All member states 3,241 782 Africa 112 13 The Americas 472 300

2. 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

8. Source: Murray CJL, Lopez AD. 1996.DALYs 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

9. Source: Murray CJL, Lopez AD. 1996DALYs 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

10. Murray CJL, Lopez AD. 1996 ”By 2020, tobacco is expected to cause more premature death and disability than any single disease.”

11. Why do people smoke?P. Hajek 2001 • Initiation - social reasons • Maintenance - pharmacological reasons

12. Smokers have low degree of control over their behaviourP. 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

13. 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

20. WHO ICD 10International 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

21. Intervention strategies for reduction of tobacco-related death and disability • Decreasing onset of tobacco use • Increasing cessation • Finding less harmful kinds of tobacco use

22. 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

23. 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

24. 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

25. Three intervention scenarios as basis for:Projections 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)