3. ByBy
Dr . Ashraf El-AdawyDr . Ashraf El-Adawy
Consultant Chest PhyscianConsultant Chest Physcian
TB TEAM Expert - WHOTB TEAM Expert - WHO
EgyptEgypt
4. Tobacco is one of the greatest
emerging health disasters in
human history
))WHOWHO((
5. Tobacco use is the leading
preventable cause of death in
the world
))WHOWHO((
6. The Global Tobacco Crisis
…tobacco is the only legally
available consumer product
which kills people when it is
used entirely as intended.
The Oxford Medical Companion (1994(
14. Are Water pipes a Safe Alternative to
Cigarettes?
(hookah, arghile, hubble-bubble, narghile, or shisha)
15. CO yield of waterpipe smoke equal
to or greater than cigarettes,
Smoke stones from waterpipe
use contains about same
amount of nicotine and “tar”
as 20 cigarettes
16. Cigars Compared to cigarettes:
2x tar
5x carbon monoxide
7x nicotine
Are Cigars a Safe Alternative to Cigarettes?Are Cigars a Safe Alternative to Cigarettes?
22. Annual Smoking Death Toll Tops 5 Million
Worldwide along with another 600,000 who
die from secondhand-smoke exposure
WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER package. Geneva
23. Tobacco is the second major cause of death in
the world.
Tobacco causes 1 in 10 adult deaths worldwide.
(WHO World Health Report, 2002(
24. One out of two lifelong adult smokers will
die from a smoking related disease.
on average 15 years prematurely
WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER package. Geneva,
25.
26. This year, tobacco will kill more than five
million people )1 every 6 seconds( –
more than tuberculosis, HIV/AIDS and
malaria combined
By 2030, the death toll will exceed eight
million a year , 80% of those deaths will
occur in developing countries.
WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER package. Geneva,
27. In the 20th century, the tobacco
epidemic killed 100 million people
worldwide.
During the 21st century, it could kill
one billion.
WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER package. Geneva,
28. The number of smoking attributable
deaths is increasing worldwide
0
1
2
3
4
5
6
7
8
9
1990 2000 2010 2020
Year
Deaths)millions(
Murray CJL, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study
29. Largest absolute increase in deaths
attributed to smoking from 1990 to 2020
China
+1.4 m
In 2020, 2.2
million deaths
from smoking
will occur
China
+1.4 m
In 2020, 2.2
million deaths
from smoking
will occur
India
+1.4 m
In 2020, 1.5
million deaths
from smoking
will occur
30. Deaths attributed to tobacco use in 1990
& 2020 by region
Deaths (millions( Change
Region 1990 2020 absolute %
China 0.8 2.2 +1.4 +175%
India 0.1 1.5 +1.4 +1400%
Middle Eastern Crescent 0.1 0.8 +0.7 +700%
Formerly Socialist Economies of Europe 0.5 1.1 +0.6 +120%
Other Asia and Islands 0.2 0.7 +0.5 +250%
Latin America and Caribbean 0.1 0.4 +0.3 +300%
Sub-Saharan Africa 0.1 0.3 +0.2 +200%
Established Market Economies 1.1 1.3 +0.2 +18%
World 3.0 8.4 +5.4 +180%
Murray CJL, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study
31. Where is the burden increasing the fastest,
1990 to 2020?
India
+1400%Middle
Eastern
Crescent
+700%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
India
+1400%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
Other Asia
and Islands
+250%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
Sub-
Saharan
Africa
+200%
Other Asia
and Islands
+250%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
Sub-
Saharan
Africa
+200%
Other Asia
and Islands
+250%
China
+175%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
Sub-
Saharan
Africa
+200%
Other Asia
and Islands
+250%
China
+175%
Formerly Socialist
Economies of Europe
+120%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
Sub-
Saharan
Africa
+200%
Other Asia
and Islands
+250%
China
+175%
Formerly Socialist
Economies of Europe
+120%
Established Market
Economies
+18%
32. Past and Future Annual Deaths due to
Tobacco Use
0.3 0 0.3
1.3
0.2
1.5
2.12.1
4.2
3
7
10
0
1
2
3
4
5
6
7
8
9
10
1950 1975 2000 2025-2030
Developed
Developing
World
36. The number of smokers in the world, estimated
at 1.3 billion, is estimated to rise to 1.7 billion
by 2025 if the global prevalence of tobacco
use remains unchanged
(WHO World Health Report, 2003(
37. Approximately 1.3 billion people smoke cigarettes
)1 in 5 of the world’s population; 1 in 3 of those over
15 years(
Global prevalence )2000( = 29%
)47% men: 10% women(
300million are in China
(WHO World Health Report(
38. Today’s teenager is tomorrow’s
potential regular customer, and the
overwhelming majority of smokers first
begin to smoke while still in their teens.
Philip Morris internal document (1981(
39. According to the American Cancer
Society, 90 percent of new smokers are
children and teenagers
40. Every Day About 80,000 - 100,000 Young
People Worldwide become Addicted to
Tobacco , roughly half of whom live
in Asia
41. Global cigarette consumption
Billions of sticks, 1880-2000
10 20 50 100
300
600
1,000
1,686
2,150
3,112
4,388
5,419 5,500
0
1000
2000
3000
4000
5000
6000
Billionsofcigarettes
1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Year
Source: The Tobacco Atlas, World Health Organization 2002.
42. WHO World Health Report .Tobacco Atlas .2008.
Global Cigarette Consumption
45. 82.8
809.7
114.8
24.2
114.7
75.9
0 200 400 600 800 1,000
Smokers )millions(
Women
Men
Most smokers in 2000 lived in economically
developing countries
Guindon GE, Boisclar D. Past, Current and Future Trends in Tobacco use. HNP discussion paper: Economics of
Tobacco Control Paper No. 6; March 2003.
Developed countries
Japan, Canada, US, Australia,
New Zealand, Western Europe
(24 countries)
Transitional countries
Former Soviet bloc / Eastern
Europe (23 countries)
Developing countries
(84 countries)
46. Worldwide, over 15 billion cigarettes are sold
every day or 10 million every minute
China consumes more than 30 percent of the
world's cigarettes, with almost 70 percent of
males smoking.
China is the largest cigarette manufacturer,
followed by the U.S
Global Tobacco Consumption
47. Two Thirds of Smokers Live in Just
10 Countries
More than 40% live in just two countries.
48. The Bloomberg Initiative
focuses on 15 countries where around
80% of the world’s smokers live
China
India
Indonesia
Russia
Bangladesh
Brazil
Mexico
Turkey
IUATLD
Pakistan
Egypt
Ukraine
Philippines
Thailand
Vietnam
Poland
49.
50. By 2030, 7 of every 10 tobacco attributable
deaths projected to be in developing countries
Tobacco deaths 2000
Developed 2million
Developing 2million
The global burden of deaths from tobacco
is shifting from developed to developing
countries
Tobacco deaths 2030
3million
7million
World Health Organization. 1999. Making a Difference. World Health Report. 1999.
Geneva, Switzerland
51.
52.
53.
54. Rear View Mirror- Trends in Cigarette Consumption and
Lung Cancer Mortality in the US
0
1000
2000
3000
4000
5000
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Year
0
20
40
60
80
100
Numberofcigarettespercapita
Lungcancerdeathrateper100,000
Per capita cigarette
consumption
Lung cancer
death rates
Men
Lung cancer
death rates
Women
*Per 100,000, age-adjusted to 2000 U.S. standard population.
Data Source: Death rates: US Mortality Public Use Tapes, 1960-2002, US Mortality Volumes, 1930-1959,
National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
Cigarette consumption: US Department of Agriculture, 1900-1987, 1988, 1989-2003.
1964
55. Major events in tobacco control and tobacco products dutied for sale per person 15 years and
over, Australia
56. Globally, use of tobacco products is increasing,
although it is decreasing in high-income countries
The epidemic is shifting to the developing world
By 2020, it is estimated that only 15% of the world’s
smokers will live in developed countries
More than 80% of the world's smokers live in low- and
middle- income countries
66. Smoking: Leading Preventable Cause ofSmoking: Leading Preventable Cause of
Disease and DeathDisease and Death
Cancer
Lung (#1)
Leukemia (AML, ALL, CLL)2-4
Oral cavity/pharynx
Laryngeal
Esophageal
Stomach
Pancreatic
Kidney
Bladder
Cervical
Cardiovascular
Ischemic heart disease (#2)
Stroke – vascular dementia5
Peripheral vascular disease6
Abdominal aortic aneurysm
Respiratory
COPD (#3)
Pneumonia
Poor asthma control
Reproductive
Low-birth weight
Pregnancy complications
Reduced fertility
SIDS
Other
Adverse surgical outcomes/wound
healing
Hip fractures
Low-bone density
Cataract
Peptic ulcer disease in Helicobacter
pylori-positive patients
AML = acute myeloid leukemia; ALL = acute lymphocytic leukemia; CLL = chronic lymphocytic leukemia;
COPD = chronic obstructive pulmonary disease; SIDS = sudden infant death syndrome.
• Surgeon General’s Report. The Health Consequences of Smoking; 2004.
• Sandler DP, et al. J Natl Cancer Inst. 1993;85:1994-2003.
• Crane MM, et al. Cancer Epidemiol Biomarkers Prev. 1996;5:639-644.
• Miligi L, et al. Am J Ind Med. 1999;36:60-69.
• Roman GC. Cerebrovasc Dis. 2005;20:91-100.
• Willigendael EM, et al. J Vasc Surg. 2004;40:1158-1165.
67. Tobacco use is a risk factor for six of the eight
leading causes of death in the world
68. Middle East
Australia & New Zealand
Africa (mainly south Africa)
South America
Southeast Asia & Japan
South Asia
China
Central & eastern Europe
Western Europe
North America
45.5%
44.8%
38.9%
38.3%
37.4%
36.2%
35.9%
30.2%
29.3%
26.1%
Population attributable risks associated with smoking by geographic
region
INTERHEART ; Lancet 2004;364:937-52
1
2
3
4
5
6
7
8
9
10
70. Tobacco use is the single leading preventable
cause of death
Mokdad AH, Marks JS, Stroup DF, Gerberding JL (March 2004). “Actual causes of death in the United States, 2000″.
71.
72. • Compared with nonsmokers smoking increases the
risk of:
Coronary heart disease by 2 to 4 times
Stroke by 2 to 4 times
Men developing lung caner by 23 times
Women developing lung cancer by 13 times
Dying from chronic obstructive lung diseases by
12 to 13 times
Smoking and Increased
Health Risks
CDC
73. • Smoking causes approximately
90% of all lung cancer deaths in men
80% of all lung cancer deaths in women
90 % of deaths from COPD
Smoking Causes Death
CDC
74. Nothing Kills Like Tobacco
Yearly Deaths in the U.S.A.
Cigarettes
Alcohol
2nd
Hand Smoke
Car Accidents
Suicide
AIDS
Homicides
430,000
105,095
53,000
46,300
30,906
29,939
24,932
Source: Centers for Disease Control and Prevention (CDC)
75. Smoking kills more Americans each year than alcohol,
cocaine, heroin, homicide, suicide, car accidents,
fires and AIDS combinedined
78. • Cigarette smokers are 2–4 times more likely to
develop coronary heart disease than nonsmokers
• Cigarette smoking approximately doubles a person's
risk for stroke
• Smokers are more than 10 times as likely as
nonsmokers to develop peripheral vascular disease
• Smoking causes abdominal aortic aneurysm
Smoking and Cardiovascular Disease
CDC
79. The Numbers Tell The Story
Cardiovascular disease (CVD) is the leading cause
of death globally (in all regions except sub-Saharan
Africa).
It causes:
1 in 4 deaths (high-income countries)
1 in 5 deaths (low and middle-income countries) –
nearly twice as many deaths as tuberculosis,
HIV/AIDS, and malaria combined.
Cardiovascular disease (CVD) is the leading cause
of death globally (in all regions except sub-Saharan
Africa).
It causes:
1 in 4 deaths (high-income countries)
1 in 5 deaths (low and middle-income countries) –
nearly twice as many deaths as tuberculosis,
HIV/AIDS, and malaria combined.
]see Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A race against time: the challenge of cardiovascular
diseases in developing countries. New York: Columbia University, 2004[
80. The Numbers Tell The Story
An estimated 17.5 million people died from
CVDs in 2005, representing 30% of all
global deaths.
Over 80% of CVD deaths occur in low- and
midlle-income countries.
Globally, deaths from cardiovascular diseases
will rise from 17.1 million in 2005, to 23.4
Million in 2030
An estimated 17.5 million people died from
CVDs in 2005, representing 30% of all
global deaths.
Over 80% of CVD deaths occur in low- and
midlle-income countries.
Globally, deaths from cardiovascular diseases
will rise from 17.1 million in 2005, to 23.4
Million in 2030
]see Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A race against time: the challenge of cardiovascular
diseases in developing countries. New York: Columbia University, 2004[
81. • The American Heart Association estimates
that approximately 38,000 people die each
year from heart and blood vessel disease
caused by secondhand smoke.
Smoking and Cardiovascular Disease
CDC
82. • Smoking, in addition to high cholesterol, high blood
pressure, physical inactivity, obesity, and diabetes
tops the list as a primary risk factor for
cardiovascular disease.
Smoking and Cardiovascular Disease
CDC
88. Smoking and cancer
Tobacco is the single largest preventable
cause of cancer in the world today.
It causes 80-90% of all lung cancer deaths,
and about 30% of all cancer deaths in
developing countries
89. Smoking and cancer
Nearly 90 percent of people who develop
lung cancer are smokers, yet only
about 10 percent of lifetime smokers
will develop the disease..
The American Chemical Society
90. Smoking and cancer
Patients who had been diagnosed with chronic
bronchitis or emphysema prior to their
cancer diagnosis were about 30 percent
more likely to develop lung cancer than
those without such a diagnosis
The American Chemical Society
91. Smoking and cancerSmoking and cancer
WHO estimates that 7.6 million people died of cancer
in 2005 - representing 13% of deaths worldwide
.
Cancer is not simply a problem of rich countries more
than 50% of all cancer and 70% of all cancer deaths
occur in low and middle income countries.
97. 90%of the people with COPD are
current or ex- smokers
The primary cause of
(COPD) is tobacco
smoke (including
second-hand
exposure)
GOLD 2009
98. Smoking And COPD
Not all smokers develop clinically significant COPD,
which suggests that genetic factors must modify
each individual’s risk.
The common statement that only 15-20% of smokers
develop clinically significant COPD is misleading.
A much higher
proportion may develop abnormal lung function at
some point if they continue to smoke.
GOLD 2009
101. According to the latest WHO estimates (2007),
currently 210 million people have COPD and
3 million people died of COPD in 2005 which
corresponds to 5% of all deaths globally.
Smoking And COPD
WHO May 2008
102. COPD is the only chronic disease that is rapidly
increasing in prevalence on a worldwide basis
103. • Total deaths from COPD are projected to
increase by more than 30% in the next 20
years without interventions to cut risks,
particularly exposure to tobacco smoke.
WHO May 2008
Smoking And COPD
104. COPD predicted to be third leading
cause of death in 203030
"Much of the increase in
COPD is associated with
projected increases in
tobacco use"
WHO May 2008
107. “The most important risk factor for COPD is
cigarette smoking.”
“Smoking cessation is the only intervention
that has been shown to slow the progression
of COPD.”
1
Am J Respir Crit Care Med 2001;163:1256-1276
22
CRJ . 10;(Suppl A). 2003CRJ . 10;(Suppl A). 2003
111. Future Mortality Worldwide
The global scenario of diseases is shifting from
infectious diseases to noncommunicable diseases,
with chronic conditions now being the chief causes
of death globally.
World health statistics 2008
112.
113. Cardiovascular disease, mainly heart
disease, stroke
Cancer
Chronic respiratory diseases
Diabetes
WHO, Preventing Chronic Disease : A Vital Investment. 2009
The leading chronic diseases
120. Tobacco is the second major cause of death
in the world
121. The Five Leading Global Risks For Mortality
in The World
High blood pressure (responsible for 13% of deaths)
Tobacco use (9%)
High blood glucose (6%)
Physical inactivity (6%)
Overweight and obesity (5%).
WHO report Preventing chronic diseases: a vital investment 2009
122. The main causes of chronic disease
Common
modifiable
risk factors:
unhealthy diet;
Tobacco use
Lack of physical
activity
Non-
modifiable
risk factors
Age
heredity
Intermediate
risk factors:
high blood
pressure
high blood
glucose
high cholesterol
overweight &
obesity
Main Chronic
Diseases:
Heart disease
stroke
Cancer
Chronic
respiratory
disease
Diabetes
Source: World Health Organisation, Preventing Chronic Diseases: A Vital Investment (2005) p 48
[ [
124. The failure to use available knowledge
about chronic disease prevention and
control endangers future generation
WHO Report 2005, Preventing chronic diseases: a vital investment
128. Did you know?
On average, each cigarette shortens
a smoker's life by around 11 minutes
129. Every cigarette a man smokes reduces his
expected life span by 11 minutes.
Each carton of cigarettes thus
represents a day and a half of lost life.
Every year a man smokes a pack a day, he
shortens his life by almost 2 months
University of California, Berkeley Wellness Letter, April 2000
130. On average, smokers die 13 to 14 years earlier
than nonsmokers Worldwide,
Cigarette smoking increases the length of time
that people live with a disability by about
2 years
University of California, Berkeley Wellness Letter, April 2000
131. But the good news is that giving up at any age will add
years to a person's life
Men who quit at 40 lived just one year less than those
who had never smoked
Men who stopped at 50 increased life expectancy by
six years
Men who gave up at 60 added an average of three
years to their life
Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ
2004
137. For every eight smokers who die from smoking,
one innocent bystander dies from secondhand
smoke
138. Lung cancerr
Risk increased by 20-30%
Coronary heart disease
Risk increased by 25-30%
Discomfort
80 % for non smokers,
53% for smokers.
The 2 Main Risks of Passive Smoking in Adultsults
141. “Nicotine is highly addictive, to a degree
similar or in some respects exceeding
addiction to ‘hard’ drugs such as
heroin or cocaine””
Royal College of Physicians of London, 2000 Nicotine Addiction in Britain
142. Addiction to nicotine
Characteristics of dependence
Strong desire to take substance, taking
more than intended for longer
Difficulty quitting or controlling use
Considerable time spent obtaining, using
and/or recovering from use
Higher priority given to the drug than other
social activities
Continued use despite knowledge of harm
Tolerance develops
Withdrawal syndrome
143.
144. The Cycle of Nicotine Addiction
Nicotine binding causes an increase in
release of dopamine1,2
Dopamine gives feelings of pleasure
and calmness1
Competitive binding of nicotine to
nicotinic acetylcholine receptors
causes prolonged activation,
desensitization, and upregulation2
1. Jarvis MJ. BMJ. 2004; 328:277-279.
2. Picciotto MR, et al. Nicotine and Tob Res. 1999:Suppl 2:S121-S125.
Dopamine
Nicotine
145. Changing Evidence About Nicotine
Dependence
if there is a minimum duration, frequency or quantity
of tobacco use required to develop symptoms of
dependence
146. Changing Evidence About Nicotine
Dependence
1st
Symptoms of tobacco dependence commonly
develop with days or weeks rapidly after the onset of
intermittent smoking, although individuals differ
widely in this regard ,Girls tend to develop
symptoms faster
There does not appear to be a minimum nicotine dose
or duration of use as a prerequisite for symptoms
to appear.
DiFranza JR. et al. Tobacco Control, 2002
147. The younger children are when they first try smoking,
the more likely they are to become regular smokers
and the less likely they are to quit.
Evidence shows that around 50 percent of those who
start smoking in adolescent years go on to smoke
for 15 to 20 years.
Although anyone who uses tobacco can become
addicted to nicotine, people who do not start
smoking before age 21 are unlikely to
ever begin.
WHO
149. Economic Effects of Tobacco Use
The WHO estimates the annual global cost
of tobacco to be US$500 billion
Smoking-related costs can contribute up
to 15% of total health care costs in
high-income countries.
150. The Centers for Disease Control and
Prevention (CDC) estimates the cost of
smoking to the U.S economy is over $157
billion each year
151. Tobacco use tends to beTobacco use tends to be
more common amongmore common among
poorpoor..
Tobacco leads to poorTobacco leads to poor
health, in turn leads tohealth, in turn leads to
greater povertygreater poverty..
152. Tobacco purchases can be a significant economic
burden on families, especially among the poor,
in developing nations.
Poor households in developing nations spend 7-15%
of household income on tobacco
Money spent on tobacco means less resources forMoney spent on tobacco means less resources for
food, shelter, education, health care and basicfood, shelter, education, health care and basic
needsneeds..
WHO 2008
153. The poorest households in Bangladesh spend
almost 10 times as much on tobacco as on
education.
In Indonesia, where smoking is most common among
the poor, the lowest income group spends 15% of
its total expenditure on tobacco
In Egypt, more than 10% of household expenditure inIn Egypt, more than 10% of household expenditure in
low-income homes is on tobaccolow-income homes is on tobacco....
WHO 2008
154. The poor are much more likely than the
rich to become ill and die prematurely
from tobacco-related illnesses.
The Tobacco Tragedy
WHO 2008
157. Why Quit? Potential Health Benefits of Quitting
Smoking
Cessation
3months
Lung function may start to improve
with decreased cough, sinus
congestion, fatigue, and shortness of
breath
Cardiovascular Heart Disease (CHD): excess
risk is reduced by 50% among ex-smokers
1year
Stroke risk returns to the level of people who have never
smoked at 5–15 years post-cessation
5years
Lung cancer risk is 30%–50% that of continuing
smokers
10years
CHD risk is similar to never smokers
15years
1. USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990. Available at:
http://profiles.nlm.nih.gov/NN/B/B/C/T/.
2. American Cancer Society. Guide to Quitting Smoking. Available at: http://www.cancer.org.
160. WHO FCTC and MPOWERWHO FCTC and MPOWER
strategystrategy
Mechanisms for Tobacco Control
161.
162.
163.
164. MMonitor tobacco use and prevention policies
PProtect people from tobacco smokerotect people from tobacco smoke
OOffer help to quit tobacco use
WWarn about the dangers of tobacco
EEnforce bans on tobacco advertising,
promotion and sponsorship
RRaise taxes on tobacco
MPOWER strategyMPOWER strategy
165.
166. WHO Report on the Global Tobacco Epidemic, 2008
Most Countries Have Not Implemented
Effective Tobacco Control Policies
167. Only 5% of world covered by effective
Tobacco Control Policies
168. Any country, regardless of income level, can
implement smoke-free laws effectively However,
only 5% of the global population is protected by
comprehensive smoke-free legislation
..In most countries, smoke-free laws cover only
some indoor spaces, are weakly written or are
poorly enforced
WHO Report on the Global Tobacco Epidemic, 2008
169. Global Tobacco Control is
Underfunded
Globally, tobacco tax
revenues are 500
times higher than
spending on tobacco
control.
In low- and middle-
income countries, tax
revenues are 5,000
times higher.
170.
171.
172. Tobacco control is relatively
inexpensive to implement , and
the return is enormous
173.
174.
175.
176.
177.
178.
179.
180.
181.
182.
183.
184.
185. Many Health Professionals Smoke DespiteMany Health Professionals Smoke Despite
Known RisksKnown Risks
3 4
6 8
11 13 15
19
27
30
35 35
42
0
5
10
15
20
25
30
35
40
45
50
Australia
UK
Sweden
Brazil
Venezuela
Canada
Poland
Mexico
China
Argentina
Spain
Iran
Turkey
Prevalence of
Smokers
(%)
2005or latest available data.
Mackay J, Eriksen M. The Tobacco Atlas. World Health Organization; 2006.
186.
187.
188. Tobacco control, rather than being a
luxury that only rich nations can
afford, is now a necessity that
all countries must address.
WHO Report on the Global Tobacco Epidemic, 2008
189. As the tobacco epidemic is entirely
manmade, the end of the tobacco epidemic
must also be manmade. We must act now..
WHO Report on the Global Tobacco Epidemic, 2008
Editor's Notes
Key Points
Smoking has been causally linked to a host of cardiovascular, respiratory, reproductive, and other conditions, as well as many types of cancer
These diseases affect smokers of all ages, but …
Increases in a smoker’s age correlate with increased frequency of smoking-related diseases
Background
In 2004, the US Surgeon General published a report on the health effects of active smoking1, focusing specifically on the evidence for a causal relationship between smoking and disease and death. According to the research summarised in the report, many serious conditions are caused by smoking, including cardiovascular, respiratory, reproductive, and other conditions, as well as cancer affecting diverse areas and organs of the body. In addition to the widely known consequences of lung cancer and respiratory disease, smoking has been causally linked to such diverse morbidities as low-bone density, nuclear cataract, bladder cancer, and reduced fertility. Other studies have linked smoking to vascular dementia5 and peripheral arterial disease.7 These conditions can affect young and middle-aged smokers and, in general, as a smoker’s age increases, the frequency of smoking-caused diseases rises.
References
Surgeon General’s Report. The Health Consequences of Smoking; 2004.
Sandler DP, et al. J Natl Cancer Inst. 1993;85:1994-2003.
Crane MM, et al. Cancer Epidemiol Biomarkers Prev. 1996;5:639-644.
Miligi L, et al. Am J Ind Med. 1999;36:60-69.
Roman GC. Cerebrovasc Dis. 2005;20:91-100.
Willigendael EM, et al. J Vasc Surg. 2004;40:1158-1165.
If you combine the first and third bars on this chart, first and secondhand smoke combined kills nearly 500,000 people in the U.S. per year. This is equivalent to four jumbo jets falling out of the sky every day of the year, killing everyone aboard!
The majority of deaths worldwide for all ages are due to chronic diseases. Cardiovascular diseases (mainly heart disease and stroke) are responsible for 30% of all deaths. Cancer, chronic respiratory diseases, and diabetes are also major causes of mortality.
The contribution of diabetes is underestimated because although people may live for years with diabetes, their deaths are usually recorded as being caused by heart disease or kidney failure.
Good afternoon.
It's my pleasure to share with you the overall messages and key findings of this new WHO global report: Preventing chronic diseases: a vital investment. Several misunderstandings about chronic diseases have contributed to their global neglect. This report dispels these misunderstandings with the strongest evidence and proposes a way forward for stopping the rising global epidemic.
Key Points
For most people, smoking is a nicotine addiction
Nicotine addiction is a cycle, as described in the slide
It begins with nicotine binding to receptors in the brain
This causes a release of dopamine, which in turn results in feelings of pleasure and calmness
A lack of nicotine (eg, during smoking abstinence) leads to dopamine decrease
Craving is increased to replenish dopamine levels
Background
The binding of nicotine to its relevant receptors results in the release of multiple neurotransmitters, most critically dopamine. The release of dopamine in the nucleus accumbens neurons is thought to play a critical role in the addictive nature of nicotine. This release of dopamine requires binding of nicotine to 42 receptors.1,2
Absorption of cigarette smoke from the lungs is rapid and complete, producing with each inhalation a high concentration of arterial nicotine that reaches the brain within 10 to 16 seconds. Nicotine has a terminal half-life in blood of 2 hours. Smokers therefore experience a pattern of repetitive and transient high blood nicotine concentrations from each cigarette. Nicotine’s activation of acetylcholinergic receptors induces the release of dopamine in the nucleus accumbens. This is similar to the effect produced by other drugs of misuse, such as amphetamines and cocaine. The symptoms of nicotine withdrawal are a major barrier to smoking cessation for most people. Smokers start to experience impairment of mood and performance within hours of their last cigarette. These effects are completely alleviated by smoking a cigarette. Withdrawal symptoms include irritability, restlessness, feeling miserable, impaired concentration, and increased appetite, as well as craving for cigarettes. Cravings, sometimes intense, can persist for many months.
References
Jarvis MJ. Why people smoke. BMJ. 2004;328:277-279.
Picciotto MR, Zoli M, Changeux J. Use of knock-out mice to determine the molecular basis for the actions of nicotine. Nicotine Tob Res. 1999; Suppl 2:S121-S125.
Key Points
The US Surgeon General Report and the American Cancer Society indicate that the health benefits of quitting smoking can start as early as 2 weeks and are sustained
After quitting smoking
Within 2 weeks to 3 months, lung function can improve and over time, can reach the levels of never smokers
After 1 year, risk of cardiovascular heart disease (CHD) can decrease by 50% and continues to decline thereafter
Between 5-15 years, risk of stroke can become comparable to never smokers
After 10 years, lung cancer risk is reduced to 30%-50% of continuing smokers
Moreover, the risk can be reduced for cancers of the larynx, oral cavity, esophagus, pancreas, urinary bladder, and of developing ulcers of the stomach or duodenum
After 15 years, CHD risk can return to level of never smokers
Background
When gauging the health benefits from smoking cessation one is encouraged to assess both the short-term and long-term improvements. Within 2 weeks to 3 months lung function may begin to improve and there may be notable decreases in coughing, sinus congestion, fatigue, and shortness of breath.
Around the year mark, coronary heart disease risk, the leading cause of death in the United States, improves with smoking cessation to a point where excess risk is reduced by 50% and continues to decline thereafter. Within the 5–15 year range, the risk of stroke for smoking cessators returns to the level of a person who has never smoked.
Other potential long-term benefits include: the risk of lung cancer—the most common cause of cancer death in the United States—declines steadily after smoking cessation; and by 10 years after cessation, the risk of lung cancer is 30%-50% that of continuing smokers. And beyond this, smoking cessation may also reduce the risk of cancers of the larynx, oral cavity, esophagus, pancreas, urinary bladder, and of developing ulcers of the stomach or duodenum. Other long-term benefits include the rate of decline in lung function among former smokers returns to that of never smokers, reducing the risk of COPD. And the risk of coronary heart disease, after 15 years of abstinence, becomes similar to that of a person who has never smoked. Clearly, a patient has health benefits to gain if they successfully quit and remain quit.
References
US Department of Health & Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1990. Available at: http://profiles.nlm.nih.gov/NN/B/B/C/T/. Accessed July 2006.
American Cancer Society. Guide to Quitting Smoking. Available at: http://www.cancer.org.
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