 293, 296, 297, 344, 484, 506, 517, 518, 526, 561

neutrophils, 156, 338, 344, 485, 508, 517, 518, 561

nonneoplastic respiratory disease, 526, 527

particulates, 297–298

preeclampsia, 572

rheumatoid arthritis, 174, 562

susceptibility to toxic effects, ix, 6, 13, 145, 153, 164, 166, 192, 233, 344–347

Immunoglobulin, 296, 519, 526, 527, 562

Incidence of disease, general, vii, viii, 14, 66, 596

see also Epidemiology;

Risk assessment;

Surveillance

cancer, 367, 384, 392, 410, 411, 415, 418

cardiovascular disease, 167, 470, 471, 472, 473, 479, 487

nonneoplastic respiratory diseases, 500, 518, 519, 526

PREPs, 5–6, 193

Infectious diseases

AIDS, 23, 44, 45, 48, 52, 53

animal models, 296–297

bladder, 418

intrautrine, 547

oral, 563

placental, 546

respiratory, 170, 296, 297, 354, 500–501, 502, 506, 508, 516, 525–531, 532, 546, 547, 551

influenza, 297, 502, 526, 530

pneumonia, 501, 502, 526, 527–528, 529, 530, 551

tuberculosis, 501, 526, 528

Inflammations, 144, 162, 169, 291, 338–339

anti-inflammatory agents, 123, 561

carcinogenesis, 394, 416

cardiovascular disease, 168, 252, 253, 270, 291, 482–483, 485, 490, 491, 492

gingivitis, 563–564

pelvic inflammatory disease, 544–545

placental, 546

respiratory, 12, 13, 95, 113, 149, 156, 170–171, 295, 298, 302, 338, 343–344, 395, 502, 505, 506, 507, 516–518, 527, 531, 533

asthma, 170, 500–501, 518–525, 527, 530–531, 551

Inflammatory bowel disease, 174, 302, 560, 561–562, 574

Influenza, 297, 502, 526, 530

Information dissemination,

see Advertising;

Labeling;

Marketing;

Public education

Inhalation depth and retention, 210, 219, 252, 322

cancer, 390, 392, 395, 420, 426

cardiovascular disease, 471, 473

compensatory smoking, 2, 26, 67, 88, 285, 322

menthol cigarettes, 73, 86

Inhalers,

see Oral/nasal sprays

Innovative products,

see Potential reduced-exposure products (PREPs);

Technological innovation

International Agency for Research on Cancer (IARC), 293, 374

International Diagnostic Code, 257, 258–259

International perspectives

addiction, 261

bidis, 83

cancer, 88–89, 407–408, 418, 423, 424, 425

environmental tobacco smoke (ETS), 423, 424

filters, 286

label warnings, 219

oropharyngeal disease, 415, 416

prevalence of tobacco use, 23, 88–89

smokeless tobacco, 93, 300, 426–428

snus, 4, 14, 167, 204, 270, 300, 301, 302, 427, 428, 434

smoker knowledge of toxins, 72–73

International Standards Organization, 87, 283

International Workshop on Genotoxicity Test Procedures, 292

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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Internet

cigarette-like products, 94

marketing of tobacco, 190

smoke yields, 92

Investigational New Drug, 122, 215

In vitro assays, 160, 215, 291–292

cancer, 154, 165, 367, 376, 383–384, 385, 391–392, 432

cardiovascular disease, 168, 480

PREPs, 12, 34, 144, 148–149, 151, 152, 154, 156, 158, 160, 168, 208, 212, 215, 303, 350, 351

cancer, 154, 167, 367, 383–384, 385, 432

J

Japan, 88–89, 261, 286, 342, 409

K

Kidneys,

see Renal disease

Kreteks, 83, 321

L

Labeling, 7, 10, 17, 29, 203, 206, 207, 208, 211, 213, 216–221, 222, 229, 232

definition of cigarette, 27

FDA criteria, 27, 122, 123, 128, 227

health warnings, 125, 215–216, 219–221, 595, 599

historical perspective, 219, 595, 599

nicotine replacement products, 123

Legal issues, 207

see also Litigation;

Regulatory issues

Legislation

advertising, bans on, 120, 125, 597, 602

automobile safety belts, 42, 43

Cigarette Labeling and Advertising Act, 125

committee recommendations, 204, 205, 227, 228

Comprehensive Smokeless Tobacco Health Education Act, 125

Consumer Product Safety Act, 125

Controlled Substances Act, 123, 125

Federal Cigarette Labeling and Advertising Act , 595

fire-safe cigarettes, 87, 571, 604

Food, Drug and Cosmetic Act, 30, 122, 124, 125–126, 128, 204, 205, 206, 214

label warnings, 216–217, 219–221

minors, sales of tobacco to, 120, 125, 202, 604

Public Health Cigarette Smoking Act, 125

public smoking restrictions, 120, 206, 225, 597, 599, 600, 601

state tobacco laws, 125, 207, 571, 584, 601, 604

surveillance, 188, 197

tobacco products regulation, committee recommendation, 204, 205

Toxic Substances Control Act, 125

see also Regulatory issues

Leptin, 268, 378–379

Leukocytes, 314, 492, 506–507, 527

Leukoplakia, 415, 427, 429, 563

Leukotrines, 156, 344, 388, 519–520, 563

Life expectancy, 23

Light cigarettes,

see Low-yield products

Lipids and lipoproteins, 12, 154, 169, 243, 253, 314, 330–331, 336–337, 343, 378–379, 471, 479, 482, 485, 486, 491–492

leukotrines, 156, 344, 388, 519–520, 563

Litigation

additives, 90–91

FDA jurisdiction, 21, 30, 124, 127–128, 204, 227, 228, 604

smoke yield assessment, 211

tobacco companies, litigation against, 126, 595, 601–604

Liver,

see Hepatic system

Lorillard Tobacco Company, 184, 584

Loss of heterozygosity,

see Heterozygosity, loss of

Low-yield products, 4, 27, 28, 73–76, 89–90, 95, 116, 205, 319, 432, 532, 533, 584

see also Black vs blond tobacco;

Filters;

Ventilation

advertising, 26, 56, 61–66, 72, 73, 76

bladder cancer, 421

cardiovascular disease, 471, 477

chronic obstructive pulmonary disease (COPD), 517–518

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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compensatory smoking, 2, 26, 67, 88, 121, 164, 219, 266, 285, 322, 380, 402, 403, 405, 477, 517

gender factors, 74, 404–405

historical perspectives, 3, 60, 61–66, 72–73, 121, 596–604 (passim)

lung cancer risk, 399–404

nitrosamines, 377

oropharyngeal disease, 416

relapse into smoking, 75

risk assessment, 143, 145, 164, 399–400

risk perception, 66–67, 68–71, 76–77

Lung Health Study, 232, 471, 505, 514–515, 532

Lungs,

see Respiratory system

Lymphocytes, 156, 296–297, 314, 338, 346, 376, 399, 417, 436, 518, 519

M

Macrophages, 293, 296, 297, 344, 484, 506, 517, 518, 526, 561

Magnesium nitrate, 90–91

Males,

see Gender factors

Marketing, viii, 7, 8, 10, 30, 31, 32, 64, 74, 237, 240

see also Advertising;

Federal Trade Commission;

Labeling;

Packaging

FDA regulation, 128, 205

historical perspectives, 60–66

postmarket surveillance, x, 182, 184, 189, 190, 203, 207, 208, 213, 221–222, 270

regulation, general, 207, 208, 213, 215, 216–221, 222–223, 228, 229, 232

premarket testing/approval, x, 8, 129, 213–215, 217, 223, 224, 227–228

Mass media, 188, 190

see also Advertising

Mecamylamine, 107, 124, 266

Medical Device Amendments of 1976, 124

Medical devices, 111

see also Oral/nasal sprays

birth control, 45

burning temperature, 95

computerized, 118

PREP defined, 3, 28, 205

regulatory issues, 30, 91, 124, 125–126, 127, 128, 129, 204, 205, 206, 209–210, 214, 225, 228

Memory, 254, 319, 564

Men,

see Gender factors

Menthol-containing cigarettes, 62, 64, 72, 73, 77, 86–87, 98, 183, 319, 406–407, 438, 439

African Americans, 72, 73, 86, 406–407

Methadone, 42, 48, 49–50, 51, 52, 55, 114–115

Methodology,

see Research methodology

Methoxsalen, 110

Military personnel, 70, 76, 398

Minority groups,

see Race/ethnicity

Mitochondria, 154, 314, 336–337, 341, 394

Modified tobacco products, viii, ix-x, 2, 8, 17, 52, 231, 303, 596

see also Additives;

Low-yield products;

Potential reduced-exposure products (PREPs);

Technological innovation

committee charge and methodology, 3–4, 205, 206

genetically altered, 189

regulatory issues, 8, 10–11, 205, 206, 207, 209

Molecular biology, 207, 298–299

see also Biomarkers;

Genetic factors;

Pharmacology;

Receptors;

Toxicology

cytochrome P-450, 109, 152, 248, 269, 298, 323, 327, 334, 342, 375, 377, 378, 385, 409, 417, 421, 570

lipids, 12, 154, 169, 314, 330, 336–337, 343, 379, 471, 479, 482, 485, 486, 491–492

oropharyngeal disease, 417

proteomics, 12–13, 152, 314, 334, 353, 389, 492

Monitoring the Future, 185–187, 320–321

Mortality, 201, 434, 595, 598

auto accidents, 42, 43

bladder cancer, 418, 419

cancer, 392, 398, 400, 411–414, 415, 418, 419, 426, 434

cardiovascular disease, 470, 472, 473, 477, 487

chronic obstructive pulmonary (COPD), 505, 508, 509, 512, 513–514

cigar smokers, 426

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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committee charge, 4, 31

dementia risk assessment and, 564

drug treatment to reduce, 111, 112–113

fetal, 543, 545, 552, 596

fires caused by smoking, 571

harm reduction defined, 2, 25, 40

historical perspectives, vii, 2, 23

international perspectives, 23, 25

low-yield products, 2, 400

lung cancer, 392, 398, 411–414

nonneoplastic respiratory disease, 170, 505, 508, 509, 512, 513–514, 528, 530

oropharyngeal cancer, 415

registries, 321

regulatory issues, 213, 215, 220

sudden infant death syndrome, 173, 268, 543, 546, 549, 552, 596

surveillance, 194

Musculoskeletal effects,

see Orthopedic effects;

Rheumatoid arthritis

Mutagenesis and mutagens, 144, 148, 154, 292, 367–370, 371, 373–379, 380, 384, 429–430

see also Cancer and carcinogens

biomarkers, 313, 314, 323, 326, 327, 334, 340–342, 345, 346–347, 353

defined, 368

DNA adducts, 153, 292, 293, 313, 314, 327–335 (passim), 341, 346, 348, 353, 368–370 (passim), 372, 375–378 (passim), 385–390 (passim), 399, 405, 409, 417, 420–424 (passim), 429, 435, 492

particulates, 148, 374, 436

teratogenic, 545, 554–555

transgenic animals, 298–299, 385, 391

tumor suppressor genes (including p53), 155, 336, 341–342, 343, 371–372, 375, 376, 391–392, 393–394, 405, 409, 415, 417, 418–419, 420, 421, 428–429, 435

N

Naloxone, 108

Naltrexone, 108

Nasal sprays,

see Oral/nasal sprays

National Cancer Institute, 185, 211, 596

National Center for Environmental Health, 184, 185

National Committee for Clinical Laboratory Standards, 349

National Health and Nutrition Examination Survey (NHANES), 184–185, 190, 320–321, 413, 422, 565

National Health Interview Survey, 69, 185–187, 320–321, 544

National Highway Traffic Safety Administration, 42, 44

National Household Survey on Drug Abuse, 50, 92–93, 185–187, 260, 261

National Institutes of Health, 301

National Cancer Institute, 185, 211, 596

National Institute for Environmental Health Sciences, 604

National Survey of Family Growth, 187

National Toxicology Program, 53, 384

National Vital Statistics System, 188

National Youth Tobacco Survey, 185–187

Native Americans,

see American Indians

Neurological diseases

dementia, 174, 254, 564–565

depression, 104, 174, 186, 256–257, 347, 568–569

antidepressants, 105–106, 115–116, 254, 256, 570

Parkinson’s disease, 162, 270, 347, 571–572

schizophrenia, 162, 174, 244, 257, 268–269, 347, 568

Neurotransmitters, 105, 134, 161, 244, 245, 255, 256, 519, 550–551, 571

see also Receptors

acetylcholine (Ach), 161, 244–245, 252, 254, 266, 269, 347, 568

dopamine, 105, 109, 110, 244, 245, 256, 257, 266, 347–348, 551, 568, 571, 572

serotonin, 105, 109, 244, 347, 478, 551

Neutrophils, 156, 338, 344, 485, 508, 517, 518, 561

New products,

see Potential reduced-exposure products (PREPs);

Technological innovation

New Zealand, 261

NEXT, 29, 91

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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Nicorette, 97, 123, 129

Nicotine, vii, 25, 26, 28–29, 66, 67, 597

see also Addiction;

Filters;

Low-yield products;

Nicotine replacement therapy;

Pharmacology;

Potential reduced-exposure products (PREPs);

Ventilation

antagonists, 4, 106–108, 110, 116, 244

antibodies, 107–108

antidepressants, 105

biomarkers, 323, 324–325, 326, 347

see also Cotinine

plasma markers, 99, 113, 250, 293

body weight, 126, 158–159, 162, 255, 267, 270, 568–569

carcinogenesis, 167, 402, 403, 405

cardiovascular disease, 168, 470–471

nicotine replacement therapy (NRT), 98–99, 112, 115, 252–253, 471

cigarette-like products, 94, 95

cognitive effects, 254, 255, 259, 270, 564

compensatory smoking, 2, 26, 67, 88, 121, 164, 219, 266, 285, 322, 380, 402, 403, 405, 477, 517

definitional issues, 27, 126

dementia, 564

gender factors, 74

marketing factors, 61

mecamylamine, 107, 124, 266

metabolism, 109, 110, 116, 162, 248–252, 256, 269, 313, 422

processing of tobacco, 85

public understanding of content, 60

regulatory issues, 10, 207, 210, 211–212

receptors, 550, 564, 568

drug treatments, 97, 103, 105, 106–107, 110

genetic predisposition to smoking, 347–348

pharmacology, 161, 245, 252, 254, 255, 257

reproductive and developmental effects, 172, 545, 550, 552, 554–555, 572

smoker knowledge of, 72–73

surveillance, 184, 189

yield assessment, 88, 90, 184, 207, 210, 211–212, 317–319, 373

Nicotine replacement therapy (NRT), viii, 1, 3, 4, 29, 51–53, 95–104, 110–115, 161–162, 231, 233–234, 254, 263, 269, 270–271, 325, 326, 430, 533, 552–553, 554–555

see also Chewing gum;

Oral/nasal sprays;

Patches

addiction, 161

behavioral therapy and, 96, 115

cardiovascular disease, 98–99, 112, 115, 252–253, 471

clinical trials, 96, 101–103, 113–115, 533

cost of, 101–102, 129, 554–555

dose-response relationship, 255–256, 264, 266

doses per day, 98, 105–106, 113, 248

gastrointestinal system, 267, 270

gender factors, 267–268

genetic factors, 270

historical perspectives, 113, 599, 601

labeling, 123

relapse into smoking, 101, 111, 115

reproductive and developmental effects, 112, 116, 172–173, 267, 552–553, 554–555

research methodology, 101–103

research recommendations, 269–271

risk perception, 110–111, 112

time factors,

blood concentrations, 99–101, 103

FDA approval, 123

long-term use, 115, 121

Nicotrol Nasal Spray, 97, 124, 129

Nitrosamines, 4, 67, 86, 87, 91–92, 93, 148, 151, 210, 215, 294, 300, 301, 319, 326–327, 328, 348, 373–374, 376–377, 379, 380, 403, 405, 429–430, 603, 604

environmental tobacco smoke, 424

racial/ethnic differences, 406, 407

smokeless tobacco, 4, 93, 428, 429

Nonneoplastic respiratory diseases, 170–171, 500–542

see also Chronic obstructive pulmonary disease

asthma, 170, 500–501, 518–525, 527, 530–531, 551

biomarkers, general, 170–171, 501–503, 506, 507, 512, 517, 527, 531, 532

urine, 503, 506, 523, 524, 525, 529, 531

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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bronchi, 24, 156, 500, 505, 514, 520, 522, 526, 551

bronchitis, 21, 295, 338, 502, 503, 505, 510, 525, 529, 551

epithelium, 298, 375, 376, 393

children, 500, 501, 506, 508, 510–511, 518–526 (passim), 528–530, 551

clinical research, 13, 171, 511–512, 514, 518, 522, 523–525, 529, 530, 532–533

cotinine, 517, 523, 525, 526, 529, 530, 532

dose-response relationship, 170, 171, 510–514, 521, 523, 527–528, 531, 532

environmental tobacco smoke (ETS), 500, 509–511, 521–522, 528–530, 531, 551

genetic factors, 170, 501–502

historical perspectives, 500, 506, 598, 599

immune system, 526, 527

incidence, 500, 518, 519, 526

infections, 170, 296, 297, 354, 500–501, 502, 506, 508, 516, 525–530, 532, 546, 547

children, 501, 506, 526, 528–529, 551

influenza, 297, 502, 526, 530

pneumonia, 501, 502, 526, 527–528, 529, 530, 551

surrogate markers, 507, 512

tuberculosis, 501, 526, 528

sputum, 12, 193–194, 313, 353–354, 391, 435, 437, 503, 505, 514, 515

Nortriptyline, 4, 104, 106, 124

Nurses’ Health Study, 168, 487, 567

O

Occupational factors,

see Workplace

Ocular disease, 174, 193, 565–566

Oncogenes, 294, 341–342, 371, 389, 391, 393

Oral/nasal sprays, vii, 4, 94, 97–101, 103, 124, 266

Oropharyngeal disease, 174, 563–564, 574

see also Smokeless tobacco

biomarkers, 156, 333, 338–339, 342

cancer, 23, 167, 301, 333, 342, 368, 372, 415–418, 425, 427–429, 597

gingivitis, 563–564

gum bleeding, 156, 338, 563

oral clefts, 549–550

Orthopedic effects, 565

osteoporosis, 158, 174, 176, 193, 338–339, 565, 574

rheumatoid arthritis, 174, 562

Over-the-counter drugs, 31, 94, 96, 97, 102, 110, 120, 263

FDA approval process, 123

P

Packaging, 27, 30–31, 70, 77, 124

see also Labeling

Palladium, 90–91

Pancreatic cancer, 372

Paper, 27, 85, 87, 88, 89, 91, 92, 128, 287, 571, 604

see also Ventilation

cigarette defined, 82, 83

regulatory issues, 210, 224, 225

ventilation, 26, 71, 87, 88, 89, 90, 121, 211, 286, 287, 317, 380, 399, 595, 597

Parental factors,

see Family/home factors

Parkinson’s disease, 162, 270, 347, 571–572

Particulates, viii, 284–285, 286–287, 322

see also Aerosols

carcinogens and mutagens, 148, 374, 436

free radicals, 378

immune response, 297–298

smoke yields, 87

Passive smoking,

see Environmental tobacco smoke

Patches, vii, 3, 4, 29, 96, 97, 98, 99, 100, 101, 103, 104, 112, 113, 601

clonidine, 108

mecamylamine, 107

pharmacokinetics, 246

Peptic ulcers, 175, 560–561, 573

Periodontal disease,

see Oropharyngeal disease

Pharmaceutical products,

see Chewing gum;

Drug treatment;

Oral/nasal sprays;

Nicotine replacement therapy;

Psychotrophic drugs;

Patches

Pharmacology, 101, 161–163, 215, 243–282, 570, 583, 593

see also Addiction;

Receptors

alcohol, 253, 570

animal models, 244, 253, 258, 268

cardiovascular effects, 471

cotinine, 248, 249, 250, 265

historical perspectives, 243, 593–595, 597

regulatory issues, 126, 127

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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risk assessment, 161–163

withdrawal, 161, 244, 245, 254–260 (passim), 263–267 (passim)

Philip Morris, 184, 584

Accord, 4, 65, 95, 603

NEXT, 29, 91

Pipe smoking, 85, 321, 473, 508, 597

Placental complications, 268, 545–547, 552

Plasma markers, 325, 480

cotinine, 348

leptin, 268, 378–379

nicotine, 99, 113, 250, 293

Platelet activation, 12, 156, 157, 168, 169, 252, 253, 296, 337–339, 343, 354, 479, 480, 481, 483–486, 490–491, 492, 493, 561

Pneumonia, 501, 502, 526, 527–528, 529, 530, 551

Policy, general, 7, 9, 38–39, 41–42, 51–56, 119–122, 176, 201–230

see also Automobile safety;

Regulatory issues

alcohol and drug abuse, 39–40, 46–50, 51, 52, 53, 55, 56, 601

automobile safety, vii, 41–44, 50, 52, 53, 56

surveillance, 197

taxation, 119, 128, 202, 596, 603

teen sexual behavior, 44

Political factors, 22

Polycyclic aromatic hydrocarbons (PAHs), 86, 148, 149, 295, 322, 326–327, 328–331, 333, 348, 374, 375–376, 377, 379, 391–392, 418, 570

Polymer chain reaction, 340, 391

Polymorphisms, 252, 256, 314, 315, 345, 346, 347, 405–406, 409, 478, 526

Potential reduced-exposure products (PREPs), 2, 3–17 (passim), 21, 53, 231, 232–240, 273, 574

see also Drug treatment;

Filters;

Low-yield products;

Modified tobacco products;

Nicotine replacement therapy;

Ventilation

additives, 144, 149, 165, 212

age factors, 76, 161, 164, 319, 321, 331

animal models, 144, 145, 147, 148–149, 162, 163, 165, 208, 212–213, 303, 350, 351, 384–386

behavioral effects of availability, 7, 73–76, 185, 197, 315

biomarkers, 142, 144, 145, 150–161, 162–163, 165, 237, 309–317, 323–352, 388, 435–436, 553

committee charge and methodology, 3–5, 31–32, 33, 34, 142, 202–203, 205, 237

currently available and novel, 91–95

definitional issues, 3, 28, 205

dose-response relationship, 14, 15, 33, 34, 140, 141, 144–147, 152, 154, 156, 158, 159, 160, 167, 237–238, 271, 310, 312, 325, 326, 352, 381, 395–396

epidemiology, 6, 7, 8, 10, 13–14, 141, 142, 147, 153, 160, 165, 193, 195, 197, 203, 206, 208, 221, 222, 229, 232, 236, 238, 437–438, 584

FDA actions, 15, 122–124, 129–130, 141, 181, 204–205, 206, 209, 221, 226–227

Federal Trade Commission (FTC), 2, 15, 26, 61, 67, 207, 210, 221, 227, 350

historical perspectives, 24, 26, 55, 60–81, 88–91

incidence of disease, 5–6, 193

in vitro assays, 12, 34, 144, 148–149, 151, 152, 154, 156, 158, 160, 168, 208, 212, 215, 303, 350, 351

cancer, 154, 167, 367, 383–384, 385, 432

lung cancer, 294–295, 395–399, 407–409

marketing, 61–66

other harm reduction intervention compared, 50–53

policy, general, 202–204

postmarket surveillance, x, 182, 184, 189, 190, 203, 207, 208, 213, 221–222, 270

pregnant women, 173–174, 552–553, 554–555

prevalence of use, 67

product descriptions, 82–140

regulation, 5, 6, 7–11, 30–32, 33, 122–124, 129–130, 147, 202–229 (passim), 234–235, 236, 238

relapse into smoking, 75, 101, 111, 115, 141, 146

risk assessment, general, 140–179 (passim)

risk thresholds, 9, 164, 167, 222–224, 225–226, 431, 439, 480, 481, 487

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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risk perception, 26, 68–69, 77, 78

smokeless tobacco, 93

Surgeon General’s reports, 24

surveillance, x, xi, 7–8, 10, 13–14, 147, 162, 176, 181, 182, 183, 185, 189, 203, 208, 221–222, 225, 236, 237, 238, 269, 270, 573, 574

time requirements for evaluation, 5, 141, 146, 147, 232, 320

toxicology, 144, 145, 147–150, 204–205, 207, 208–209, 212–213, 228, 292, 302–303

Preeclampsia, 268, 560, 572

Pregnancy, 53–54, 543–555

see also Reproductive and developmental effects

alcohol use, 172, 545, 547

animal models, 13, 298

biomarkers, 174, 191, 545, 548, 553, 570, 572

birthweight, 11, 23, 24, 149, 172, 173–174, 188, 193, 212, 267, 340–341, 344, 529, 543, 547–549, 550, 551, 552, 554, 596

bupropion, 172, 174, 552–553, 554

carbon monoxide, 172, 173–174, 549, 550, 552, 554

cohort studies, 173, 547

contraceptives, 45, 477, 481, 544, 597

cotinine, 545, 548, 553, 572

diet, 547

drug treatments, 116

environmental tobacco smoke (ETS), 544, 545, 548, 549, 551

fetal lung development, 149, 298, 511, 551

hemoglobin, 546, 549

nicotine, 172, 545, 550, 552, 554–555, 572

nicotine replacement therapy (NRT), 112, 116, 172–173, 267, 552–553, 554–555

placental complications, 268, 545–547, 552

preeclampsia, 268, 560, 572

PREPs, 173–174, 552–553, 554–555

preterm delivery, 172, 543, 546–547, 552, 596

regulatory issues, 10–11, 208, 222

smokeless tobacco, 301–302, 551–552

spontaneous abortion, 11, 24, 268, 545, 554, 596

teenage, 44, 172, 543, 545, 552

surveillance, 187–188, 191, 193

teratogenic effects, 545, 554–555

Pregnancy Risk Assessment Monitoring System, 187–188

Premarket notification/testing/approval, x, 8, 129, 213–215, 217, 223–224, 227–228

Premier, 4, 93, 94, 600

PREPs,

see Potential reduced-exposure products

President’s Cancer Committee, 211

Prevalence, 195, 262, 594, 603

see also Incidence

adolescents, 1, 22, 38, 319

birthweight, low, 11, 23, 24, 149, 172, 173–174, 188, 193, 212, 267, 340–341, 344, 529, 543, 547–549, 550, 551, 552, 554, 596

cigar smoking, 425

gender factors, 22, 74, 87, 404

harm reduction defined, 40

orthopedic effects, 565

PREP use, 67

respiratory infections, 529

smokeless tobacco use, 92–93, 427

smoking, general, viii, 1, 22, 23, 25, 74, 189, 191, 197, 414

antidepressants, 106

international perspectives, 23, 88–89

nicotine replacement drugs, clinical trials, 102–103

pregnant women, 543–544

Processing of tobacco, 66, 82, 84–87, 89, 90–91, 299–300, 597

see also Additives

blending, viii, 26, 82, 85, 87, 94, 128, 209, 287

curing, 8, 82, 83, 84, 91, 128, 189, 209, 300

FDA regulation, 128

regulation recommendations, 209

surveillance, 189

Proteomics, 12–13, 152, 314, 334, 353, 389, 492

Psychological factors, 118

see also Attitudes and beliefs;

Behavioral effects of tobacco use;

Behavioral treatments;

Dementia;

Depression;

Schizophrenia

addiction, 41, 118, 161, 254, 256–257, 259

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.
×

adolescents, 74

anxiety, 109

depression, 104, 174, 186, 256–257, 347, 568–569

antidepressants, 105–106, 115–116, 254, 256, 570

menthol cigarettes, 73

nicotine mood enhancement, 245, 254

nicotine replacement therapy, addiction, 161

surveillance, 186

Psychotrophic drugs, vii, 268–269

FDA attempt to regulate tobacco, 126

Public education, x, 9, 203–204, 236, 603

see also Internet;

Schools

committee charge, 4–5

consumer information, 7, 231, 240

see also Labeling

regulatory framework, 204, 205, 225, 229

surveillance, 188

Public Health Cigarette Smoking Act, 125

Public Health Service, 102, 103, 109, 595

Public health, general, 4, 5, 6, 7, 14, 16, 25, 31, 33, 141, 142, 202, 235–237

see also Cessation programs;

Epidemiology;

Fires;

Policy, general;

Surveillance

restrictions on public smoking, 120, 206, 225, 597, 599, 600, 601

Pulmonary system,

see Respiratory system

R

Race/ethnicity, 73, 86, 233, 321, 543, 548

see also specific groups

birthweight, 548

cancer, 406–408, 416, 436

dementia, 564

dose-response relationship, 164, 407

metabolic processes, 250, 270–271, 389

nitrosamines, 406, 407

oropharyngeal disease, 416

pregnant smokers, 543, 553

prevalence of smoking, 22, 24

Surgeon General’s reports, 24, 125, 603

Radon, 195, 298, 408

Receptors, 108, 244, 482, 485–486, 550–551, 564, 568

see also Neurotransmitters

dopamine, 256, 266, 347–348

estrogen, 394, 405

nicotinic, 550, 564, 568

drug treatments, 97, 103, 105, 106–107, 110

genetic predispositions for smoking, 347–348

pharmacology, 161, 245, 252, 254, 255, 257

progesterone, 405

Red Book, 14, 15, 33, 34, 141

Regulatory issues, x, 6, 30–31, 201–229, 584

see also Enforcement;

Federal Trade

Commission;

Food and Drug Administration;

Labeling;

Legislation;

Standards

additives, 128, 149, 209, 210, 212, 224–225

advertising, 7, 10, 120, 125–126, 127, 128, 141, 203, 206, 207, 208, 211, 216–221, 222, 229, 232, 595, 597, 602, 603

animal models, 10, 208, 212–213, 215

automobile safety, vii, 41–44, 50, 52, 53, 56

biomarkers, 10, 11–12, 207–208, 211, 220, 348–349

carbon monoxide, 210, 218

carcinogens, 10, 208, 215

clinical trials, 122, 208, 209, 212, 213, 215, 227, 229

committee charge and methodology, 4, 5, 31–32, 34, 202–203

consumer information, general, 204, 205, 225, 229

conventional tobacco, 124–130, 207, 209–229 (passim), 234–235

definitional issues, 11, 27–28, 30, 124, 126, 205, 225–226

enforcement, 11, 30, 40, 43–44, 48, 120, 125, 196, 207, 209, 226, 238, 239

epidemiology, 8, 10–11, 129, 203, 206, 207, 208, 221, 222, 229

exposure, general, 10, 204, 207–208, 215

filters, 128, 210, 225

historical perspectives, 124–130, 595–604

marketing, 207, 208, 213, 215, 216–221, 222–223, 228, 229, 232

see also “advertising” supra;

Labeling postmarket surveillance, x, 182, 184, 189, 190, 203, 207, 208, 213, 221–222, 270

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.
×

premarket testing/approval, x, 8, 129, 213–215, 217, 223, 224, 227–228

medical devices, 30, 91, 124, 125–126, 127, 128, 129, 204, 205, 206, 209–210, 214, 225, 228

modified tobacco products, 8, 10–11, 205, 206, 207, 209

mortality, 213, 215, 220

nicotine, 10, 207, 210, 211–212

paper, 210, 224, 225

pharmacology, 126, 127

PREPs, 5, 6, 7–11, 30–32, 33, 122–124, 129–130, 147, 202–229 (passim), 234–235, 236, 238

principles, 10–11, 17

processing of tobacco, 189, 209

public smoking restrictions, 120, 206, 225, 597, 599, 600, 601

reproductive and developmental effects, 10–11, 208, 222

respiratory effects, 10, 208, 215, 222

smokeless tobacco products, 126, 128, 209

surveillance, 183, 184, 188, 189, 190, 197, 203, 204, 208, 221–222, 225

taxation, 119, 128, 202, 596, 603

toxicology, 9, 10–11, 128, 204–205, 207, 212–213, 222, 224–225, 228

yield assessment, 183, 184, 207–208, 210–212, 219

smoking machines, 2, 3, 26–27, 87–88, 90, 210–211, 226, 283–284, 317–319, 350, 352, 373, 380, 395, 404

Relapse, 5, 40, 141, 262

alcohol abuse, 47

depression and, 104

drug treatment and, 111

low-yield cigarettes, 75

nicotine replacement products, 101, 111, 115

PREP risk assessment, 75, 101, 111, 115, 141, 146

risk perception and, 41

substance abusers, 49

Renal disease, 481, 567–568

Reproductive and developmental effects, 4, 24, 172–174, 268, 298, 302, 543–559, 598, 601

see also Age factors;

Genetic factors;

Pregnancy

animal models, 13, 298

behavioral/cognitive disorders, 268, 550–551

biomarkers, 174, 191, 545, 548, 553, 570, 572

serum, 548, 553, 570, 572

urine, 545, 548, 553

birthweight, 11, 23, 24, 149, 172, 173–174, 188, 193, 212, 267, 340–341, 344, 529, 543, 547–549, 550, 551, 552, 554, 596

carbon monoxide, 172, 173–174, 549, 550, 552, 554

cervical cancer, 24

clinical research, 173–174, 547, 548, 554

cognitive and behavioral disorders, 268, 550–551

congenital malformations, 268, 545, 549–550

contraceptives, 45, 477, 481, 544, 597

environmental tobacco smoke (ETS), 544, 545, 548, 549, 551

fertility, 173, 267, 544–545

menstrual cycle, 267

nicotine, 172, 545, 550, 552, 554–555, 572

nicotine replacement therapy (NRT), 112, 116, 172–173, 267, 552–553, 554–555

pelvic inflammatory disease, 544–545

PREP risk assessment, 172–174, 552–553, 554–555

regulatory issues, 10–11, 208, 222

research recommendations, 553–555

smokeless tobacco, 551–552

sudden infant death syndrome, 173, 268, 543, 546, 549, 552, 596

surveillance, 187–188, 193

teratogenic, 545, 554–555

Research methodology, 55–56, 121–122, 438–439

see also Animal models;

Biomarkers;

Clinical research;

Cohort studies;

Epidemiology;

Internet;

In vitro assays;

Surveillance

addiction measures/models, 257–267

asthma studies, 520, 521

carcinogenesis, 378, 379–394, 410, 434–439

committee study at hand, 3–5, 16, 31–35, 142

dementia, 564–565

exposure, 309–366

see also “smoke yields” infra

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.
×

forced expiratory volume (FEV), 156, 171, 338, 343, 503, 506, 508–509, 514–515, 516, 520, 523, 532–533

free radical carcinogens, 378

health impact research, 66–67

nicotine metabolism, 252

nicotine replacement drugs, 101–103

Parkinson’s disease, 572

quitting smoking, 76

respiratory infections, 529–530

risk perception, 68

smoking machines, 2, 3, 26–27, 87–88, 90, 210–211, 226, 283–284, 317–319, 350, 352, 373, 380, 395, 404

Research recommendations, 7–17, 33–35, 77–78, 203, 206–207, 232–233, 239–240, 573–574

biomarkers, 352–355, 438, 491

cancer, 434–439

cardiovascular, 491–493

nicotine replacement therapy, 269–271

nonneoplastic respiratory diseases, 532–533

reproductive and developmental effects, 553–555

smokeless tobacco, 301–302

toxicology, 301–303

Respiratory system, 4, 156, 285–286, 343

see also Nonneoplastic respiratory diseases

bronchi, 24, 156, 500, 505, 514, 520, 522, 526, 551

bronchitis, 21, 295, 338, 502, 503, 505, 510, 525, 529, 551

cancer and carcinogenesis, 285, 298, 375, 376, 391, 392, 393, 437, 518

epithelium, 298, 375, 376, 393

bronchoalveolar lavage, 13, 156, 295, 338–339, 343–344, 437, 517

bronchoscopy, 157, 171, 339, 392, 502–503, 517, 531

epithelial function, 500, 519, 525–526

bronchial, 298, 375, 376, 393

forced expiratory volume (FEV), 156, 171, 338, 343, 503, 506, 508–509, 514–515, 516, 520, 523, 532–533

gender factors, 416, 520

chronic obstructive pulmonary (COPD), 500, 509, 512, 514, 515, 516

lung cancer, 24, 401, 402–403, 404–406, 410, 411, 412, 413, 598, 599

inflammation, 12, 13, 95, 113, 149, 156, 170–171, 295, 298, 302, 338, 343–344, 395, 502, 505, 506, 507, 516–518, 527, 531, 533

asthma, 170, 500–501, 518–525, 527, 530–531, 551

lung cancer, viii, 21, 23, 24, 66, 67, 86, 89, 149, 166–167, 192, 193, 215, 293–295, 296–297, 302, 333, 342, 355, 368, 372

nicotine pharmacology, 244–245, 246

regulatory issues, 10, 208, 215, 222

Rheumatoid arthritis, 174, 562

Risk assessment, general, ix-x, 14, 15, 33–35, 66–67, 239–240

see also Biomarkers;

Dose-response relationship;

Epidemiology;

Exposure;

Surveillance;

specific diseases and anatomical systems

age factors, 67, 145, 186, 321

committee charge, 3–4

definitional issues, 28

exposure-to-adverse effect, time, ix, 140, 145, 166, 511, 530

filters, 143, 164, 168, 399–400, 402–404

gender factors, 67, 145, 164, 168

genetic predisposition to toxic effects, ix, 6, 13, 145, 153, 164, 166, 192, 233, 344–347, 390, 408–409, 416, 429, 436, 478, 490, 508

low-yield products, 143, 145, 164, 399–400

modified tobacco products, viii

pharmacology, 161–163

PREPs, 140–179 (passim)

risk thresholds, 9, 164, 167, 222–224, 225–226, 431, 439, 480, 481, 487

tobacco, 141–144

Risk characterization, general, 14, 33–34, 140, 237–238, 239

Risk perception, 2, 6, 8, 10, 26, 28, 40–41, 42–43, 67–73, 76–77, 185–188 (passim), 212, 434, 584

addiction, 68

additives, 72–74, 77

adolescents, 41, 68, 72, 73–74, 112, 185

carbon monoxide, 72–73

international perspectives, 72–73

low-yield products, 66–67, 68–71, 76–77

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.
×

negative attitudes toward unsafe behavior, general, 43

nicotine replacement products, 110–111, 112

R.J.Reynolds, 184, 585, 594, 595, 597, 600

Eclipse, 4, 65, 94–95, 129, 215, 517–518, 602

Premier, 4, 93, 94, 600

Winston, 72, 91

RNA, 152, 153, 299, 314, 334, 353, 389

S

Saliva, 209, 267, 300, 311, 323, 325, 422, 428, 523, 525

Schizophrenia, 162, 174, 244, 257, 268–269, 347, 568

Schools

impacts of smoking on performance, 187

prevention/cessation programs, 24, 120, 598, 601

teen sexual behavior, 44–45

Youth Risk Behavior Survey, 93, 185–187, 261, 320–321

Secondary smoke,

see Environmental tobacco smoke

Serotonin, 105, 109, 244, 347, 478, 551

Sertraline, 105

Serum markers, 157, 174, 184–185, 187, 190, 300, 313, 314, 321, 323, 330, 335, 339, 353

cancer, 333, 422

cholesterol levels, 289, 296, 477, 482

diabetes, 567

environmental tobacco smoke, 348, 422

nonneoplastic respiratory diseases, 506, 517, 527, 532

reproductive and developmental effects, 548, 553, 570, 572

Sex differences,

see Gender factors

Sexual behavior, adolescents, 44–46, 50, 51

pregnancy, 44, 172, 543, 545, 552

Sidestream smoke,

see Environmental tobacco smoke

Skeletal system,

see Orthopedic effects

Skin diseases,

see Dermatologic diseases

Skin patches,

see Patches

Sleep disturbance, 105, 106, 254, 255

Smith Kline Beecham, 585

Smokeless tobacco products, 83, 85, 92–95, 99, 101, 149, 167, 255, 426–429, 563, 598, 600

see also Chewing tobacco;

Snuff

addiction, 266

additives, 299–300

adolescents, 302

advertising, 93

age factors, 93, 302

cancer, 4, 93, 300–301, 426–429

epidemiology, 301

international perspectives, 93, 300, 426–428

snus, 4, 14, 167, 204, 270, 300, 301, 302, 427, 428, 434

nitrosamines

oral disease, 167, 563

prevalence of use, 92–93, 427

regulation of, 126, 128, 209

research recommendations, 301–302

toxicology, 299–302

use surveys, 321

Smoking machines (Federal Trade Commission), 2, 3, 26–27, 87–88, 90, 210–211, 226, 283–284, 317–319, 350, 352, 373, 380, 395, 404

Smoking topography, 151, 182, 322, 323, 349, 352, 399, 405, 406, 407–408, 437

see also Inhalation depth and topography

compensatory smoking, 2, 26, 67, 88, 121, 164, 219, 266, 285, 322, 380, 402, 403, 405, 477, 517

Snuff, 83–84, 92–93, 100, 300, 301, 427, 593

DNA adducts, 332

snus, 4, 14, 167, 204, 270, 300, 301, 302, 427, 428, 434

Socioeconomic factors

asthma, 519

educational attainment, 390, 425, 530, 543, 547, 564

lung cancer, 407, 414

pregnant smokers, 543, 547

Spontaneous abortions, 11, 24, 268, 545, 554, 596

Sprays,

see Oral/nasal sprays

Sputum, 12, 193–194, 313, 353–354, 391, 435, 437, 503, 505, 514, 515

Standards, 11, 17, 30–31, 209, 225–226

see also Definitional issues;

Regulatory issues

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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addiction, 255, 257–262 (passim), 265

additives, 224–225

biomarkers, 348–349

Diagnostic and Statistical Manual of Mental Disorders (DSM), 255, 257, 258–259, 260–262

fire-safe cigarettes, 87, 571

International Diagnostic Code, 257, 258–259

International Standards Organization, 87, 283

medical devices, 124, 228

pregnant women, clinical guidelines, 172

risk thresholds, 9, 164, 167, 222–224, 225–226, 431, 439, 480, 481, 487

smoke yields, 87–88, 210–212, 283–284

smoking machines, 2, 3, 26–27, 87–88, 90, 210–211, 226, 283–284, 317–319, 350, 352, 373, 380, 395, 404

tobacco industry regulation, 128, 204

Star Scientific (Star Tobacco), 91–92, 585, 603, 604

Advance, 4, 92

Stroke, 24, 168, 470, 473, 476, 487, 489, 600

Sudden infant death syndrome, 173, 268, 543, 546, 549, 552, 596

Surgeon General, 21–26 (passim), 69, 125, 379, 380–381, 513, 595–603 (passim)

Surgery, 438

cardiovascular, 473, 476

inflammatory bowel disease, 561–562

lung cancer, 395

Surgical wounds,

see Wound healing

Surrogate markers, 6, 11–12, 16, 31, 147, 153, 235, 270, 310, 314, 335, 339

cancer, 166, 327, 330, 435–436

cardiovascular disease, 168, 483–486, 490

nonneoplastic respiratory disease, 507, 512

regulatory issues, 220

Surveillance, 10, 17, 176, 180–200, 203, 208, 232, 573, 574

see also Centers for Disease Control and Prevention;

Epidemiology

additives, 189, 196

adolescents, 185, 192

age factors, 185, 186, 191, 192, 194, 321

attitudes and beliefs, 8, 10, 185–188 (passim), 192, 196, 197

behavioral effects of smoking, 183, 185–188, 191–192, 195, 197

carbon monoxide, 184

clinical research and, 183, 193, 197

cost of, 181, 195

cotinine, 184–185, 187

defined, 180, 181, 194

dependence potential, 269

environmental tobacco smoke (ETS), 194

FDA, 181

Federal Trade Commission (FTC), 183, 184, 189, 190

filters, 183, 189

gender factors, 187

national surveillance system, general, 8, 181, 207

pregnant women, 174, 553

postmarket surveillance, x, 182, 184, 189, 190, 203, 207, 208, 213, 221–222, 270

PREPs, x, xi, 7–8, 10, 13–14, 147, 162, 176, 181, 182, 183, 185, 189, 203, 208, 221–222, 225, 236, 237, 238, 269, 270, 573, 574

regulatory issues, 183, 184, 188, 189, 190, 197, 203, 204, 208, 221–222, 225

time factors, 181, 194

yield assessments, 182, 183, 184

Sweden, 4, 14, 93, 167, 204, 270, 300, 301, 302, 427, 428, 434, 548

Synergistic effects, 298, 342, 378, 387, 390, 570

see also Air pollutants

alcohol and tobacco, 342, 415–416, 418, 426, 428

asbestos, 89, 298, 408, 501, 599

bladder cancer, 420

chronic obstructive pulmonary disease (COPD), 508–509

cardiovascular disease, 477–478

drug interactions, 122, 269, 570

lung cancer, 408–409

oropharyngeal disease, 415–416, 418

pregnancy, 545

T

Tar, 2, 11, 24, 26, 66, 67, 70–71, 184, 584

see also Filters;

Low-yield products;

Potential reduced-exposure products (PREPs);

Ventilation

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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carcinogenesis, 373–374, 399–404, 407

cigarette-like products, 94

marketing factors, 61, 65

public understanding of content, 60

yield assessment, 87, 90, 91, 92, 94, 184, 210, 211–212, 317–319, 373–374, 399–401, 407

Taxation, 119, 128, 202, 596, 603

T cells,

see Lymphocytes

Technological innovations

see Drug treatments;

Filters;

Fire-safe cigarettes;

Modified tobacco products;

Potential reduced-exposure products (PREPs);

Ventilation

automobile safety, 41, 42, 43

FTC smoking machine, 2, 3, 26–27, 87–88, 90, 210–211, 226, 283–284, 317–319, 350, 352, 373, 380, 395, 404

processing of tobacco, 66

Teenagers,

see Adolescents

Temperature factors, viii, 95, 210, 284

definition of cigarette, 27

Teratogenic effects, 545, 554–555

Thrombosis, 154, 157, 336–337, 339, 356, 481, 485–486, 491, 493

Time factors

addiction, 255–256, 260, 262, 263–264

adverse effects of treatment, 121

behavioral treatments, 117–118

biomarkers, half-life, 152, 154, 156, 157, 158, 250, 297, 316, 323, 324, 328, 333, 376, 422

burn rate, 87

chronic obstructive pulmonary (COPD), 503, 511–512

committee charge, 4

dose-response assessment, 140, 141

duration of smoking, lifetime, 67, 76, 151, 168, 390, 395, 396–397, 401, 402, 404, 419, 420, 471, 493, 508, 566, 572

duration of smoking cessation, 75, 115, 186, 409–415, 419, 438, 470, 473, 475, 476, 487, 490, 562

see also Relapse

exposure-to-adverse effect, ix, 140, 145, 166, 511, 530

FDA approval for medical devices, 124

legislation, 221

nicotine pharmacology, 246, 250, 251, 255–256

nicotine replacement drugs,

blood concentrations, 99–101, 103

FDA approval, 123

long-term use, 115, 121

population surveys, 320

PREP evaluation, 5, 141, 146, 147, 232, 320

reproductive effects,

time to conception, 544

surveillance, 181, 194

thrombosis bleeding, 154, 336

withdrawal symptoms, 255

wound healing, 174, 175, 194, 561, 573

Tobacco Testing Laboratory, 600

Toluene, 89, 148, 290, 374

Toxicology, 26–28, 34, 121, 129, 147–148, 283–308, 553, 583

see also Animal models;

Biomarkers;

Carbon monoxide;

Dose-response relationship;

Exposure;

Synergistic effects;

Tar;

Yield assessment

advertising and, 66

arsenic, 72, 148, 184, 374

asbestos, 89, 298, 408, 501, 599

cyanide, 72, 89, 291, 324–325, 401, 549, 561, 572

environmental tobacco smoke, 283, 285, 287, 289–290

filters, 284, 287

genetic susceptibilities, ix, 6, 13, 145, 153, 164, 166, 192, 233, 344–347, 390, 408–409, 416, 429, 436, 478, 490, 508

nicotine-derived, 28–29, 86, 94–95, 111-112, 173–174, 207, 270, 429–430, 554

reproductive and developmental effects, 172, 545, 550, 552, 554–555, 572

PREP risk assessment, 144, 145, 147–150, 204–205, 207, 208–209, 212–213, 228, 292, 302–303

processing of tobacco, 85, 128

regulatory issues, 9, 10–11, 128, 204–205, 207, 212–213, 222, 224–225, 228

research recommendations, 301–303

susceptibility to toxic effects, ix, 6, 13, 145, 153, 164, 166, 192, 233, 344–347

smoker knowledge of, 72–73, 77

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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smoking machines, 2, 3, 26–27, 87–88, 90, 210–211, 226, 283–284, 317–319, 350, 352, 373, 380, 395, 404

standards, 204, 283–284

Toxic Substances Control Act, 125

True, 26, 64

Tuberculosis, 501, 526, 528

U

Ulcers,

see Peptic ulcers

Urine biomarkers, 12, 106, 109, 156, 157, 171, 190, 250, 252, 295, 312, 313, 314, 325, 326, 336–337, 339, 343, 346

cancer, 326, 353–354, 376, 378, 407, 420–421, 422, 424, 429, 435, 437

cardiovascular disease, 485, 486

environmental tobacco smoke, 323, 348

nonneoplastic respiratory diseases, 503, 506, 523, 524, 525, 529, 531

reproductive and developmental effects, 174, 545, 548, 553, 548

V

Vapors, 27, 87, 88, 92, 94, 148, 284, 374

Vascular activation, 12, 157, 169, 269, 337, 480, 490–491, 493

Vascular disease,

see Cardiovascular disease;

Extracardiac vascular disease

Ventilation

asthma, 522

chronic obstructive pulmonary (COPD), 503, 510

cigarette paper, 26, 71, 87, 88, 89, 90, 121, 211, 286, 287, 317, 380, 399, 595, 597

respiratory infections, 526

Visual impairments,

see Ocular disease

Vitamin C, 486

Volatile organic compounds, 89, 148, 374

W

Weight,

see Birthweight;

Body weight

White persons,

see Caucasians

Withdrawal symptoms, 405, 569

drug treatments, 96, 101, 104–114 (passim), 123

nicotine pharmacology, 161, 244, 245, 254–260 (passim), 263–267 (passim)

Women,

see Gender factors

Women’s Health Study, 544

Workplace

occupational toxins, 33, 140, 151, 164, 166, 180, 195, 298, 329, 332, 350, 375, 377, 390, 408, 419, 420, 431, 433, 508, 599

smoking restrictions, 119–120, 422

World Bank, 23

World Health Organization, 23, 25, 258, 470

World Wide Web,

see Internet

Wound healing, 174, 175, 194, 561, 573

Y

Yield assessment, 70–71, 87–88, 90, 92, 234, 284

see also Low-yield products

carbon monoxide, 87, 88, 90, 92, 94, 95, 184, 210

nitrosamines, 376

particulates, 87

regulatory issues, 183, 184, 207–208, 210–212, 219

smoking machines, 2, 3, 26–27, 87–88, 90, 210–211, 226, 283–284, 317–319, 350, 352, 373, 380, 395, 404

surveillance, 182, 183, 184

tar, 87, 90, 91, 92, 94, 184, 210, 211–212, 317–319, 373–374, 399–401, 407

Youth Risk Behavior Survey, 93, 185–187, 261, 320–321

Z

Zyban, 30, 104, 123–124

see also Bupropion

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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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