AMERICAN JOURNAL OF PUBLIC HEALTH
EDITOR’S CHOICE
EDITOR-IN-CHIEF ASSISTANT EDITOR DEPUTY EDITOR FEATURE EDITOR IMAGE EDITOR ASSOCIATE EDITORS
Public Health in Action Fifty years ago my father, a physician, quit smoking. At the time, I was too young to understand his reasons, but learned later it was because of the first Surgeon General’s report on smoking and health. My story is not unlike many other Americans who quit smoking or had family members who quit after the report was released in January 1964. As we celebrate the 50th anniversary of this ground-breaking document, it is important to examine how it resulted in determined action on the part of the public health community to address the incontrovertible evidence of the deadly effects of smoking on the nation’s health. In this issue of the Journal, the 1964 Surgeon General’s report and its impact are nicely summarized in an editorial by Warner (pp. 5---8), in which he shows that prevalence rates of smoking have been cut by more than one half since 1964, leading the Centers for Disease Control and Prevention, the nation’s premier public health agency, to list tobacco control as one of the 10 great public health achievements of the 20th century. The achievements in the area of tobacco control are further illuminated in a research article by Warner et al. (pp. 83---89). In a thoughtful and elegant analysis, the authors demonstrate the success of tobacco control efforts since publication of the 1964 report and find that had these efforts not been implemented, per capita consumption of cigarettes in the United States would have been almost five times higher than it was in 2011. However, in his editorial, Warner also shows that there is more to be done. A considerable minority of the population continues to smoke (18% prevalence in the United States today) and some groups are more likely to smoke than others. It is imperative, then, that we do not become complacent in our tobacco control efforts. In addition to monitoring tobacco use and identifying those at increased risk, we must continually assess the focus and effectiveness of interventions through new research. An essay by Dorfman et al. (pp. 37---46) examines how tobacco control in the United States was viewed, specifically how arguments about responsibility (for causing and remedying tobacco-related problems) were framed in the news, legislative testimony, and internal tobacco documents from 1952 to 1965. Analyses of this information show that government was viewed
4 | Editor's Choice
as the responsible actor to protect the health of its citizens, as opposed to the individual’s responsibility or that of the tobacco industry. While this view may change over time, the important lesson here is that the political context must be taken into account in the development of tobacco control interventions. The article by Rogers and Sherman (pp. 90---95) evaluates screening and treatment of tobacco use by psychiatrists before and after implementation of the American Psychiatric Association guidelines for the treatment of nicotine dependence. They find, however, that screening declines from the period before to the period after the American Psychiatric Association guidelines are implemented. Furthermore, although the provision of cessation counseling increased after guideline implementation, the percentage of smokers receiving treatment overall was quite low (< 1% of patients were prescribed nicotine replacement therapy during the full time period of study). The lesson here is that we must continue to evaluate tobacco control efforts to uncover where improvements can be made. Tolstrup et al. (pp. 96---102) conducted an investigation to examine the effect of age on smoking and risk of coronary heart disease. Controlling for other relevant factors (e.g., diet, exercise, education), they find that age has little effect on the relationship between smoking and coronary heart disease. This significant finding underscores the tremendous effect of smoking on disease, from which even younger age offers no protection. The lesson here is that we need to redouble our control efforts. The impact of the interventions over the past 50 years to both prevent and stop persons from smoking is a remarkable account of public health in action. I firmly believe that my father would not have lived to the ripe old age of 91 years had he continued to smoke. However, as illustrated by the articles in this issue, there is more that can and should be done. As Warner concludes in his editorial, “We do not want to celebrate the 75th anniversary of the report with still more to do.” j
Deborah Holtzman, PhD, MSW AJPH Department Editor
Mary E. Northridge, PhD, MPH Cynthia Golembeski, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Hortensia Amaro, PhD Mary T. Bassett, MD, MPH Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Sydney, Australia) DEPARTMENT EDITORS Roy Grant, MA Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2015), Chair Chinua Akukwe, MPH (2015) Caroline Bergeron, MSc (2016) Eric R. Buhi, PhD (2016) Keith Elder, PhD, MPH (2016) Thomas Greenfield, PhD (2015) Jeffrey Hallam, PhD (2014) Dio Kavalieratos, PhD (2016) Maureen Lichtveld, MD, MPH (2015) Justin B. Moore, PhD (2016) Samuel L. Posner, PhD (2015) Joan Reede, MD, MPH (2014) Helena Temkin-Greener, PhD, MPH (2014) David H. Wegman, MD, MSc (2014) Ruth Zambrana, PhD (2016) STAFF Georges C. Benjamin, MD Executive Director/Publisher Ashell Alston, Interim Publications Director Brian Selzer, Interim Deputy Publications Director Aisha Jamil, Production Coordinator Michael Henry, Associate Production Editor (Sr) Maya Ribault, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Coordinator FREELANCE STAFF Gretchen Becker, Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Nestor Ashbery, Alex Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer
doi:10.2105/AJPH.2013.301743
American Journal of Public Health | January 2014, Vol 104, No. 1
EDITOR’S CHOICE
EDITOR-IN-CHIEF ASSISTANT EDITOR DEPUTY EDITOR FEATURE EDITOR IMAGE EDITOR ASSOCIATE EDITORS
Public Health in Action Fifty years ago my father, a physician, quit smoking. At the time, I was too young to understand his reasons, but learned later it was because of the first Surgeon General’s report on smoking and health. My story is not unlike many other Americans who quit smoking or had family members who quit after the report was released in January 1964. As we celebrate the 50th anniversary of this ground-breaking document, it is important to examine how it resulted in determined action on the part of the public health community to address the incontrovertible evidence of the deadly effects of smoking on the nation’s health. In this issue of the Journal, the 1964 Surgeon General’s report and its impact are nicely summarized in an editorial by Warner (pp. 5---8), in which he shows that prevalence rates of smoking have been cut by more than one half since 1964, leading the Centers for Disease Control and Prevention, the nation’s premier public health agency, to list tobacco control as one of the 10 great public health achievements of the 20th century. The achievements in the area of tobacco control are further illuminated in a research article by Warner et al. (pp. 83---89). In a thoughtful and elegant analysis, the authors demonstrate the success of tobacco control efforts since publication of the 1964 report and find that had these efforts not been implemented, per capita consumption of cigarettes in the United States would have been almost five times higher than it was in 2011. However, in his editorial, Warner also shows that there is more to be done. A considerable minority of the population continues to smoke (18% prevalence in the United States today) and some groups are more likely to smoke than others. It is imperative, then, that we do not become complacent in our tobacco control efforts. In addition to monitoring tobacco use and identifying those at increased risk, we must continually assess the focus and effectiveness of interventions through new research. An essay by Dorfman et al. (pp. 37---46) examines how tobacco control in the United States was viewed, specifically how arguments about responsibility (for causing and remedying tobacco-related problems) were framed in the news, legislative testimony, and internal tobacco documents from 1952 to 1965. Analyses of this information show that government was viewed
4 | Editor's Choice
as the responsible actor to protect the health of its citizens, as opposed to the individual’s responsibility or that of the tobacco industry. While this view may change over time, the important lesson here is that the political context must be taken into account in the development of tobacco control interventions. The article by Rogers and Sherman (pp. 90---95) evaluates screening and treatment of tobacco use by psychiatrists before and after implementation of the American Psychiatric Association guidelines for the treatment of nicotine dependence. They find, however, that screening declines from the period before to the period after the American Psychiatric Association guidelines are implemented. Furthermore, although the provision of cessation counseling increased after guideline implementation, the percentage of smokers receiving treatment overall was quite low (< 1% of patients were prescribed nicotine replacement therapy during the full time period of study). The lesson here is that we must continue to evaluate tobacco control efforts to uncover where improvements can be made. Tolstrup et al. (pp. 96---102) conducted an investigation to examine the effect of age on smoking and risk of coronary heart disease. Controlling for other relevant factors (e.g., diet, exercise, education), they find that age has little effect on the relationship between smoking and coronary heart disease. This significant finding underscores the tremendous effect of smoking on disease, from which even younger age offers no protection. The lesson here is that we need to redouble our control efforts. The impact of the interventions over the past 50 years to both prevent and stop persons from smoking is a remarkable account of public health in action. I firmly believe that my father would not have lived to the ripe old age of 91 years had he continued to smoke. However, as illustrated by the articles in this issue, there is more that can and should be done. As Warner concludes in his editorial, “We do not want to celebrate the 75th anniversary of the report with still more to do.” j
Deborah Holtzman, PhD, MSW AJPH Department Editor
Mary E. Northridge, PhD, MPH Cynthia Golembeski, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Hortensia Amaro, PhD Mary T. Bassett, MD, MPH Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Sydney, Australia) DEPARTMENT EDITORS Roy Grant, MA Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2015), Chair Chinua Akukwe, MPH (2015) Caroline Bergeron, MSc (2016) Eric R. Buhi, PhD (2016) Keith Elder, PhD, MPH (2016) Thomas Greenfield, PhD (2015) Jeffrey Hallam, PhD (2014) Dio Kavalieratos, PhD (2016) Maureen Lichtveld, MD, MPH (2015) Justin B. Moore, PhD (2016) Samuel L. Posner, PhD (2015) Joan Reede, MD, MPH (2014) Helena Temkin-Greener, PhD, MPH (2014) David H. Wegman, MD, MSc (2014) Ruth Zambrana, PhD (2016) STAFF Georges C. Benjamin, MD Executive Director/Publisher Ashell Alston, Interim Publications Director Brian Selzer, Interim Deputy Publications Director Aisha Jamil, Production Coordinator Michael Henry, Associate Production Editor (Sr) Maya Ribault, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Coordinator FREELANCE STAFF Gretchen Becker, Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Nestor Ashbery, Alex Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer
doi:10.2105/AJPH.2013.301743
American Journal of Public Health | January 2014, Vol 104, No. 1
