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 six million people die each year from tobacco related
diseases, and this number is expected
to rise to eight 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 non-smokers at risk,
including children and pregnant women.
Worldwide, at least 40% of children
and 33% off non-smoking adults are
exposed to second hand 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
beedies, popular in southeast Asia
and heavily smoked in Bangladesh and India,
kreteks, which are clove flavored cigarettes
popular in Indonesia, and water pipe, also known
as hookah, shisha, hitboo, 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, gutka, 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 2000 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 beedies 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 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 then 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 may 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 effects
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.