This video presents material on the epidemiology
of tobacco use, including the relationship between tobacco
products, users and involuntary users, tobacco product
manufacturers, and environmental factors.
Tobacco use is the single-most preventable cause
of death in the world, killing more people
than AIDS, tuberculosis, and malaria combined.
Nearly 6 million people die each year
from tobacco-related diseases.
And this number is expected to rise to 8 million
by the year 2030.
One in two smokers will die from smoking.
When used as intended, tobacco will kill half of its users.
Many of the leading causes of death
around the world such as cardiovascular disease,
chronic obstructive lung disease, and lung cancer
are caused by tobacco use.
The smoke produced when a cigarette is burned,
known as secondhand smoke, also contributes
to morbidity and mortality.
Exposure to secondhand smoke occurs in homes, at work,
and in public areas and puts many nonsmokers
at risk including children and pregnant women.
Worldwide at least 40% of children
and 33% of nonsmoking adults are exposed to secondhand smoke.
The western Pacific region has the highest rate
of secondhand smoke exposure with more than 50%
of the population exposed to secondhand smoke.
Secondhand smoke is responsible for 10%
of tobacco-related deaths, and 28% of these deaths
are children.
Tobacco comes in many forms.
And whether it is inhaled, sniffed, sucked, or chewed,
there is no safe way of using it.
By far, the most common form is manufactured cigarettes,
which make up 96% of tobacco sales worldwide.
Other forms of smoking tobacco include
Bidis, popular in Southeast Asia and heavily
smoked in Bangladesh and India, Kretek,
which are clove-flavored cigarettes
popular in Indonesia, and Water Pipe, also known
as Hookah, Shisha, Hubble Bubble, and Nargile.
Its use is most prevalent in North Africa,
the Mediterranean, and parts of Asia.
But it is also increasing in popularity
in other parts of the world.
Types of smokeless tobacco include
chewing tobacco, such as Zarda, Gutkha, and Khaini,
which are popular in India and Bangladesh,
and moist snuff, which originated in Sweden
but is increasing in popularity globally.
20% of adults around the world smoke cigarettes.
In 2009 5.9 trillion cigarettes were consumed.
That's enough for every person in the world
to smoke 865 cigarettes or 43 packs.
Cigarette consumption was historically
highest in high-income countries.
But it has been steadily increasing
in low-and-middle-income countries due to increased
marketing, increased social acceptability,
continued economic development, and population increases.
Between 2002 and 2009 cigarette consumption
increased by 57% in the Middle East and Africa,
by 48% in the western Pacific, by 24% in Europe,
and by 11% in the Americas.
The top five countries for cigarette consumption
include China at 2.3 trillion cigarettes per year,
Russia at 390 billion, the United States at 316 billion,
Indonesia at 261 billion, and Japan at 234 billion.
In India the consumption of manufactured cigarettes
may seem low at about 100 billion,
but if Bidis are included, the consumption
would be close to a trillion.
Manufacturing tobacco is a profitable enterprise.
In 2010, the six leading tobacco companies'
total combined revenue was $346.2 billion.
Their combined profit was $35.1 billion.
These profit margins are equal to Microsoft, Coca-Cola,
and McDonald's 2010 profits combined.
While the majority of tobacco consumption in the world
is through cigarettes, smokeless tobacco
is an increasing problem.
Containing the same carcinogens and toxins as cigarettes,
some smokeless tobacco products combine tobacco
with chemical additives and other ingredients that may pose
additional risk to the user.
In addition to causing some of the same diseases as smoking,
smokeless tobacco use also increases
tooth loss, precancerous mouth lesions, and gum disease.
In some countries such as India, Bangladesh,
and other countries in the Southeast Asia region,
more tobacco users use smokeless tobacco than smoke
or they do both, which is known as dual use.
Specific health consequences from combustible tobacco use
and smokeless tobacco use are well documented.
However, less information is known about dual users'
additional risks.
Dual use is concerning because it has the potential
to prolong nicotine dependence and slow reductions
in prevalence.
Countries generally go through stages of the tobacco
epidemic over time.
And we have seen a pattern develop
with the smoking prevalence and smoking-related deaths
within countries.
In the first stage, smoking prevalence
increases within a country, and deaths caused by smoking
are small.
In the second stage, the prevalence increases rapidly,
and smoking-related deaths begin to rise.
In the third stage, smoking prevalence peaks
and begins to decline, but smoking-related deaths
increase more rapidly.
And in the fourth and final stage,
smoking prevalence continues to decline
while smoking-related deaths continue to rise.
High-income countries are mainly in the fourth stage,
whereas low-and-middle-income countries are in the second
stage.
In fact, worldwide 80% of male tobacco users and 50% of female
tobacco users live in low-and-middle-income
countries.
In adolescence the difference in the rates
of smoking between boys and girls
is much smaller than the difference typically seen
between men and women.
In 25 countries more girls smoke than boys.
Overall we see that the majority of smokers
begin smoking in their youth.
In the United States, 83% of smokers
begin smoking before the age of 18.
The same pattern is seen in many other parts of the world.
Many youth start smoking due to motivation
by peers, the desire to appear cool to friends,
the persuasive tactics used in tobacco marketing,
and the availability of affordable tobacco products.
Additionally, girls will smoke because of the belief
that it will help with weight loss.
Women in developing countries often
start smoking due to the tobacco industry's marketed association
that smoking makes women equal to men
in power and independence.
In addition to the direct health affects
tobacco use has on people, the tobacco epidemic
results in costs to society.
Direct medical costs of treating tobacco-related illnesses
can be significant.
For example in Egypt and Mexico, over 10%
of health care expenses are spent
on treating tobacco-related illnesses.
Direct medical costs don't account
for the indirect costs of tobacco use,
such as loss of labor productivity, cigarette butt
littering, and fire damage from cigarette use.
Tobacco use is expensive to society in terms of health care
expenditures and lives lost.
While the epidemic is decreasing in developed countries,
less developed countries are in the early stages of the tobacco
epidemic.
There are multiple forms of tobacco use.
And patterns of use are changing.
Fortunately there are proven population-level policies
and strategies, such as smoke-free air policies,
cessation assistance, and taxation,
that when implemented fully can help
make the next generation tobacco free.