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Global Smoking Epidemic

Global Smoking Epidemic. Prof. Elif Dağlı Marmara University Istanbul Turkey. Why is tobacco control a priority ?. 1.1 billion smokers worldwide, 800 million in developing countries By 2030: 10 million deaths/year, and tobacco is likely to be the biggest cause of death worldwide

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Global Smoking Epidemic

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  1. Global Smoking Epidemic Prof. Elif Dağlı Marmara University Istanbul Turkey

  2. Why is tobacco control a priority ? • 1.1 billion smokers worldwide, 800 million in developing countries • By 2030: 10 million deaths/year, and tobacco is likely to be the biggest cause of death worldwide • Burden is shifting to developing world • Globally, 80,000 to 100,000 youth start smoking every day • Smokers do not know the health risks • Tobacco is very addictive, its hard to quit Source: Curbing the Epidemic, 1999

  3. Main-stream smoke the smoked exhaled by the smoker Side-stream smoke Emitted from the burning cone. (85% of the smoke) Environmental Tobacco Smoke

  4. Cigarette smoke contains particulate matter and more than 4000 chemical compounds. These include: • carcinogens and mitogens such as nitrosamines and nicotine; • cilia toxic substances such as formaldehyde, cyanide and acid aldehyde; • irritants such as ammonia, carbon monoxide and nitrogen oxides

  5. Cigarette smoke has the capacity to damage the bronchi in a number of ways: • direct toxicity to the bronchial • epithelium, • oxidative damage, • recruitment of inflammatory cells, • increased epithelial permeability, Rahman I, McNee W. Thorax 1996; 51:348–350   Sunyer J, Anto JM, Kogevinas M, et al. Thorax 1997; 52:235–238   Roth MD, Arora A, Barsky SH, et al. Am J Respir Crit Care Med 1998; 157:928-937   Di Stefano A, Capelli A, Lusuardi M, et al. Am J Respir Crit Care Med 1998; 158:1277–1285  

  6. NICOTINE Dendritic cells Nicotine can exert its immunosuppressive effects on immune surveillance through functional impairment of the DC system. (-) (-) Stimulation of antigen-presenting cell dependent T-cell responses • pro-inflammatory • cytokines • interleukin-12 (-) induction of differentiation and expansion of type TH1 cells interferon-gamma-producing effector cells Nouri-Shirazi M - Immunology - 2003; 109(3): 365-73

  7. BALF of non-symptomatic smokers vs non-smokers • No cells spontaneously secreting IL-2 • Reduced number of IFN-gamma-secreting cells • Decreased mitogen-stimulated Th(1) cytokine-secreting cells • Cigarette smoking depletes Th(1) cytokine-secreting cells in the human airway. • It may explain the susceptibility of smokers to certain airway diseases Hagiwara E - Cytokine 2001; 14(2): 121-6

  8. BAL specimens from nonasthmatic smokers have greater concentrations of: • neutrophils, • macrophages, • IL-1β, IL-6, IL-8, • monocyte chemoattractant protein-1 Mio T, et al. Am J Respir Crit Care Med 1997; 155:1770–1776  

  9. Chalmers G W. et al Chest 2001

  10. Smoking increases tuberculosis mortality In India Half of TB male deaths of is due to smoking Tuberculosis mortality increased risk for tobacco use 4.5

  11. * TNF-alfa controls the latency of the mycobacterium. *Nicotine supresses TNF-alfa release. Nicotine *mimics central nervous system parasympathic activity *inhibits noradrenalin and cortisol IL-12 release. *increases Il-10 release

  12. Passive smoking and TB risk Tuber Lung Dis 1996;77:537 Case control study 93 contact 95 contact TB diagnosed TB not diagnosed Urinary cotinine measured Exposure to tobacco smoke at home OR: 5.29 Exposure to tobacco smoke at home and elsewhere OR: 6.35

  13. Four Stages of the Tobacco Epidemic

  14. Tobacco addiction starts early in life • Every day 80,000 to 100,000 youths become regular smokers Source: Chinese Academy of Medicine 1997, Gupta 1996, US Surgeon General Reports, 1989 and 1994, Authors’ calculations

  15. Prevalence of smoking at ages 25-34 in United Kingdom men women 1948-1952 80% 53% 1998 39% 33%

  16. Trend in Cigarette Smoking Among Men and Women in the United States, Ages 18+ 1965-1997 % MMWR. 1999;48(43):998; National Center for Health Statistics 1998.

  17. Youth rates falling too CBRC Research Series No 4 Dec 2003

  18. Adult smoking prevalence (latest available data)

  19. Prevalence of smoking in Australia, Persons aged 14 years and over

  20. Projections if 2% annual reduction between 2004 and 2007, then as before

  21. World consumption has increased last 5 years, due to increasing consumption in developing world. Source: USDA data 1996-2001

  22. Transnational market increase 1991-2000 Global increase 4.4-5.2 % Asian increase 33 %

  23. Global Mortality Mortality Million people 3 million 7 million Year

  24. Global causes of death, 2003 (millions) • High blood pressure 7.0 • Tobacco 4.9 • HIV/AIDS 2.7 • Diarrhoea 1.8 • Malaria 1.3 • Road deaths 1.2 • Suicide 0.9 • Violence/war 0.7 10 million tobacco deaths per annum by year 2030, approx 25% beforeretirement age Source:WHO

  25. 500 400 300 200 Baseline — 100 If youth smoking cut 50% by 2020 — 1950 2000 2025 2050 — If adult smoking cut 50% by 2020 Year Reducing adult smoking is key to reducing deaths in the next 30 years Tobacco deaths (millions) World Bank. Curbing the epidemic: Governments and the economics of tobacco control. World Bank Publications, 1999. p80.

  26. "We believe that nicotine is not addictive"

  27. Comprehensive control policy is vital

  28. So what does the industry scream about? • Tax rises • Smoking restrictions • Advertising bans • Big, hard-hitting TV campaigns which personalise the risks of smoking • Picture-warnings on packs • Putting cigarettes under the counter • Anything that “de-normalises” smoking

  29. What does the tobacco industry support in tobacco control? • “decision-making” school programs • Warning signs in shops about not selling to children • Smokers’ rights • Voluntary codes of advertising control • Corporate social responsibility programs • Quit clinics & cessation advice

  30. Marketing activities after bans • Altering the pack • Lifestyle premiums (give- aways) • The development of corporate websites • Internet marketing • Retailer loyalty programs • Selling as promotion

  31. Product Placement Inserting a brand into a film, concert, theather play, in return for a fee or other benefits -It does not disclose the relation of the payee with the payer -It blurs the commercial relation -It misleads the consumer

  32. Brown and Williamson payed Sylvester Stallone In 1983, 500 000 Dollars in return for smoking in five films

  33. BROSNAN ATTACKS IRELAND'S SMOKING BAN Suave actor PIERCE BROSNAN has attacked his native Ireland for its recent ban on smoking in public places. The 51-year-old complains he has to travel to London to enjoy cigarettes and alcohol with friends, because the new law has destroyed pub culture in his homeland.

  34. The industry collected lists of things reported to be unhealthy or dangerous to try and trivialise the health risks of smoking BW690137964/7983

  35. Cigarette sellers (“Betel Barbies”) in Taiwan streets

  36. Recommendations Governments can control the tobacco epidemic • adopt a comprehensive set of proven measures, tailored to each country • children and adults respond to higher taxes • help current smokers quit • inform the public well • educate & enlist health professionals • IMPLEMENT FCTC

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