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Background
Smoking and other forms of tobacco use affect virtually every organ system.1–3 To see the range of effects one only needs to consider the chapter titles for the 2010 Report of the Surgeon General, How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease3: The Changing Cigarette, Chemistry and Toxicology of Cigarette Smoke and Biomarkers of Exposure and Harm, Nicotine Addiction, Cancer, Cardiovascular Diseases, Pulmonary Diseases, Reproductive and Developmental Effects. The National Institutes of Health (NIH), particularly the National Cancer Institute (NCI), the National Heart Lung and Blood Institute (NHLBI) and the National Institute on Drug Abuse (NIDA) have supported extramural, and conducted intramural, research that has built the knowledge base that led to the conclusions in this report. They have also developed population-based and clinical interventions which have fuelled the extraordinary reductions in tobacco-induced disease which we have experienced in the USA over the past half-century. Recognising that smoking kills more people through heart, lung and vascular disease than cancer,4 the NHLBI has recently increased its efforts to contribute to the ongoing development of the knowledge base to reduce smoking.5 Since 2002, the NIH Fogarty International Center, in collaboration with other NIH institutes, has built international tobacco and health research capacity by supporting transdisciplinary research in low- and middle-income countries.6
Tobacco control at NCI is fully integrated into the infrastructure within NCI in complex ways, as it should be, because tobacco use causes nearly one-third of all cancer deaths. The Tobacco Control Branch has contributed to reducing the cancer burden of our nation. The Branch is a complex integrated transdisciplinary programme, that has been developed over a quarter century, and embedded within the NCI structure in a manner difficult to replicate elsewhere (eg, in a new institute) …