Jonathan M Samet

Keck School of Medicine USC, Los Ángeles, California, United States

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Publications (657)

  • Seri Hong · Yejin Mok · Christina Jeon · [...] · Jonathan M. Samet
    [Show abstract] [Hide abstract] ABSTRACT: Among the exposures associated with risk for lung cancer, a history of tuberculosis is one potentially important factor, given the high prevalence of tuberculosis worldwide. A prospective cohort study was conducted to evaluate the associations of preexisting pulmonary tuberculosis with lung cancer incidence and mortality. The cohort consisted of 1,607,710 Korean adults covered by the National Health Insurance System who had a biennial national medical examination during 1997-2000. During up to 16 years of follow-up, there were 12,819 incident cases of lung cancer and 9,562 lung cancer deaths. Using Cox proportional hazards models and controlling for age, cigarette smoking and other covariates, the presence of underlying tuberculosis was significantly associated with increased risk for lung cancer incidence (HR 1.37 in men with 95% CI 1.29–1.45; HR 1.49 in women with 95% CI 1.28–1.74) and mortality (HR 1.43 in men with 95% CI 1.34–1.52; HR 1.53 in women with 95% CI 1.28–1.83). We also observed a dose-response relationship between number of cigarettes smoked daily and lung cancer risk. There was no evidence for synergism between a history of tuberculosis and smoking. The elevation in risk is relatively modest, particularly in comparison to that from smoking, and a prior history of TB is not likely to be useful risk indicator for clinical purposes. In populations with high prevalence of tuberculosis, it can be considered for incorporation into models for lung cancer risk prediction. This article is protected by copyright. All rights reserved.
    Article · Aug 2016 · International Journal of Cancer
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Adolescent e-cigarette use has increased rapidly in recent years, but it is unclear whether e-cigarettes are merely substituting for cigarettes or whether e-cigarettes are being used by those who would not otherwise have smoked. To understand the role of e-cigarettes in overall tobacco product use, we examine prevalence rates from Southern California adolescents over 2 decades. Methods: The Children's Health Study is a longitudinal study of cohorts reaching 12th grade in 1995, 1998, 2001, 2004, and 2014. Cohorts were enrolled from entire classrooms in schools in selected communities and followed prospectively through completion of secondary school. Analyses used data from grades 11 and 12 of each cohort (N = 5490). Results: Among 12th-grade students, the combined adjusted prevalence of current cigarette or e-cigarette use in 2014 was 13.7%. This was substantially greater than the 9.0% adjusted prevalence of current cigarette use in 2004, before e-cigarettes were available (P = .003) and only slightly less than the 14.7% adjusted prevalence of smoking in 2001 (P = .54). Similar patterns were observed for prevalence rates in 11th grade, for rates of ever use, and among both male and female adolescents and both Hispanic and Non-Hispanic White adolescents. Conclusions: Smoking prevalence among Southern California adolescents has declined over 2 decades, but the high prevalence of combined e-cigarette or cigarette use in 2014, compared with historical Southern California smoking prevalence, suggests that e-cigarettes are not merely substituting for cigarettes and indicates that e-cigarette use is occurring in adolescents who would not otherwise have used tobacco products.
    Article · Jul 2016 · Pediatrics
  • Beth L. Pineles · Sarah Hsu · Edward Park · Jonathan M. Samet
    [Show abstract] [Hide abstract] ABSTRACT: We conducted a systematic review and 3-part meta-analysis to characterize the relationship between smoking and perinatal death, defined as the combination of stillbirth and neonatal death. The PubMed database was searched (1956–August 31, 2011) with keywords, and manual reference searches of included articles and Surgeon Generals' reports were conducted. The full texts of 1,713 articles were reviewed, and 142 articles that examined the associations between active or passive smoking and perinatal death were included in the meta-analyses. Data were abstracted by 2 reviewers. Any active maternal smoking was associated with increased risks of stillbirth (summary relative risk (sRR) = 1.46, 95% confidence interval (CI): 1.38, 1.54 (n = 57 studies)), neonatal death (sRR = 1.22, 95% CI: 1.14, 1.30 (n = 28)), and perinatal death (sRR = 1.33, 95% CI: 1.25, 1.41 (n = 46)). The risks of stillbirth, neonatal death, and perinatal death increased with the amount smoked by the mother. Biases in study publication, design, and analysis were present but did not significantly affect the results. These findings strengthen the evidence that women should not smoke while pregnant, and all women of reproductive age should be warned that smoking increases the risks of stillbirth, neonatal death, and perinatal death.
    Article · Jul 2016 · American Journal of Epidemiology
  • Mellissa Withers · David Press · Heather Wipfli · [...] · Jonathan Samet
    [Show abstract] [Hide abstract] ABSTRACT: Background Finding solutions to global health problems will require a highly-trained, inter-disciplinary workforce. Global health education and research can potentially have long-range impact in addressing the global burden of disease and protecting and improving the health of the global population. Methods We conducted an online survey of twelve higher education institutions in the Pacific Rim that spanned the period 2005–2011. Program administrators provided data on program concentrations, student enrollment and student funding opportunities for 41 public health programs, including those specific to global health. Results The Master of Public Health (MPH) was the most common degree offered. A growing demand for global health education was evident. Enrollment in global health programs increased over three-fold between 2005–2011. Very few institutions had specific global health programs or offered training to undergraduates. Funding for student scholarships was also lacking. Conclusions The growing demand for global health education suggests that universities in the Pacific Rim should increase educational and training opportunities in this field. Schools of medicine may not be fully equipped to teach global health-related courses and to mentor students who are interested in global health. Increasing the number of dedicated global health research and training institutions in the Pacific Rim can contribute to building capacity in the region. Faculty from different departments and disciplines should be engaged to provide multi-disciplinary global health educational opportunities for undergraduate and graduate students. New, innovative ways to collaborate in education, such as distance education, can also help universities offer a wider range of global health-related courses. Additional funding of global health is also required.
    Article · Jun 2016 · Globalization and Health
  • Jonathan M. Samet · Hossein Bahrami · Kiros Berhane
    Article · Jun 2016 · Circulation
  • [Show abstract] [Hide abstract] ABSTRACT: Background: There has been little research examining whether e-cigarette use increases the risk of cigarette initiation among adolescents in the transition to adulthood when the sale of cigarettes becomes legal. Methods: The Children's Health Study is a prospectively followed cohort in Southern California. Data on e-cigarette use were collected in 11th and 12th grade (mean age = 17.4); follow-up data on tobacco product use were collected an average of 16 months later from never-smoking e-cigarette users at initial evaluation (n = 146) and from a sample of never-smoking, never e-cigarette users (n = 152) frequency matched to e-cigarette users on gender, ethnicity, and grade. Results: Cigarette initiation during follow-up was reported by 40.4% of e-cigarette users (n = 59) and 10.5% of never users (n = 16). E-cigarette users had 6.17 times (95% confidence interval: 3.30-11.6) the odds of initiating cigarettes as never e-cigarette users. Results were robust to adjustment for potential confounders and in analyses restricted to never users of any combustible tobacco product. Associations were stronger in adolescents with no intention of smoking at initial evaluation. E-cigarette users were also more likely to initiate use of any combustible product (odds ratio = 4.98; 95% confidence interval: 2.37-10.4), including hookah, cigars, or pipes. Conclusions: E-cigarette use in never-smoking youth may increase risk of subsequent initiation of cigarettes and other combustible products during the transition to adulthood when the purchase of tobacco products becomes legal. Stronger associations in participants with no intention of smoking suggests that e-cigarette use was not simply a marker for individuals who would have gone on to smoke regardless of e-cigarette use.
    Article · Jun 2016 · Pediatrics
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: One concern regarding the recent increase in adolescent e-cigarette use is the possibility that electronic (e-) cigarettes may be used by those who might not otherwise have used cigarettes, and that dual use, or transition to cigarette use alone, may follow. Methods: Questionnaire data were obtained in 2014 from 11th/12th grade students attending schools in 12 communities included in the Southern California Children's Health Study. We evaluated the cross-sectional association between e-cigarette use, the social environment (family and friends' use and approval of e-cigarettes and cigarettes), and susceptibility to future cigarette use among never cigarette smokers (N = 1,694), using previously validated measures based on reported absence of a definitive commitment not to smoke. Results: Among adolescents who had never used cigarettes, 31.8% of past e-cigarette users and 34.6% of current (past 30-day) e-cigarette users indicated susceptibility to cigarette use, compared with 21.0% of never e-cigarette users. The odds of indicating susceptibility to cigarette use were two times higher for current e-cigarette users compared with never users (odds ratio = 1.97; 95% confidence interval: 1.21-3.22). A social environment favorable to e-cigarettes (friends' use of and positive attitudes toward the use of e-cigarettes) was also associated with greater likelihood of susceptibility to cigarette use, independent of an individual's e-cigarette use. Conclusions: E-cigarette use in adolescence, and a pro-e-cigarette social environment, may put adolescents at risk for future use of cigarettes. E-cigarettes may contribute to subsequent cigarette use via nicotine addiction or social normalization of smoking behaviors.
    Article · May 2016 · Journal of Adolescent Health
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Whether sleep-disordered breathing (SDB) severity and diminished lung function act together to synergistically heighten the risk of adverse health outcomes remains a topic of significant debate. The current study sought to determine whether the association between lower lung function and mortality would be stronger in those with increasing severity of SDB in a community-based cohort of middle-aged and older adults. Methodology: Full montage home sleep testing and spirometry data were analyzed on 6,173 participants of the Sleep Heart Health Study. Proportional hazards models were used to calculate risk for all-cause mortality, with forced expiratory volume in one second (FEV1) and apnea-hypopnea index (AHI) as the primary exposure indicators along with several potential confounders. Results: All-cause mortality rate was 26.9 per 1,000 person-years in those with SDB (AHI > 5 events/hr) and 18.2 per 1,000 person-years in those without (AHI < 5 events/hr). For every 200 mL decrease in FEV1, all-cause mortality increased by 11.0% in those without SDB (HR 1.11, 95% CI 1.08-1.13). In contrast, for every 200 mL decrease in FEV1 all-cause mortality increased by 6.0% in participants with SDB (HR 1.06, 95% CI 1.04-1.09). Additionally, the incremental influence of lung function on all-cause mortality was less with increasing severity of SDB (p-value for interaction between AHI and FEV1: 0.004). Conclusions: Lung function was associated with risk for all-cause mortality. The incremental contribution of lung function to mortality diminishes with increasing severity of SDB.
    Article · Apr 2016 · American Journal of Respiratory and Critical Care Medicine
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    [Show abstract] [Hide abstract] ABSTRACT: Background: Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant-data meta-analyses of the prospective studies of body mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding prior disease and the first 5 years of follow-up. Methods: Of 10,625,411 participants in Asia, Australia/New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 [IQR: 11·4-14·7] years), 3,951,455 in 189 studies were never-smokers without specific chronic diseases at recruitment who survived 5 years, of whom 385,879 died. The primary analyses are of these deaths, using age and sex-adjusted hazard ratios (HRs). Findings: All-cause mortality was minimal (HR=1) at BMI (kg/m^2 ) 20-25, and increased significantly both just below this range (BMI 18·5-<20: HR=1·13, 95%CI 1·09-1·17; BMI 15-<18·5: HR=1·51, 1·43-1·59) and throughout the overweight range just above it (BMI 25-<27·5: HR=1·07, 1·07-1·08; BMI 27·5-<30: HR=1·20, 1·18-1·22). Continuing upwards, HRs for obesity grade I, II, and III (BMI 30-<35, 35-<40, 40-<60) were 1·45 (1·41-1·48), 1·94 (1·87-2.01), and 2·76 (2·60-2·92), respectively. For BMI>25, mortality increased approximately log-linearly with BMI; HR per 5 units higher BMI was 1·31 (1·29-1·33) in all regions; 1·39 (1·35-1·43) in Europe; 1·29 (1·26-1·32) in North America, 1·39 (1·34-1·44) in East Asia, and 1.31 (1.27, 1.35) in Australia/New Zealand. This HR per 5 units higher BMI (for BMI>25) was greater in younger than older people (1.52 at 35–49 years vs 1·21 at 70-89 years; P heterogeneity <0·0001), greater in men than women (1·51 vs 1·30; P heterogeneity <0·0001), but similar in studies with self-reported and measured BMI. Interpretation: The associations of both overweight and obesity wit h higher all-cause mortality were broadly consistent in four continents. This supports strategies to combat the entire spectrum of excess adiposity in many populations.
    Full-text Article · Apr 2016
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    Jonathan Samet · Mellissa Withers
    [Show abstract] [Hide abstract] ABSTRACT: The Association of Pacific Rim Universities (APRU) is an international consortium of 45 universities in the Pacific Rim, representing 16 economies, 130 000 faculty members and more than two million students. The APRU Global Health Program aims to expand existing collaborative research efforts among universities to address regional and global health issues. Since its launch in 2007–08, the program has covered a significant range of topics including emerging public health threats, ageing and chronic diseases, infectious diseases and health security issues, among others. The Program’s activities in research, training, and service around the globe illustrate the diverse dimensions of global health. In this paper, the major activities to date are outlined and future planned activities are discussed.
    Full-text Article · Apr 2016 · Journal of Epidemiology
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    Dataset: eFigure 1.
    Jonathan Samet · Mellissa Withers
    [Show abstract] [Hide abstract] ABSTRACT: Group picture of the 2015 Global Health Workshop of APRU attendees.
    Full-text Dataset · Apr 2016
  • Jonathan M. Samet
    [Show abstract] [Hide abstract] ABSTRACT: In this article, I provide a perspective on the tobacco epidemic and epidemiology, describing the impact of the tobacco-caused disease epidemic on the field of epidemiology. Although there is an enormous body of epidemiologic evidence on the associations of smoking with health, little systematic attention has been given to how decades of research have affected epidemiology and its practice. I address the many advances that resulted from epidemiologic research on smoking and health, such as demonstration of the utility of observational designs and important parameters (the odds ratio and the population attributable risk), guidelines for causal inference, and systematic review approaches. I also cover unintended and adverse consequences for the field, including the strategy of doubt creation and the recruitment of epidemiologists by the tobacco industry to serve its mission. The paradigm of evidence-based action for addressing noncommunicable diseases began with the need to address the epidemic of tobacco-caused disease, an imperative for action documented by epidemiologic research.
    Article · Feb 2016 · American Journal of Epidemiology
  • Smita Pakhale · Jonathan Samet · Patricia Folan · [...] · Alexander White
    [Show abstract] [Hide abstract] ABSTRACT: On November 10th, 2015, the United States Food and Drug Administration (FDA) approved for the first time, the sale of smokeless tobacco products authorized under the new premarket tobacco application pathway. This FDA regulatory decision draws attention to growing worldwide use of smokeless tobacco products in general. Use of these tobacco products is particularly popular in low- and middle-income countries of Asia. Due to aggressive and strategic marketing to children, young adults and current smokers, rates of smokeless tobacco use in men of all ages are on the rise in US and elsewhere. The tobacco industry also continues to market these products to current cigarette smokers for use in the growing number of 'smoke-free environments'. Smokeless tobacco products are associated with cancers of the upper aero-digestive tract, particularly the oral cavity, esophagus and pancreas, cardiovascular diseases, small-for-gestational-age infants, premature births, increased risk of apnea and stillbirth. There is no convincing evidence regarding the efficacy of smokeless tobacco, including snus, to promote smoking cessation. Rather, studies from Europe and the US demonstrate that smokeless tobacco use may facilitate regular cigarette smoking by acting as a gateway drug, especially for children. Caution is warranted before proposing smokeless tobacco as a harm-reduction strategy in part because of the potential for further promoting smokeless tobacco in low- and middle-income countries where use is already widespread. Continued vigilance through comprehensive surveillance is warranted. We strongly recommend use of graphic warning labels as a "no regrets" strategy for all smokeless tobacco products marketed globally.
    Article · Jan 2016 · Annals of the American Thoracic Society
  • Yong S. Chung · Jonathan M. Samet
    Article · Jan 2016 · Air Quality Atmosphere & Health
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: Using nationwide cancer incidence data, we examined whether the strength of the association of cigarette smoking with lung cancer risk differs according to major histological type and gender, taking account of other risk factors in the Korean population. Methods: The study population derived from government employees and teachers aged 20 years and over who participated in a national health examination program in 1998 or 1999. Total study subjects were 1,357,447. After excluding 1556 subjects who were treated with lung cancer during 1998-2000, we restricted our analysis to 1,355,891 cases. We followed up those 1,355,891 subjects who were cancer-free at baseline until December 31, 2010. The incident cancer cases were identified from the Korea Central Cancer Registry, which is a nationwide hospital-based cancer registry system that includes 94 % of the university hospitals and 96 % of the resident training hospitals of the country. Results: A higher risk for having ever smoked was observed for squamous-cell and small-cell carcinoma in both men and women. Heavy and long-term smokers were at higher risk for these carcinomas. Significant associations with quantity and duration-related factors were observed mainly among men. These findings indicate that smoking is closely related to the risk of squamous-cell and small-cell carcinoma among women as well as men. However, the magnitude of smoking-related lung cancer risk is likely to differ between men and women. Conclusion: The hazard ratios for all types of lung cancer were significantly higher in male current smokers than in male never smokers. In case of women, the hazard ratios for adenocarcinoma were not different between current smokers and never smokers. The hazard ratios we found, however, were lower than those reported in Western countries and in Korea, but consistent with those reported in North-eastern Asian countries.
    Article · Dec 2015 · Beiträge zur Klinik der Tuberkulose
  • Heather L Wipfli · Jonathan Samet
    [Show abstract] [Hide abstract] ABSTRACT: Much has been learned about the tobacco epidemic, including its consequences, effective measures to control it, and the actors involved. This article identifies lessons learned that are applicable to the other principal external causes of noncommunicable diseases: alcohol abuse, poor nutrition, and physical inactivity. Among these lessons are the development of evidence-based strategies such as proven cessation methods, tax increases, and smoke-free policies; the role of multinational corporations in maintaining markets and undermining control measures; and the need for strategies that reach across the life course and that begin with individuals and extend to higher levels of societal organization. Differences are also clear. Tobacco products are relatively homogeneous and have no direct benefit to consumers, whereas food and alcohol consumed in moderation are not inherently dangerous. Some tobacco-related diseases have the singular predominant cause of smoking, while many noncommunicable diseases have multiple interlocking causes such as poor diet, excess alcohol consumption, insufficient physical activity, and smoking, along with genetics. Thus, the tobacco control model of comprehensive multilevel strategies is applicable to the control of noncommunicable diseases, but the focus must be on multiple risk factors.
    Article · Sep 2015 · Health Affairs
  • Jonathan M Samet · David Coultas · Ganesh Raghu
    Article · Sep 2015 · European Respiratory Journal
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    [Show abstract] [Hide abstract] ABSTRACT: Exposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco. To evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah). Longitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections. Student self-report of whether he or she ever used e-cigarettes (yes or no) at baseline. Six- and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3). Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% CI, 16.4%-28.9%]) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio [OR], 4.27 [95% CI, 3.19-5.71]) and in the analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR, 2.73 [95% CI, 2.00-3.73]). Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette (OR, 2.65 [95% CI, 1.73-4.05]), cigar (OR, 4.85 [95% CI, 3.38-6.96]), and hookah (OR, 3.25 [95% CI, 2.29-4.62]) use and with the number of different combustible products used (OR, 4.26 [95% CI, 3.16-5.74]) averaged across the 2 follow-up periods. Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year. Further research is needed to understand whether this association may be causal.
    Full-text Article · Aug 2015 · JAMA The Journal of the American Medical Association
  • [Show abstract] [Hide abstract] ABSTRACT: Background Several lifestyle and environmental exposures have been suspected as risk factors for oral clefts, although few have been convincingly demonstrated. Studies across global diverse populations could offer additional insight given varying types and levels of exposures. Methods We performed an international case-control study in the Democratic Republic of the Congo (133 cases, 301 controls), Vietnam (75 cases, 158 controls), the Philippines (102 cases, 152 controls), and Honduras (120 cases, 143 controls). Mothers were recruited from hospitals and their exposures were collected from interviewer-administered questionnaires. We used logistic regression modeling to estimate odds ratios (OR) and 95% confidence intervals (CI). ResultsFamily history of clefts was strongly associated with increased risk (maternal: OR = 4.7; 95% CI, 3.0-7.2; paternal: OR = 10.5; 95% CI, 5.9-18.8; siblings: OR = 5.3; 95% CI, 1.4-19.9). Advanced maternal age (5 year OR = 1.2; 95% CI, 1.0-1.3), pregestational hypertension (OR = 2.6; 95% CI, 1.3-5.1), and gestational seizures (OR = 2.9; 95% CI, 1.1-7.4) were statistically significant risk factors. Lower maternal (secondary school OR = 1.6; 95% CI, 1.2-2.2; primary school OR = 2.4, 95% CI, 1.6-2.8) and paternal education (OR = 1.9; 95% CI, 1.4-2.5; and OR = 1.8; 95% CI, 1.1-2.9, respectively) and paternal tobacco smoking (OR = 1.5, 95% CI, 1.1-1.9) were associated with an increased risk. No other significant associations between maternal and paternal factors were found; some environmental factors including rural residency, indoor cooking with wood, chemicals and water source appeared to be associated with an increased risk in adjusted models. Conclusion Our study represents one of the first international studies investigating risk factors for clefts among multiethnic underserved populations. Our findings suggest a multifactorial etiology including both maternal and paternal factors. Birth Defects Research (Part A) 103:863-879, 2015. (c) 2015 The Authors Birth Defects Research Part A: Clinical and Molecular Teratology Published by Wiley Periodicals, Inc.
    Article · Aug 2015 · Birth Defects Research Part A Clinical and Molecular Teratology
  • [Show abstract] [Hide abstract] ABSTRACT: Since the mid-20th century, the scientific community has substantially improved its understanding of the worldwide tobacco epidemic. Although significant progress has been made, the sheer enormity and scope of the global problem put it on track to take a billion lives this century. Curbing the epidemic will require maximizing the impact of proven tools as well as the development of new, breakthrough methods to help interrupt the spread of nicotine addiction and reduce the downstream morbidity. Members of the Tobacco Action Committee of the American Thoracic Society queried bibliographic databases, including Medline, Embase, and the Cochrane Collaborative, to identify primary sources and reviews relevant to the epidemic. Exploded search terms were used to identify evidence, including tobacco, addiction, smoking, cigarettes, nicotine, and smoking cessation. Evidence was consolidated into three thematic areas: (1) determinants of risk, (2) maternal-fetal exposure, and (3) current tobacco users. Expert panel consensus regarding current gaps in understanding and recommendations for future research priorities was generated through iterative discussion. Although much has been accomplished, significant gaps in understanding remain. Implementation often lags well behind insight. This report identifies a number of investigative opportunities for significantly reducing the toll of tobacco use, including: (1) the need for novel, nonlinear models of population-based disease control; (2) refinement of "real-world" models of clinical intervention in trial design; and (3) understanding of mechanisms by which intrauterine smoke exposure may lead to persistent, tobacco-related chronic disease. In the coming era of tobacco research, pooled talent from multiple disciplines will be required to further illuminate the complex social, environmental and biological codeterminants of tobacco dependence.
    Article · Aug 2015 · American Journal of Respiratory and Critical Care Medicine

Publication Stats

41k Citations


  • 2015
    • Keck School of Medicine USC
      Los Ángeles, California, United States
    • University of Southern California
      • Department of Preventive Medicine
      Los Ángeles, California, United States
    • University of California, Los Angeles
      Los Ángeles, California, United States
  • 1996-2011
    • Johns Hopkins Bloomberg School of Public Health
      • • Department of Biostatistics
      • • Department of Epidemiology
      Baltimore, Maryland, United States
  • 2007
    • University of Ottawa
      Ottawa, Ontario, Canada
  • 2006
    • Boston College, USA
      Boston, Massachusetts, United States
  • 2005-2006
    • Yonsei University
      • Graduate School of Public Health
      Seoul, Seoul, South Korea
  • 2004-2006
    • Yale University
      • School of Forestry and Environmental Studies
      New Haven, Connecticut, United States
    • University of Florida
      • Department of Statistics
      Gainesville, FL, United States
  • 1995-2006
    • Johns Hopkins University
      • • Department of Biostatistics
      • • Department of Epidemiology
      Baltimore, MD, United States
    • University of Adelaide
      Tarndarnya, South Australia, Australia
  • 2003
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2002
    • Boston University
      Boston, Massachusetts, United States
  • 2001
    • Emory University
      • Department of Environmental and Occupational Health
      Atlanta, Georgia, United States
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2000
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 1999
    • University of North Carolina at Chapel Hill
      North Carolina, United States
  • 1998
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States
  • 1984-1995
    • Albuquerque Academy
      Albuquerque, New Mexico, United States
  • 1994
    • University of Texas Medical Branch at Galveston
      Galveston, Texas, United States