Cigarette smoking is a major cause of illness and death. This new article in our Global Health series reviews both the magnitude of the disease burden from cigarette smoking worldwide and strategies to limit smoking.
On the basis of current smoking patterns, with a global average of about 50% of young men and 10% of young women becoming smokers and relatively few stopping, annual tobacco-related deaths will rise from about 5 million in 2010 to more than 10 million a few decades hence.
The 2013 World Health Assembly called on governments to reduce the prevalence of smoking by about a third by 2025, which would avoid more than 200 million deaths from tobacco during the remainder of the century. Price is the key determinant of smoking uptake and cessation. Worldwide, a reduction of about a third could be achieved by doubling the inflation-adjusted price of cigarettes, which in many low- and middle-income countries could be achieved by tripling the specific excise tax on tobacco. Without large price increases, a reduction in smoking by a third would be difficult to achieve.
Large studies in the United Kingdom, the United States, Japan, and India have examined the eventual effects on mortality in populations of men and of women in which many began to smoke in early adult life and did not quit. All these studies showed that in middle age (about 30 to 69 years of age), mortality among cigarette smokers was two to three times the mortality among otherwise similar persons who had never smoked, leading to a reduction in life span by an average of about 10 years. This average reduction combines zero loss for those not killed by tobacco with an average loss of well over a decade for those who are killed by it. Many of those killed are still in middle age, losing many years of life. Some of those killed in middle age might have died soon anyway, but others might have lived on for decades. On average, those killed in middle age by smoking lose about 20 years of life expectancy as compared with persons who have never smoked.
Morning Report Questions
Q: What are the benefits of tobacco cessation on mortality?
A: Whereas tobacco-attributable mortality increases slowly after the uptake of smoking, the effects of cessation emerge more rapidly. Persons who began smoking in early adulthood but stopped before 40 years of age avoid more than 90% of the excess risk during their next few decades of life, as compared with those who continue to smoke, and even those who stop at 50 years of age avoid more than half the risk, although substantial hazards persist.
Q: How are changes in marketing and advertising changing the tobacco epidemic?
A: Though tobacco advertising is banned throughout the European Union, China, and some other countries, cigarettes are still among the most heavily advertised and promoted products in the world, with spending on tobacco marketing reaching $8.6 billion annually in the United States alone. In 2011 Australia, which had already banned advertising, introduced plain packaging for tobacco products, removing all brand imagery. The brand is printed only in small standard lettering below a pictorial warning. Recent evidence suggests that plain packaging increases cessation attempts. New Zealand will introduce plain packaging in 2014, and the United Kingdom is considering it. Pictorial warnings can reach even illiterate persons; half the deaths from tobacco in India occur among the illiterate. In the United States and the United Kingdom, bans on tobacco advertising on television coincided with the start of the long-term downturn in sales, although these partial bans on advertising allowed the industry to shift to other forms of advertising or promotion. More comprehensive bans on all direct and indirect advertising or promotion of any tobacco goods or trademarks further help to reduce consumption and have the advantage of severing any dependence of the media on the tobacco industry.