Last updated February 2011 Demographics and Health Effects Revised 05/06.
Transcript of Last updated February 2011 Demographics and Health Effects Revised 05/06.
Last updated February 2011
Demographics andHealth Effects
Revised 05/06
Last updated February 2011
Demographics and Health Effects Section
Revised 05/06
Chair Ann Malarcher Centers for Disease Control and Prevention, Atlanta, USA
Peter Anderson Indept. Consultant in Public Health, Spain
Mary-Jane Ashley University of Toronto, Canada
Shanta R Dube Centers for Disease Control and Prevention, Atlanta, USA
Linda Pederson Centers for Disease Control and Prevention, Atlanta, USA
Jonathan Samet Johns Hopkins University, School of Hygiene and Public Health, Baltimore, USA
Michael Thun American Cancer Society, Atlanta, USA
Last updated February 2011
Health and Economic Costs of Tobacco Use
Last updated February 2011
Estimates are based on data and information from the World Health Organization* Childhood and maternal under nutrition includes: vitamin A Deficiency, zinc, iron; under weight 1 Years of life lost
Global burden of disease and injury attributableto selected risk factors, 2000 (Total in thousands)
Risk Factor Deaths (thousands)
% of total deaths
YLLs1 (thousands)
As % of total YLLs1
Childhood and maternal under nutrition*
6,156 11.0 205,372 22.4
Tobacco 4,907 8.8 45,622 5.0
Blood Pressure 7,141 12.5 55,548 6.0
Physical Inactivity 1,922 3.4 15,841 1.7
Occupation 784 1.4 9,975 1.1
Unsafe sex 2,886 5.2 76,970 8.4
Alcohol 1,800 3.2 32,697 3.6
Unsafe water, sanitation and hygiene
1,730 3.1 49,232 5.4
Illicit drugs 204 .4 4,819 .5
Urban air pollution 799 1.4 6,404 .7
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AFRO African Region
AMERO Region of the Americas
EMRO Eastern Mediterranean Region
EURO European Region
SEARO South-East Asia Region
WPRO Western Pacific Region
Last updated February 2011
Projected global burden of lung cancer in 2030
Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. World Health Organization
Region Total deaths(thousands)
Male Female
AFRO 39 31 8
AMRO 288 185 103
EMRO 76 61 16
EURO 362 226 137
SEARO 467 364 103
WPRO 984 656 328
WORLD 2,216 1,522 694
Last updated February 2011
Projected global burden of ischemic heart disease in 2030
Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. World Health Organization
Region Total deaths (thousands)
Male Female
AFRO 610 312 298
AMRO 1,321 638 683
EMRO 1,026 539 487
EURO 2,223 982 1,241
SEARO 3,187 1,627 1,559
WPRO 1,369 604 765
WORLD 9,737 4,702 5,034
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Projected global burden of COPD in 2030
Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. World Health Organization
Region Total deaths (thousands)
Male Female
AFRO 243 159 84
AMRO 379 216 163
EMRO 236 131 105
EURO 354 165 189
SEARO 1,537 886 651
WPRO 3,148 1,425 1,723
WORLD 5,896 2,981 2,915
Last updated February 2011
Projected global burden of cerebrovascular disease in 2030
Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. World Health Organization
Region Total deaths (thousands)
Male Female
AFRO 672 269 402
AMRO 659 277 382
EMRO 451 208 243
EURO 1,400 510 890
SEARO 1,816 807 1,009
WPRO 2,679 1,189 1,491
WORLD 7,677 3,260 4,417
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Burden of disease and injury attributable to tobacco use, 2000
Estimates are based on data and information from the World Health Organization1 Years of life lost
Region Deaths(thousands)
As % of total deaths
YLLs1 (thousands)
As % of total YLLs1
AFRO 160 1.5 2,002 .7
AMRO 873 14.9 6,548 9.7
EMRO 186 4.6 2,279 2.6
EURO 1,605 16.7 14,839 17.7
SEARO 1,110 7.8 12,264 4.6
WPRO 975 8.4 7,692 5.5
WORLD 4,907 8.8 45,622 5.0
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*Age-adjusted to the 2000 US standard population. US Mortality Public Use Data Tapes 1960-2003, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
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10019
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1995
2000
Lung
Colon & rectum
Stomach
Rate Per 100,000
Prostate
Pancreas
LiverLeukemia
Cancer Death Rates*, for Men, US,1930-2003
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Cancer Death Rates*, for Women, US,1930-2003
*Age-adjusted to the 2000 US standard population. US Mortality Public Use Data Tapes 1960-2003, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
Rate Per 100,000
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Smoking-Attributable Mortality Fractions Among Males in the United States, 2001
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Smoking-Attributable Mortality Fractions Among Females in the United States, 2001
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CDC, Adult SAMMEC, http://apps.nccd.cdc.gov/sammec/
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Ischmeic Heart Disease; 86,801
Other Diagnosis; 35,502
Other Cancers; 34,693
Secon Hand Smoke Deaths; 38,112
Lung Cancer; 123,836 Respiratory Diseases; 101,454
Stroke (Cerbovascular Disease); 17,436
CDC. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, 1997-2001. MMWR 2005;54(25): 625-628
Nearly 440,000 Average Annual Deaths Attributable to Cigarette Smoking – United States, 1997-2001
Ischemic Heart Disease; 86,801
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National Center for Health Statistics, Deaths: Final Deaths 2003. National Vital Statistics Report, 2006; 54(13); Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses- United States, 1997-2001; MMWR. 2005:54(25):625-628.
14 2145
18 29 31
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04080
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Num
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eath
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Annual Deaths from Smoking Compared with Selected Other Causes in the United States
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One out of two lifelong
adult smokers will die
from a smoking related
disease.
CDC. Projected smoking-related deaths among youth – United States. MMWR 1996;45(44):971-974
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Smoking and Health Among Adolescents
• Rapid addiction to nicotine from early smoking• More likely to use other drugs (alcohol, marijuana, &
cocaine) • More likely to be involved in other risky behaviors• Poorer overall health• Increased resting heart rates
USDHHS. Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994; Arday, DR, et al. Cigarette smoking and self-reported health problems among US high school seniors, 1982-1989Am J of Health Promotion 1995;10(2):111-116.
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Smoking and Health Among Adolescents
Increased effects on the respiratory system• Increased wheezing, gasping and shortness of
breath• Increased coughing and phlegm production• Decreased physical performance• Decreased endurance• Reduced lung function• Slowed growth of lung function
USDHHS. Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994; Arday et al. Cigarette smoking and self-reported health problems among US high school seniors, 1982-1989. Am J Health Promot 1995;10: 111-116.
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Effects of Smoking and Pregnancy/Reproduction
• Reduced Fertility• Reduced risk for preclampsia• Fetal growth restriction • Increased risk of premature rupture of the membranes,
placenta previa, & placental abruption • Increased risk of preterm delivery & shortened gestation
USDHHS. The Health Consequences of Smoking: A Report of the Surgeon General, 2004.
Last updated February 2011
• Increased risk of low birth weight• Increased risk of perinatal mortality (stillbirth & neonatal
deaths)• Increased risk of reduction of lung function in infants• Increased risk of sudden infant death syndrome (SIDS)
USDHHS. The Health Consequences of Smoking: A Report of the Surgeon General, 2004.
Effects of Smoking and Pregnancy/Reproduction
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Health Effects of Secondhand Smoke
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Contents of Secondhand Smoke (SHS)
• Cigarette smoke contains more than 7000 chemical compounds
• Sixty nine chemicals in tobacco smoke are known or probable carcinogens
• SHS is a known human carcinogen
USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.
Last updated February 2011
“An hour a day in a room with smoke is nearly a hundred times more likely to cause lung cancer in a non-smoker than 20 years spent in a building containing asbestos.”
-Sir Richard Doll, 1985
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Health Effects of Secondhand Smoke - Adults
• SHS exposure causes lung cancer among lifetime nonsmokers
• SHS exposure associated with living with a smoker increases risk of lung cancer by 20%-30%.
• SHS exposure causes coronary heart disease morbidity and mortality
• SHS exposure increases risk of heart disease by 25%-30%
• SHS exposure causes increased respiratory symptoms of odor annoyance & nasal irritation
USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.
Last updated February 2011
Health Effects of Secondhand Smoke -Children
• SHS exposure causes sudden infant death syndrome (SIDS)
• Maternal exposure to SHS during pregnancy causes a small reduction in birth weight
• SHS exposure after birth causes a lower level of lung function
• SHS exposure from parental smoking causes lower respiratory illness in infants and children
USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.
Last updated February 2011
• SHS from parental smoking causes cough, phlegm, wheeze and breathlessness in school age children
• SHS from parental smoking causes exacerbations of asthma
• SHS exposure from parental smoking causes the onset of wheeze illness in early childhood
• SHS exposure from parental smoking causes middle ear disease (acute and recurrent otitis media, chronic middle ear effusion)
USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.
Health Effects of Secondhand Smoke -Children
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Approximately, 5 million people will die from tobacco related illness this year. By 2030, 10 million people will
die each year.
World Health Organization. The Tobacco Atlas (2002). http://www.who.int/tobacco/en/atlas11.pdf Ezzati & Lopez. Estimates of Global Mortality Attributable to Smoking in 2000. Lancet 2003; 362: 847-852.
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Benefits of Cessation
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Benefits of Cessation Overall
• Former smokers live longer compared with continuing smokers
• Smoking cessation reduces risk of premature death• Risk of death decrease shortly after quitting• Smoking cessation benefits almost every part of the body
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011
Smoking Cessation and Lungs
• Lung function starts to improve 2-3 months after quitting• Smoking cessation reduces risk of lung cancer, 10 years
after quitting, the risk of lung cancer decreases to 30- 50% that of a continuing smoker
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011
Smoking Cessation and the Respiratory System
• Risk of death from Chronic Obstructive Pulmonary Disease is decreased after quitting
• Risk of upper and lower respiratory illness such as colds, flu, bronchitis and pneumonia is lowered
• Coughing, sinus congestion, fatigue and shortness of breath decrease 2-3 months after quitting
• Smoking cessation lowers risk of larynx cancer
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011
Smoking Cessation and the Heart
• Smoking cessation reduces the excess risk of dying from abdominal aortic aneurysm by 50% among former smokers
• Risk of coronary heart disease decreases by half 1-2 years after quitting
• After 15 years of quitting, coronary heart disease risk is nearly that of a non-smoker
• Among persons diagnosed with cardiovascular heart disease, smoking cessation reduces risk of recurrent infarction and cardiovascular death
• After quitting peripheral artery disease decreases
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011
Smoking Cessation and Other Parts of the Body
• Stroke risk is reduced to that of a never smoker after 5 to 15 years of cessation
• Risk of mouth, throat, and esophagus cancers are halved five years after quitting
• Bladder cancer risk is halved a few years after quitting• Smoking cessation lowers the risk of kidney, stomach,
pancreatic and cervical cancer• Smoking cessation lowers risk of peptic ulcers
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011
Smoking Cessation and Pregnancy
• Quitting smoking before or early during pregnancy lowers risk of miscarriage, low birth weight of baby and SIDS
• Although abstinence early in pregnancy will produce the greatest benefits to the fetus and expectant mother, quitting at any point in pregnancy can yield benefits
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
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Summary: Health Benefits of Smoking Cessation
• Smoking cessation has major and immediate health benefits for men and women of all ages
• Benefits apply to persons with and without smoking-related diseases
• Former smokers live longer than continuing smokers• Smoking cessation decreases the risk of lung and other
cancers, heart attack, stroke, and chronic lung disease• Smoking cessation improves reproductive outcomes
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
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Tobacco Dependence
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"In a sense, the tobacco industry may be thought of as being a specialized, highly ritualized, and stylized segment of the pharmaceutical industry. Tobacco
products uniquely contain and deliver nicotine, a potent drug with a variety of physiological effects."
-1972 Claude Teague memo "RJR Confidential Research Planning Memorandum on the Nature of the
Tobacco Business and the Crucial Role of Nicotine Therein”
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Frequency of Cigarette Use, 2004
SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health
02468
1012141618
12 17 24 30-34 40-49 50-65
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Per
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Tobacco Dependence in the United States, 2004
• 35.5 million Americans 12 years or older met the criteria for nicotine dependence in the past month based on their cigarette use
• 1.1 million youth 12 to 17 years old are nicotine dependent cigarette smokers
• The rate of dependence is higher for those who start smoking at an earlier age than for those who initiate cigarette use later in life
SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health
Last updated February 2011
Nicotine Dependence among Past Month Smokers, by age, 2004
SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health
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Relapse Rate Over Time
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USDHHS. The Health and Consequences of Tobacco: Nicotine Addiction. A Report of the Surgeon General, 1988.
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80,000 to 100,000 young people around the world become addicted to tobacco, everyday.
World Bank, Curbing the Epidemic: Governments and the Economics of Tobacco Control (Washington: World Bank, 1999).
Last updated February 2011
Effective Treatment Interventions
Last updated February 2011
Effective Treatment Interventions
• Brief advice to quit from doctors, nurses and other healthcare providers
• Group counseling• Individual counseling• Telephone counseling• Pharmacotherapy
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Last updated February 2011
Identification and Assessment of Tobacco Use
• Assisting the patient in quitting (5A’s)– Ask – Systematically identify all tobacco users at
every visit – Advise – Strongly urge all tobacco users to quit– Assess – Determine willingness to make a quit
attempt– Assist – Aid the patient in quitting– Arrange – Schedule follow-up contact
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Last updated February 2011
Effective counseling treatment for tobacco use and dependence
• Practical counseling (problem solving/skills training)• Intra-treatment social support
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Last updated February 2011
Elements of counseling
• Practical Counseling – Recognize danger situations– Develop coping skills– Provide basic information
• Supportive Counseling – Encourage the patient in the quit attempt– Communicate caring and concern– Encourage the patient to talk about the quitting
process
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Last updated February 2011
Effective pharmacotherapy for smoking cessation
• Pharmacotherapy that reliably increase long term smoking abstinence rates
• Bupropion • Nicotine gum, inhaler, nasal spray, lozenge and
patch• Varenicline• Clonidine and Nortriptyline can be used if other
pharmacotherapy is not effective
Last updated February 2011
Motivational intervention for those unwilling to quit consist of the 5 R’s
• Relevance – Encourage patient to identify why quitting is relevant
• Risks – Ask patient to identify potential negative consequences of tobacco use
• Rewards – Ask patient to identify potential benefits of quitting
• Roadblocks – Ask patient to identify barriers to quitting• Repetition – Repeat motivational intervention every time
unmotivated patient enters a clinical setting
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Last updated February 2011
• Increase the unit price for tobacco products• Mass media education campaigns combined with other
interventions to inform and motivate tobacco users to quit• Provider reminder systems that identify patients who use
tobacco products and prompt providers to discuss cessation with their client or advise client to quit at every encounter
Task Force on Community Preventative Services. Zaza S, Briss PA, Harris, KW (eds). The Guide to CommunityPreventative Services. Oxford University Press. New York, New York, 2005.
Recommendations for increasing tobacco cessation
Last updated February 2011
• Provider reminder plus provider education, with or without client education
• Reduction of out-of pocket costs for effective cessation therapies
• Multi-component interventions that include client telephone support
Task Force on Community Preventative Services. Zaza S, Briss PA, Harris, KW (eds). The Guide to CommunityPreventative Services. Oxford University Press. New York, New York, 2005.
Recommendations for increasing tobacco cessation
Last updated February 2011
• Standardization of care for routine, effective treatment of tobacco use needs
• Continuous screening of tobacco use among those who enter the health care system
• Availability of effective intensive treatments that includes counseling and pharmacotherapy
Recommendations for increasing tobacco cessation
Last updated February 2011
Recommendations for increasing tobacco cessation
• Treatment that emphasizes problem-solving and within-treatment social support
• Extended or augmented psychosocial interventions beyond minimal advice to quit for pregnant smokers
• Institutionalize system changes that are essential to ensure that clinical interventions occur