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Fumo di sigarette: l’epidemiologia di una dipendenza. Carlo La Vecchia. Studio dei medici inglesi, 50 anni di follow-up. Un fumatore a vita ha un rischio di morte, in ogni età 3 volte superiore a quello di un non fumatore. A 90 anni arrivano a 26/100 maschi mai fumatori ma solo 5 fumatori.

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studio dei medici inglesi 50 anni di follow up
Studio dei medici inglesi, 50 anni di follow-up

Un fumatore a vita ha un rischio di morte, in ogni età 3 volte superiore a quello di un non fumatore.

A 90 anni arrivano a 26/100 maschi mai fumatori ma solo 5 fumatori.

(Doll et al. 2004)

studio dei medici inglesi 50 anni di follow up1
Studio dei medici inglesi, 50 anni di follow-up

Chi smette a 40 anni ha un rischio di morte di poco superiore a chi non ha mai fumato.

Anche chi smette a 50 anni evita oltre la metà del suo rischio di morte da fumo.

(Doll et al. 2004)

slide13
La mortalità per tumore del polmone, e degli altri tumori legati al tabacco, è in diminuzione negli uomini – ma non nelle donne italiane dal 1988 in poi.
slide18
I morti totali da fumo sono scesi da circa 90.000 per anno nei primi anni ’90 a circa 75.000 oggi, riflettendo la diminuzione nelle abitudini al fumo nei maschi registrate tra il 1980 e il 1995.
slide19
Di essi, circa 25.000 sono tumori del polmone, circa 15.000 altri tumori legati al tabacco, 10-15.000 malattie respiratorie non neoplastiche,

20-25.000 malattie cardio e cerebrovascolari, e

5-10.000 morti per altre malattie.

slide25

Oral cancer

(Bosetti et al., 2000)

slide41

Oral cancer – stopping smoking

(La Vecchia et al., 1999)

smoking in italy 2004 results from a survey doxa

Smoking in Italy, 2004Results from a survey (DOXA)

Percent distribution and trend of smoking in Italy (2004)

Tobacco dependence in the Italian population

Economic aspects of smoking

Smuggling

Cigarette vending machines

Smoking laws and regulations

percent prevalence of smoking among adults according to eight doxa surveys italy 1957 2004
Percent prevalence of smoking among adults according to eight DOXA surveys. Italy, 1957-2004.
age standardized percent prevalence of current smokers according to education and sex italy 2004
Age-standardized percent prevalence of current smokers according to education and sex. Italy, 2004.
tobacco dependence
Tobacco dependence
  • A six-item Fagerström questionnaire was used in two surveys on smoking, conducted in 2002-2003.
  • Subjects were 6,773 individuals representative of the Italian adult population.
  • 27.1% of individuals (1,837) described themselves as current cigarette smokers (32.1% men, 22.4% women).
tobacco dependence1
Tobacco dependence
  • Of all smokers, 13.8% were classified as high and only 3.8% as very high dependent.
  • The proportion of high + very high dependent smokers was 21.4% among men and 12.5% among women.
  • The proportion of high + very high dependent smokers was 2.8% at age 15-17 and 8.4% at age 18-24.
  • Only 23% of smokers found it difficult to avoid smoking in places where smoking was forbidden.
percent prevalence of 1 837 current smokers according to a 6 items fagerstr m score italy 2002 2003
Percent prevalence of 1,837 current smokers according to a 6-items Fagerström score. Italy, 2002-2003.
economic aspects of smoking in italy
Economic aspects of smoking in Italy.
  • Today 76% of income from cigarette selling are taxes, in line with the other developed countries.
  • Price elasticity of demand for cigarettes had an appreciable impact on smoking prevalence/consumption in several countries
  • We estimated in -0.46 the elasticity for cigarette consumption and –0.30 for smoking prevalence.
  • More than one third of ever smokers in Italy (survey DOXA 2004) had the perception of an intermediate/high influence of cigarette price on tobacco consumption in the young.
slide53
Comparison between the number of cigarettes smoked (official legal sales) and the real price of a pack of cigarettes. Italy, 1970-2001.
smuggling in italy
Smuggling in Italy
  • Smuggling has probably increased between 1985 and 1995, but its relevance is not clear.
  • In the 90’s it has been estimated in 10-30% the proportion of smuggling in the whole tobacco trading
  • Today we estimated (survey DOXA, 2004) in less then 5% the proportion of smuggling.
  • However, our estimate was self-reported, thus probably under-reported.
cigarette vending machines
Cigarette vending machines
  • In 2003, cigarette vending machines accounted for 15% of tobacco sales to Italian minors who smoked (aged 13-17 years).
  • To restrict sales, in particular to the youngest, from January 2004, vending machines are closed in Italy between 7 a.m. and 11 p.m.
  • In 2004, still 37% of smokers uses vending machines (~7.5% of cigarettes bought). 56% (~13.7% of cigarettes bought) when considering younger smokers (15-24 years).
main laws and decrees in italy
Main laws and decrees in Italy
  • 1962: (Law) Tobacco advertising forbidden.
  • 1975: (Law) Smoking forbidden in hospitals, schools, public transports, railway station waiting rooms, cinemas, museums, public libraries, theatres…
  • 1976: (Minister’s Decree) Smoking forbidden in schools, universities, areas of public administration open to the public.
  • 1980: (Decree by the President of the Republic) Smoking forbidden in trains (apart in smoking areas), waiting rooms and railway station stops.
  • 1990: (Minister’s Decree) Health warnings on cigarette packs and amount of nicotine and tar yield.
  • 1991: (Minister’s Decree) Tobacco promotion forbidden on television.
  • 1996: (Judgement by Constitutional Court) Employers must avoid exposure to passive smoking, to protect worker’s health.
  • 1997: (Law) Cigarettes must have a maximum tar yield of 12 mg.
  • 2004: (Laweffective from January 2005) smoking banned in several public areas, including cafes, restaurants, as well as in the workplace.
response to smoking regulation survey italy 2004
Response to smoking regulation survey. Italy, 2004.
  • In the survey by DOXA in 2004, for ever-smokers, two specific questions on the support of smoke-free policies were formulated as follow:
    • Do you agree or not to separate smoking areas in cafes and restaurants… and to ban smoking in their absence?
    • Do you agree or not to forbid to smoke in all the workplaces?”.
  • Every question had a structured, four-item score (strongly in favour to strongly against).