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Chapter 30: Epidemiology of Smoking and Pathophysiology of Cardiovascular Damage

At its peak in the 1960s, what proportion of the United States population consumed cigarettes?

A. 35%

B. 45%

C. 55%

D. 65%

E. 75%

The answer is B. (Hurst’s The Heart, 14th Edition, Chap. 30) Although the Surgeon General’s report in 1957 concluded that cigarette smoking is associated with an increased risk of lung cancer, it was not until publication of the landmark 1964 Surgeon General’s report that the adverse relationship between cigarette smoking and cardiovascular disease was seriously recognized. The Surgeon General’s report concluded that cigarette smoking is strongly associated with myocardial infarction and coronary heart disease deaths, and it laid the foundation for tobacco control.1 Unfortunately, health care providers, professional societies, civic bodies, and governments have also played negative or timid roles, largely attributed to the smoking industry’s exploitation of the natural skepticism and probabilistic nature inherent in scientific evidence, serious conflicts of interest, and lack of a strong public will. Smoking has claimed more than 20 million lives with premature deaths in the United States alone since the publication of the 1964 report. The annual per capita cigarette consumption in the United States was at its peak in the early 1960s, with a prevalence smoking of about 45% of the population in 1965 (option B). Through concerted efforts over more than half a century, the cigarette consumption in the United States has declined to half of its peak prevalence rates—to about 18% in 2012.2 Multiple factors, including an improved understanding of the adverse effects of secondhand smoke, policy measures such as a ban on broadcast advertising, increased public awareness, and the increase in cigarette taxes have contributed to this epidemiological transition. Despite years of progress, cigarette smoking remains the leading cause of preventable cardiovascular morbidity and mortality across the globe.

What proportion of the world’s 1 billion smokers are male?

A. 50%

B. 60%

C. 70%

D. 80%

E. 90%

The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 30) Globally, about 1 billion individuals smoke. The majority (about 800 million) are males (80%, option D). Although the prevalence of smoking has declined over the past few decades, the total number of smokers has increased globally owing to population growth. The worldwide prevalence of smoking is highly variable by country and region, suggesting a heavy influence of socio­economic and cultural currents as well as national ...

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