Public Health Effects of Tobacco Dependence
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Public Health Effects of Tobacco Dependence

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Oral presentation by Lars Ramström 2002

Oral presentation by Lars Ramström 2002

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Public Health Effects of Tobacco Dependence Public Health Effects of Tobacco Dependence Presentation Transcript

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  • Number of deaths (’000s) in 1998 attributable to tobacco use WHO Region Males Females World Health Report 1999
    • All member states 3,241 782
    • Africa 112 13
    • The Americas 472 300
    • Eastern Mediterranean 160 22
    • Europe 1,066 207
    • South-East Asia 505 75
    • Western Pacific 927 166
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  • Source: Murray CJL, Lopez AD. 1996. DALYs attributable to tobacco use % of total in Region 1990 2020 World 2.6 8.9
    • Developed Regions 12.1 18.2
    • Developing Regions 1.4 7.7
  • Source: Murray CJL, Lopez AD. 1996 DALYs attributable to tobacco use % of total in Region 1990 2020 Est. Market Economies 11.7 17.0
    • Former Socialist Econ. of Europe 12.5 19.9
    • India 0.6 10.2
    • China 3.9 16.1
    • Sub-Saharan Africa 0.4 1.7
    • Latin America & Carib. 1.4 6.8
  • Murray CJL, Lopez AD. 1996
    • ” By 2020, tobacco is expected to cause more premature death and disability than any single disease.”
  • Why do people smoke? P. Hajek 2001
    • Initiation - social reasons
    • Maintenance - pharmacological reasons
  • Smokers have low degree of control over their behaviour P. Hajek 2001
    • Most smokers say they want to quit
    • Over 95% of smokers rarely if ever go a day without a cigarette
    • Over 97% of quit attempts last <6 months
    • Some 70% resume smoking after a major smoking related health crisis
  • Are smokers addicted? Are smokers addicted? P.Hajek 2001
    • Signs of addiction include
    • Continued use despite knowledge of harmful effects
    • Witdrawal symptoms and urges to use the drug during abstinence
    • Failure of attempts to stop
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  • WHO ICD 10 International Classification of Diseases F10-F19 Mental and Behavioural Disorders Due to Psychoactive substance use
    • F10 Disorders resulting from use of alcohol
    • F11 Disorders resulting from use of opiods
    • F12 Disorders resulting from use of cannabinoids
    • F13 Disorders resulting from use of sedatives or hypnotics
    • F14 Disorders resulting from use of cocaine
    • F15 Disorders resulting from use of other stimulants
    • F16 Disorders resulting from use of hallucinogens
    • F17 Disorders resulting from use of tobacco
    • F18 Disorders resulting from use of volatile solvents
    • F19 Disorders resulting from multiplw drug use and use of other psychoactive substances
  • Intervention strategies for reduction of tobacco-related death and disability
    • Decreasing onset of tobacco use
    • Increasing cessation
    • Finding less harmful kinds of tobacco use
  • Less harmful tobacco use
    • ” Light” cigarettes ?
    • Generally no benefit. Low nicotine yield may even increase health risks unless tar/nicotine ratio is kept extra low
    • Smokeless tobacco ?
    • Most kinds of smokeless tobacco involve severe health risks.
    • However, Swedish ”snus” (a special kind of moist oral snuff) has been recognized as substantially less harmful than smoking
  • Intervention to decrease onset
    • Potential:
    • In principle it represents a long term solution
    • Difficulties:
    • It cannot yield an appreciable reduction of mortality during the nearest 40 years - only later, when today’s young people reach ages >55
    • Social pressure to smoke can be very strong and intervention programmes have limited success
  • Intervention to increase cessation
    • Potential:
    • Mortality reduction occurs quite rapidly after successful intervention
    • Widespread cessation contributes to a social climate that favours prevention of onset
    • Difficulties:
    • Smokers must be given both:
    • - motivation to quit, and
    • - support to overcome their dependence
  • Three intervention scenarios as basis for: Projections of premature tobacco deaths for periods 2000-2024 and 2025-2049 Peto R. et al 1998
    • No intervention (current trends persisting)
    • Intervention to decrease onset (halving uptake of smoking by 2020)
    • Intervention to increase cessation (halving global cigarette consumption by 2020)
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