US Surgeon General's Report Research Articles

Recent Contributions of Air- and Biomarkers to the Control of Secondhand Smoke (SHS): A Review

Since the publication of the US Surgeon General Reports in 1996 and 2006 and the report of the California Environmental Protection Agency in 1999, many reports have appeared on the contribution of air and biomarkers to different facets of the secondhand smoke (SHS) issue, which are the targets of this review. These recent studies have allowed earlier epidemiological surveys to be biologically validated, and their plausibility demonstrated, quantified the levels of exposure to SHS before the bans in various environments, showed the deficiencies of mechanical control methods and of partial bans and the frequently correct implementation of the efficient total bans. More stringent regulation remains necessary in the public domain (workplaces, hospitality venues, transport sector, etc.) in many countries. Personal voluntary protection efforts against SHS are also needed in the private domain (homes, private cars). The effects of SHS on the cardiovascular, respiratory and neuropsychic systems, on pregnancy and fertility, on cancers and on SHS genotoxicity are confirmed through experimental human studies and through the relationship between markers and prevalence of disease or of markers of disease risk.

A Comparative Effectiveness Study of Bone Density Changes in Women Over 40 Following Three Bone Health Plans Containing Variations of the Same Novel Plant-sourced Calcium

The US Surgeon General's Report on Bone Health suggests America's bone-health is in jeopardy and issued a "call to action" to develop bone-health plans incorporating components of (1) improved nutrition, (2) increased health literacy, and (3) increased physical activity. To conduct a Comparative Effectiveness Research (CER) study comparing changes in bone mineral density in healthy women over-40 with above-average compliance when following one of three bone health Plans incorporating the SG's three components. Using an open-label sequential design, 414 females over 40 years of age were tested, 176 of whom agreed to participate and follow one of three different bone-health programs. One Plan contained a bone-health supplement with 1,000 IUs of vitamin D(3 )and 750 mg of a plant-sourced form of calcium for one year. The other two Plans contained the same plant form of calcium, but with differing amounts of vitamin D(3) and other added bone health ingredients along with components designed to increase physical activity and health literacy. Each group completed the same baseline and ending DXA bone density scans, 43-chemistry blood test panels, and 84-item Quality of Life Inventory (QOL). Changes for all subjects were annualized as percent change in BMD from baseline. Using self-reports of adherence, subjects were rank-ordered and dichotomized as "compliant" or "partially compliant" based on the median rating. Comparisons were also made between the treatment groups and two theoretical age-adjusted expected groups: a non-intervention group and a group derived from a review of previously published studies on non-plant sources of calcium. There were no significant differences in baseline BMD between those who volunteered versus those who did not and between those who completed per protocol (PP) and those who were lost to attrition. Among subjects completing per protocol, there were no significant differences between the three groups on baseline measurements of BMD, weight, age, body fat and fat-free mass suggesting that the treatment groups were statistically similar at baseline. In all three treatment groups subjects with above average compliance had significantly greater increases in BMD as compared to the two expected-change reference groups. The group following the most nutritionally comprehensive Plan outperformed the other two groups. For all three groups, there were no statistically significant differences between baseline and ending blood chemistry tests or the QOL self-reports. The increases in BMD found in all three treatment groups in this CER stand in marked contrast to previous studies reporting that interventions with calcium and vitamin D(3) reduce age-related losses of BMD, but do not increase BMD. Increased compliance resulted in increased BMD levels. No adverse effects were found in the blood chemistry tests, self-reported quality of life and daily tracking reports. The Plans tested suggest a significant improvement over the traditional calcium and vitamin D(3) standard of care.

Causation in the Presence of Weak Associations

Despite their observational nature, epidemiologic studies have been used to make inductive inferences about the causes of human diseases. In this context, I mainly consider the term “cause” in its cognitive (explanatory) meaning, that is, by detecting causal factors and identifying mechanisms of diseases. The development of a theoretical framework for the establishment of causation in the absence of experimental evidence represents an important conceptual development in the interpretation and explanation of biological phenomena. The framework is based on a combination of convergent lines of evidence, none of which is sufficient per se to establish a cause-effect relationship. The criteria proposed by Hill (1965), which he derived from the list prepared in the US Surgeon General's report Smoking and Health (1964), to interpret the epidemiologic results on lung cancer risk from tobacco smoking, have been used as a paradigm for causation in observational epidemiology. Despite the fact that Hill emphasized th...

Evidence-based policy and practice of physical activity in Australia: Awareness and attitudes of attendees at a national physical activity conference (the PAPPA study)

evidence that regular moderate-intensity physical activity confers substantial health benefits has been available for more than a decade. Recent studies suggest that the availability of evidence is in itself insufficient for the development of evidence-based public policy and that comprehensive translation mechanisms are needed. This paper explores the current sources of information about effective interventions among physical activity professionals, their awareness and uptake of evidence reviews, their use of the national physical activity network AusPANet and their beliefs about evidence-based policy and practice in physical activity. this Physical Activity Policy and Practice in Australia (PAPPA) study reports data from a survey of 115 key physical activity professionals attending the Sixth National Physical Activity Conference in Adelaide, Australia, October 2007. Respondents answered questions about awareness and use of evidence sources and about their beliefs regarding policy and practice in physical activity. only 37% of respondents could accurately identify the main policy messages on 'physical activity and health' as defined in the seminal US Surgeon General's report; 48% reported using the current 'Be Active Australia' national strategic framework on more than two occasions; and just over 35% reported using the most recent national evidence synthesis 'Getting Australia Active II'. the study identifies gaps in knowledge about physical activity and health, gaps in understanding contemporary policy and gaps in translation strategies. Notwithstanding the possible limitations of evidence reviews and syntheses as a determinant of policy and practice, it is apparent that the dissemination of physical activity guidelines and evidence summaries has been less than optimal in Australia.

Evidence based policy and practice of physical activity in Australia: Awareness and attitudes of attendees of a national physical activity conference (the PAPPA study)

Issue addressed: Evidence that regular moderate-intensity physical activity confers substantial health benefits has been available for more than a decade. Recent studies suggest that the availability of evidence is in itself insufficient for the development of evidence-based public policy and that comprehensive translation mechanisms are needed. This paper explores the current sources of information about effective interventions among physical activity professionals, their awareness and uptake of evidence reviews, their use of the national physical activity network AusPANet and their beliefs about evidence-based policy and practice in physical activity. Methods: This Physical Activity Policy and Practice in Australia (PAPPA) study reports data from a survey of 115 key physical activity professionals attending the Sixth National Physical Activity Conference in Adelaide, Australia, October 2007. Respondents answered questions about awareness and use of evidence sources and about their beliefs regarding policy and practice in physical activity. Results: Only 37% of respondents could accurately identify the main policy messages on 'physical activity and health' as defined in the seminal US Surgeon General's report; 48% reported using the current 'Be Active Australia' national strategic framework on more than two occasions; and just over 35% reported using the most recent national evidence synthesis 'Getting Australia Active II'. Conclusions: The study identifies gaps in knowledge about physical activity and health, gaps in understanding contemporary policy and gaps in translation strategies. Notwithstanding the possible limitations of evidence reviews and syntheses as a determinant of policy and practice, it is apparent that the dissemination of physical activity guidelines and evidence summaries has been less than optimal in Australia.

Meta-analysis of epidemiologic studies on cigarette smoking and liver cancer

Whereas the International Agency for Research on Cancer (IARC) Monograph concluded that the evidence for the relationship between cigarette smoking and liver cancer is sufficient, the US Surgeon General's report summarized the data as suggestive but not sufficient. A meta-analysis of previous epidemiologic studies may help to clarify the potential association. We identified 38 cohort studies and 58 case-control studies in a systematic literature search for studies on liver cancer and cigarette smoking. The meta-relative risk (mRR) of liver cancer and dose-response trends were calculated. Tests for heterogeneity, publication bias assessment and influence analyses were performed. Compared with never smokers, the adjusted mRR was 1.51 [95% confidence interval (CI) 1.37-1.67] for current smokers and 1.12 (95% CI 0.78-1.60) for former smokers. The increased liver cancer risk among current smokers appeared to be consistent in strata of different regions, study designs, study sample sizes and publication periods. The results of our meta-analysis show that tobacco smoking is associated with liver cancer development, which supports the conclusion by the IARC Monograph. This conclusion has an important public health message for areas with high smoking prevalence and high liver cancer incidence such as China.

The rise and fall of Australian physical activity policy 1996 – 2006: a national review framed in an international context

BackgroundThis paper provides an historical review of physical activity policy development in Australia for a period spanning a decade since the release of the US Surgeon General's Report on Physical Activity and Health in 1996 and including the 2004 WHO Global Strategy on Diet, Physical Activity and Health. Using our definition of 'HARDWIRED' policy criteria, this Australian review is compared with an international perspective of countries with established national physical activity policies and strategies (New Zealand, Canada, Brazil, Scotland, Switzerland, the Netherlands and Finland). Methods comprised a literature and policy review, audit of relevant web sites, document searches and surveys of international stakeholders.ResultsAll these selected countries embraced multi-strategic policies and undertook monitoring of physical activity through national surveys. Few committed to policy of more than three years duration and none undertook systematic evaluation of national policy implementation. This Australian review highlights phases of innovation and leadership in physical activity-related policy, as well as periods of stagnation and decline; early efforts were amongst the best in the world but by the mid-point of this review (the year 2000), promising attempts towards development of a national intersectoral policy framework were thwarted by reforms in the Federal Sport and Recreation sector. Several well received reviews of evidence on good practices in physical activity and public health were produced in the period but leadership and resources were lacking to implement the policies and programs indicated. Latterly, widespread publicity and greatly increased public and political interest in chronic disease prevention, (especially in obesity and type 2 diabetes) have dominated the framework within which Australian policy deliberations have occurred. Finally, a national physical activity policy framework for the Health sector emerged, but not as a policy vision that was inclusive of the other essential sectors such as Education, Transport, Urban Planning as well as Sport and Recreation.ConclusionDespite some progression of physical activity policy in the decade since 1995/6, this review found inconsistent policy development, both in Australia and elsewhere. Arguably, Australia has done no worse than other countries, but more effective responses to physical inactivity in populations can be built only on sustainable multi-sectoral public health policy partnerships that are well informed by evidence of effectiveness and good practice. In Australia and elsewhere prerequisites for success are political support, long-term investment and commitment to program implementation and evaluation. An urgent priority is media and political advocacy for physical activity focussed on these factors.

Death by Smoking in the UK and Europe and the Protection of the European Court of Human Rights

It would seem that the ammunition for George Bush's new war to safeguard the deaths of Americans started in June 2006 when the US Surgeon General's Report on smoking and health, the first of its kind for around 20 years, gave a surprising and chilling account on the true impact of involuntary, or passive smoking on peoples' lives in America and by implication, worldwide. The research behind the Report found that over 120 million Americans are regular involuntary or passive smokers and over 35,000 of them die each year as a result of this exposure. It confirms that there is no minimum risk-free level of exposure to smoke for non-smokers and that even the slightest exposure is harmful. The Report acknowledges that smoking bans do not cater for private homes where in the USA, one in five children are passive smokers as a result of their parent's smoking in a scenario where young people are particularly at risk of damage. The Surgeon General's personal plea is for the US public to avoid smokers at all costs. Against this conclusive Report, this article examines the relative non-progress of the European Union and the ineffective protection of the European Court of Human Rights in safeguarding European citizens against the biggest preventable hazard to health in Europe and indeed the world.

Tobacco and the health care industry.

The 1964 US Surgeon General's report was the first from the medical profession to document tobacco as a cause of cancers and other serious illnesses. Over the next 40 years, numerous health care groups have worked to decrease tobacco use and lower the associated morbidity and mortality. Registered nurses are the largest group of health care providers and have one of the highest rates of smoking among health care professionals. As such, registered nurses are an important population to target and treat for nicotine addiction. Hospital-based tobacco control programs can provide nurses and other health care professionals with convenient on-site treatment. The chronic care model provides a useful framework for enhancing tobacco control activities and improving outcomes.

Physical activity for people with cardiovascular disease: recommendations of the National Heart Foundation of Australia

To provide physical activity recommendations for people with cardiovascular disease, an Expert Working Group of the National Heart Foundation of Australia in late 2004 reviewed the evidence since the US Surgeon General's Report: physical activity and health in 1996. The Expert Working Group recommends that: people with established clinically stable cardiovascular disease should aim, over time, to achieve 30 minutes or more of moderate intensity physical activity on most, if not all, days of the week; less intense and even shorter bouts of activity with more rest periods may suffice for those with advanced cardiovascular disease; and regular low-to-moderate level resistance activity, initially under the supervision of an exercise professional, is encouraged. Benefits from regular moderate physical activity for people with cardiovascular disease include augmented physiological functioning, lessening of cardiovascular symptoms, enhanced quality of life, improved coronary risk profile, superior muscle fitness and, for survivors of acute myocardial infarction, lower mortality. The greatest potential for benefit is in those people who were least active before beginning regular physical activity, and this benefit may be achieved even at relatively low levels of physical activity. Medical practitioners should routinely provide brief, appropriate advice on physical activity to people with well-compensated, clinically stable cardiovascular disease.

Changing Conclusions on Secondhand Smoke in a Sudden Infant Death Syndrome Review Funded by the Tobacco Industry

Changing Conclusions on Secondhand Smoke in a Sudden Infant Death Syndrome Review Funded by the Tobacco Industry

The Surgeon General's report on smoking and health 40 years later: still wandering in the desert

January 11, 2004, marks the 40th anniversary of the US Surgeon General's report on smoking and health. The unequivocal conclusion that cigarettes cause lung cancer and other diseases was to have ended a debate that had raged for decades (figure 1).1–5

Physical activity and its impact on health outcomes. Paper 1: The impact of physical activity on cardiovascular disease and all-cause mortality: an historical perspective.

The modern scientific study of physical activity began soon after World War II and focused on the epidemic of cardiovascular disease that was beginning to engulf the Western world. Early 'exercise prescriptions' then specified intense bouts of vigorous activity as the most effective way to maintain cardiovascular fitness and 'heart health'. Doctors and other health professionals then grew concerned that progressively fewer individuals were heeding this advice at a time when physical activity from manual work was becoming less common. Evidence was also emerging in the late 1980s that the value of accumulated, moderately intense activities, now of increasing importance during leisure time, may have been overlooked, or at least underplayed, in the prevention of heart disease, diabetes and some cancers. Perhaps in population terms adherence to moderate 'lifestyle' activities would be better than to the earlier vigorous recommendations. Social policy therefore shifted in the United States in 1996; the US Surgeon General's report set out the basic public health message of '30 min of moderate activity five, and preferably all, days of the week'. This recommendation was broadly adopted throughout much of the Western world. How this change in health strategy might impact on unhealthy weight gain and the growing obesity epidemic was given little attention. Here we examine how post-war public health policy in physical activity developed in an attempt primarily to prevent cardiovascular disease. In the following article we examine why too little attention may have been given to unhealthy weight gain and investigate how this may have happened. Then we consider how much physical activity--and of what kind--is needed to prevent unhealthy weight gain.

Physical activity and health-related quality of life in liver transplant recipients.

The US Surgeon General's Report on Physical Activity and Health recommends that people of all ages engage in regular physical activity, and that significant health benefits can be obtained through a moderate amount of physical activity. Physical activity appears to improve health-related quality of life (HRQOL) by enhancing physical functioning in persons compromised by poor health. The Medical Outcomes Study Short Form-36 (SF-36) Health Status Questionnaire was sent to all patients who were 5 years or more post-liver transplantation at the University of California at San Francisco. Additional questions related to coexisting medical conditions and participation in regular physical activity were included. SF-36 scale scores were compared between active and inactive patients. Regression analysis was also performed to determine the contributions of coexisting medical conditions and physical activity to the physical scales of the SF-36 questionnaire. Patients who participated in regular physical activity had significantly higher scores on all physical scales and the physical component scale (PCS). The regression model, which included age, sex, time posttransplantation, retransplantation, recurrence of hepatitis C, number of comorbid conditions, and physical activity participation showed that both the number of comorbid conditions and participation in physical activity were significant independent contributors to the physical functioning scale and PCS. This study indicates that physical activity is related to HRQOL after liver transplantation independent of other coexisting medical conditions.

FUNCTIONAL FITNESS DIFFERENCES BETWEEN SEDENTARY AND PHYSICALLY ACTIVE OLDER ADULTS

1906 Recently, the US Surgeon General's Report on Physical Activity and Health and the World Health Organization Guidelines for Physical Activity in Older Persons have endorsed the importance of regular physical activity as an integral part of healthy aging. Both reports stress that regular physical activity is associated with (1) a reduction in risk factors for many chronic diseases, and (2) the preservation of functional independence in old age. While extensive research has examined differences in health status between active and sedentary seniors, relatively less is known about the relationship between activity and functional status in older adults. In this study, a 9 item Functional Fitness Test (FFT) battery was used to assess differences in functional status between 42 physically active (PA; age range 60-84; 24 m, 18 f) and 37 sedentary older adults (SED; age range 60-85; 17 m, 20 f). The following dimensions of Functional Fitness were assessed; (1) Flexibility (Sit& Reach, Scratch, Raising Arms), (2) Agility/Balance (Timed Up & Go, One-Leg Balance), (3) Muscle Strength & Endurance (Arm Curl, Chair Stand), and (4) Aerobic Endurance (Step-in-Place, 9-Minute Walk). The PA group participants had been exercising three times weekly for at least 8 months, whereas, the SED group reported no regular physical activity. Between group analysis of variance revealed significant differences between PA and SED for all aspects of functional fitness with the exception of flexibility. Specifically, active seniors were more agile and exhibited superior balance, they had greater upper and lower body muscle strength, and they had greater aerobic endurance. Surprisingly, no differences in any of the three flexibility measures were found between the active and sedentary groups. Our data suggest that regular physical activity is associated with significant functional benefits in most dimensions of functional fitness.

Does physical activity enhance health?

This paper provides the justification of physical activity promotion for health by critically reviewing the recent US Surgeon General's Report. Evidence is summarized of the effects of physical activity on physiological responses, overall mortality, a number of diseases and disabilities, overall functional capacity, and mental health and quality of life. Cumulating evidence suggests that the effects be applicable to both genders and to a wide age range. The adverse effects of physical activity on health are shown to be small and mostly preventable. It is emphasized that substantial health effects can be gained by moderate daily physical activity which does not require high skill level nor specialized equipment or facilities. It is concluded that the health potential of physical activity is substantial due to the high prevalence of inactive lifestyle in the populations, the great number of health conditions being affected by physical activity, and the feasibility and safety of physical activity as a health measure.

Draft of Report on Secondhand Smoke Released

THE CALIFORNIA Environmental Protection Agency (EPA) has released for public comment a final draft of its report on the health effects of environmental tobacco smoke (ETS). The report, prepared by a number of California health experts, is the first comprehensive review of the health hazards of secondhand smoke since the 1986 US Surgeon General's Report. According to the report's executive summary, scientific knowledge about the health effects of ETS has expanded considerably since the release of the Surgeon General's report and studies by the US EPA and the National Research Council. "The State of California has therefore undertaken a broad review of ETS, covering the major health end points potentially associated with ETS exposure: perinatal and postnatal manifestations of developmental toxicity, adverse impacts on male and female reproduction, respiratory disease, cancer, and cardiovascular disease," the summary said. The report, entitled<i>Health Effects of Exposure to Environmental Tobacco Smoke: Final Draft</i>

Increasing physical activity participation in NSW

Physical activity has recently become a prominent topic in NSW, boosted by the pre-Olympic fervour, and the recently published US Surgeon General's Report on physical activity and health (1996). Physical activity has always been a part of human lifestyle, but in recent decades, sedentariness has become the norm for the adult population.

Treating tobacco dependence

The 1988 US Surgeon General's Report entitled Nicotine Addiction reviewed the mass of evidence on the role of nicotine in tobacco consumption and came to three main conclusions, shown in Box 1.

The role of nicotine in tobacco use

The 1988 US Surgeon General's Report titled "Nicotine Addiction", is cited frequently in the literature as having established the "fact" that nicotine derived from cigarette smoke is addictive in the same sense as "classic" addicting drugs such as heroin and cocaine. This manuscripts critically evaluates key research findings used in support of this claim and identifies shortcomings in the data that seriously question the logic of labeling nicotine as "addictive". In addition, the manuscript argues that the role of nicotine in tobacco use is not like the role of cocaine in coca leaf use as argued by the 1988 Surgeon General's Report, but is, in fact, more like the role of caffeine in coffee drinking as concluded in the 1964 US Surgeon General's Report.