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吸烟是美国当前存在的一项最大和可以防止的公卫问题。估计每年约有350,000人死亡(占美国死亡总数的1/6)是由于吸烟习惯而造成的。无论是口咀还是抽吸的烟草,都是美洲印第安人介绍给欧洲移民的,当时抽烟是革命美洲主要致富作物之一。十九世纪80年代烟卷机问世,烟草消费发生了明显的改变,由以烟斗、雪茄和咀嚼(烟叶)为主转变成香烟为主。美国每人香烟消费量,从1900年的54增至1963年的4336。消费动向向香烟急剧转变后约20～25年,出现了同样势头的肺癌死亡率的急剧上升,使得早年的一些研究报告肯定它与吸烟有关。吸烟的危险性看来与吸入的烟量密切有关。只抽烟斗和雪茄的人,往往并未将烟真正吸进,因此对健康的威胁主要与香烟的消费有关(表16-1)。本世纪初,吸烟主要是男子,但到30年代末和40年代初,妇女也开始大量吸烟。现在在青年人中,男女吸烟人数已不相上下。1980年美国成人
Smoking is one of the largest and preventable public health problems in the United States. It is estimated that about 350,000 people die each year (about one sixth of all deaths in the United States) due to smoking habits. Both mouth-opening and smoking tobacco were introduced by the Native American to European immigrants when smoking was one of the major crops of production in the revolutionary Americas. The advent of tobacco rolls in the 1980s led to a marked change in tobacco consumption, with tobacco, cigars and chewing (tobacco) predominantly converted to cigarettes. The consumption of cigarettes per person in the United States increased from 54 in 1900 to 4336 in 1963. Consumer trends Toward 20 to 25 years after a drastic change in cigarettes, the same dramatic increase in lung cancer deaths has occurred, making some early years of research certain that it is linked to smoking. The risk of smoking appears to be closely related to the amount of smoke inhaled. People who smoke only pipes and cigars often do not breathe in, so the threat to health is mainly related to the consumption of cigarettes (Table 16-1). Smoking was predominantly male at the turn of the century, but by the late 1930s and early 1940s women were also smoking heavily. Now among young people, the number of men and women who smoke is comparable. 1980 American adult