Number of deaths (’000s) in 1998 attributable to tobacco use WHO Region  Males  Females World Health Report 1999 <ul><li>A...
 
 
 
 
 
Source: Murray CJL, Lopez AD. 1996.   DALYs attributable to tobacco use     % of total in Region  1990  2020 World   2.6  ...
Source: Murray CJL, Lopez AD. 1996   DALYs attributable to tobacco use   % of total in Region  1990  2020 Est. Market Econ...
Murray CJL, Lopez AD. 1996 <ul><li>” By 2020, tobacco is expected to cause more premature death and disability than any si...
Why do people smoke? P. Hajek 2001 <ul><li>Initiation - social reasons </li></ul><ul><li>Maintenance - pharmacological rea...
Smokers have low degree of  control over their behaviour P. Hajek 2001 <ul><li>Most smokers say they want to quit </li></u...
Are smokers addicted? Are smokers addicted? P.Hajek 2001 <ul><li>Signs of addiction include </li></ul><ul><li>Continued us...
 
 
 
 
 
 
WHO ICD 10 International Classification of Diseases F10-F19  Mental and Behavioural Disorders Due to Psychoactive substanc...
Intervention strategies for reduction of tobacco-related death and disability <ul><li>Decreasing onset of tobacco use </li...
Less harmful tobacco use <ul><li>” Light” cigarettes ? </li></ul><ul><li>Generally no benefit. Low nicotine yield may even...
Intervention to decrease onset <ul><li>Potential: </li></ul><ul><li>In principle it represents a long term solution </li><...
Intervention to increase cessation <ul><li>Potential: </li></ul><ul><li>Mortality reduction occurs quite rapidly after suc...
Three intervention scenarios as basis for: Projections of premature tobacco deaths  for periods 2000-2024 and  2025-2049  ...
 
 
 
 
 
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Public Health Effects of Tobacco Dependence

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Oral presentation by Lars Ramström 2002

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Public Health Effects of Tobacco Dependence

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

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