EPID 624 - Epidemiology of Chronic Diseases- Spring 2018

Tobacco and Chronic Disease

J. Randy Koch, Ph.D & Alison Breland Ph.D.

Review chapter 5 of the required textbook, in particular look at figure 5.1. As you wil have a session on cancer epidemiology focus on the other tobacco-related topics. in particular review the descriptive epidemiology, the geographic distribution and time trends paying particular attention to figure 5.2. Look at the Atlantic Journal's 2014 view of Nicotine use over the decades. Look at the various elements of disease causation found starting on page 131 of the required text, then look at the prevention and control pages and also on page 139 then examples of evidence-based interventions and consider how effective programs to reduce smoking have been on the general public.. Do you think any 0f these are the more successful in certain population groups? If so, why? In chapter 15 what you find out about chronic obstructive pulmonary disease on page 480 and what modifiable risks have been identified at this point in time? What evidence is there of the value of these interventions?


Camcer Mortality


Lung  Cancer Mortality


global cigarrette consumption


high school smokers

In the presentation on tobacco epidemiology by doctors Breland and Kochwill cover:

Epidemiology of tobacco use (nationally and in Virginia)
Alternative tobacco products.
The Virginia Youth Tobacco Projects Research Coalition
VCU tobacco research programs.

Then Read this Viewpoint from JAMA, also review the JAMA January 08, 2014; Volume 311, Number 2, articles on tobacco control (use the TML journal research page)

Review the CDC Home Page on tobacco issues,  When you look at the CDC Tobacco page we have evidence that the projected decrease in smoking prevalence after 2007 may not hold up, particularly in teens..  There have been several discussions in the MMWR over the last 2 years ndicating that the decease may have stoipped.. Review CDC-Smoking Status by state. Also, look at the FDA discussion of the family smoking prevention and tobacco control act, the consumer fact sheetabout the legislation put in place in 2009 in response to congress's demand that the FDA develop a set of guidelines for the use of tobacco.Also look at this viewpoint on developing smoke-free "public" housing.
Take a look at the Surgeon General's on Tobacco Use. Also this editorial on Drs & Kids.

Ths furor about tobacco control at present is the use of E-cigarettes and vapors. The following articles can give you a feel for some the concerns.

Comments from the American Academy of Preventive Medicine
Alternate views from the BMJ, also quitting smoking under the NHS and the results of bannng smoking in the UK.Also the short review and lung cancer prevention.
View of Larry Gostin JD , who teaches PH Law at Georgetown and Johns Hopkins.Review review this article from the Lancet about the need for emphasis on preventing rather than just treating line cancer.
A concern about a WHO report.
As nations adopt regulatory measures for e-cigarettes, it is imperative to understand how approaches to risk, cost-benefit, and trade-offs have shaped interpretations of evidence. Look at the UK's NHS view of vaping. Look at this Sept 2015 BMJ analysis of effectiveness of use of E-cigarettes in quitting smoking..Can we learn anything from the UK attempt to change policies on the use of E cigarettes?

Do you think a vaccine is more use in preventing addiction to tobacco or in helping prevent its occurrence.? Also the role of taxing tobacco.

Examine the "State of Tobacco Control" from the American Lung Association. Note from the January 2017 edition of the Lancet regarding an NIH publication on tobacco elimination and control

Then scan to look at the contents:
50 Years of Progress, Complete report (980 Pages)
50 Years Executive Summary ( 30 pages)

Scan this summary of the following IOM book, available free.


Books: Available from Amazon.com for Kindle if you have an interest.

The Spectrum: Dean Ornish $14.

Smoking Kills: Biography of Richard Doll.

February 2, 2016, JAMA Article Public Health strategies


Note that headers and associated URLs should be mailed to me no later than midnight Friday of each week.

Header Selection

Student URLs

Professor URLs