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Searching for Answers in a Sea of Change

Thomas Houston, MD; Nancy J. Kaufman, RN, MS

JAMA. 2000;284:752-753.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The past century has witnessed dramatic changes in all aspects of life, from the Wright brothers to the space shuttle; from the telegraph to e-mail; from house calls to robotic surgery. In matters of health, the 20th century brought increased life expectancy, dramatic shifts in basic public health practice, and shifts in morbidity and mortality away from communicable and infectious disease. In developed nations, chronic illnesses, often attributable to lifestyle factors, have become major sources of ill health and premature death. And for all the health benefits realized during the 20th century, a manmade plague beset society—tobacco use.

Tobacco is the leading contributor to mortality in the United States,¹ each year claiming more than 430,000 direct users² and between 40,000 and 67,000 individuals who are exposed to environmental tobacco smoke.³ By comparison, in 1965, an estimated 183,000 deaths were attributed to tobacco.⁴ . . . [Full Text of this Article]

Author Affiliations: Science and Public Health Advocacy, American Medical Association, Chicago, Ill (Dr Houston); and The Robert Wood Johnson Foundation, Princeton, NJ (Ms Kaufman).

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