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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

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Number of deaths (’000s) in 1998 attributable to tobacco useWHO Region Males FemalesWorld 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


Source: Murray CJL, Lopez AD. 1996. useDALYs attributable to tobacco use% of total inRegion 1990 2020World 2.6 8.9

Developed Regions 12.1 18.2

Developing Regions 1.4 7.7


Source: Murray CJL, Lopez AD. 1996 useDALYs attributable to tobacco use% of total inRegion 1990 2020Est. 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
Murray CJL, Lopez AD. 1996 use

”By 2020, tobacco is expected to cause more premature death and disability than any single disease.”


Why do people smoke p hajek 2001
Why do people smoke? useP. Hajek 2001

  • Initiation - social reasons

  • Maintenance - pharmacological reasons


Smokers have low degree of control over their behaviour p hajek 2001
Smokers have low degree of control over their behaviour useP. 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
Are smokers addicted? useAre 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


WHO ICD 10 useInternational Classification of DiseasesF10-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
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
Less harmful tobacco use death and disability

”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
Intervention to decrease onset death and disability

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
Intervention to increase cessation death and disability

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: death and disabilityProjections of premature tobacco deaths for periods 2000-2024 and 2025-2049Peto 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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