Quick reaction to new Surgeon General report

I am in DC for the press conference where the report will be presented.  Here are some quick reactions, based on the Executive Summary:

It highlights the importance of smoking in the movies as a cause of smoking and concludes that “Actions [i.e., R rating onscreen smoking] that would eliminate the depiction of tobacco use in movies, which are produces and rated as appropriate for children and adolescents, could have a significant effect on preventing youth from becoming tobacco users.”

It estimates that 5.6 million adolescents alive today will die prematurely due to smoking.  Given that an R-rating would cut youth smoking by 18%, this means that an R rating would save 1 million lives among those kids (my calculation).
 
It highlights the importance of cardiovascular disease.  Cardiovascular and metabolic disease accounted for half the 20.8 million smokers active and passive smoking killed since 1964.  This is important because, unlike cancer, the risks of smoking and passive smoking change rapidly when someone starts or stops smoking or being exposed to secondhand smoke (Table 1).  It concludes that heart attacks drop rapidly when smokefree laws are passed and enforced.
 
While the report only scores that the evidence is “suggestive” that smoking and secondhand smoke cause breast cancer (the California Environmental Protection Agency concluded that secondhand smoke caused breast cancer in younger women in 2005), this is still an important conclusion.  The Surgeon General is essentially saying that he is “pretty sure” that smoking and passive smoking cause breast cancer.   Women do not need to wait until the Surgeon General is “absolutely convinced” (causal) before they take action to protect themselves.
 
The report recognizes that you cannot think about e-cigarettes independently of cigarettes.  Their effects are inexorably tied together:   “… the promotion of electronic cigarettes and other innovative tobacco products is much more likely to be beneficial in an environment where the appeal, accessibility, promotion, and use of cigarettes are being reduced.”  This is very important in light of the evidence (not discussed in the report because it is too recent) that e-cigarette use deters quitting smoking and that there are high levels of dual use of cigarettes with e-cigarettes, much of which is actually promoted by e-cigarette companies (which are increasingly the cigarette companies).
 
Another conclusion important for e-cigarettes:  “Reducing the number of cigarettes smoked per day is much less effective than quitting entirely for avoiding the risks of premature death from all smoking-related causes of death.” 
 
No mention of warning labels as an effective intervention, which is surprising.
 
The full report is available at http://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html