Steven Stellman - Tobacco smoking, cancer and social class

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      Publication Details (including relevant citation   information):

      Stellman, S. D., Resnicow, K. (138) 229-50-

      Abstract: Consumption of tobacco products, both   by smoking and by other means, has long been causally connected   with cancers of the lung, larynx, mouth and pharynx, oesophagus,   bladder, and many other sites. Tobacco is the main specific   contributor to total mortality in many developed countries and   has become a major contributor in the developing countries as   well. In most industrialized countries, prevalence of cigarette   smoking is currently higher in low than in high social classes,   although in some industrialized countries smoking was more   frequent in high social classes during the first half of this   century. The latter pattern of tobacco consumption is more likely   to apply to developing countries. To formulate and carry out   effective tobacco control activities it is essential to assess   the relative incidence of tobacco-related cancers in different   social strata and the prevalence of tobacco use across strata.   Despite many years of data gathering the information base is far   from complete, especially in developing countries where tobacco   use is increasing rapidly, and where aggressive marketing by the   transnational tobacco industry is occurring. A critical question   is the extent to which tobacco usage can 'explain' the observed   social class differences in cancer risk. Class differences in   lung cancer are likely to be mostly related to the unequal   distribution of tobacco smoking between social classes, and in   some fairly simple situations this has been satisfactorily   demonstrated. Nevertheless, there are many unresolved issues,   especially with regard to the role of collateral exposures, such   as hazardous occupations, poor diet, and limited access to health   care. The question of whether tobacco use 'explains'   socioeconomic differences in one or more of the cancers that it   causes has rarely been directly addressed in epidemiological   studies.

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