3. Additional Information:

Smoking is declining in the West, but tobacco companies still exist. Where are the cigarettes going?  Many are being dumped in the third world. What is the effect of this shift?

The WHO reports that in 2002, 4.9 million premature deaths world wide were attributed to smoking (600,000 of them in China alone). This figure is expected to rise to 9 million by 2020. Note that deaths lag about 30-50 years behind cigarette consumption, so death rates will continue to rise even if fewer children take up smoking.

• From the WHO report: "Of all the children alive today in China, around 50 million will die prematurely from tobacco use related disease"
• More than 50% of men smoke in Cambodia, China, Fiji, Japan, Kiribati, Mongolia, Nauru, Niue, Republic of Korea, Philippines, Tokelau, Tonga, Tuvalu and Viet Nam.
• Another publication called "The Tobacco Atlas" has some wonderful statistics and quotable quotes that could be used in communicating risks with your patients. Go check it out!   Here are some facts from it:
• Some of the lowest smoking rates for males are in Sweden, Libya, and Nigeria (all below 20%). The highest rates for males (>60%) are in Asia: China, Russia, Mongolia, Kazakhstan.
• The picture for women, however, is completely different. In most Muslim countries, and also in India, China and South-East Asia, men smoke 10 or more times more frequently than women. The highest smoking prevalence for women is in Argentina, Venezuela, Norway, France, Germany and in the Balkan countries. Tobacco companies are targeting women as a large untapped market.
• "Cigarettes kill half of lifetime users. Half die in middle age - between 35 and 69 years old. No other consumer product is as dangerous..."
• "Of everyone alive today, 500,000,000 will eventually be killed by tobacco."
• "While 100 million died from tobacco use in the 20th century, ten times as many will die in the 21st century."

The WHO portrays smoking trends as a pandemic in four stages.

1. In Stage 1, smoking prevalence is low, mainly confined to males, and there are few deaths due to lung cancer or other smoking-related diseases. Some sub-saharan African countries are still in this stage.
2. In Stage 2, smoking rises to over 50% prevalence in men, with earlier smoking in adolescence. Lung cancer deaths increase. There is little tobacco control. Several Asian and Latin American countries are currently in this stage.
3. In Stage 3, health education begins to decrease public acceptance of smoking, and there is a down turn in smoking among men, and a slower decrease among women, so that rates converge for the two sexes. Because of the lag time, smoking-related deaths continue to increase, forming 10% to 30% of all deaths. Southern and Eastern European countries currently fit this pattern.
4. In Stage 4 there is a marked decline in smoking prevalence; smoking-related mortality peaks at about 30% of all deaths and then declines. Northern Europe and North America are in this stage, although there is considerable variation in tobacco control.

Updated September 9, 2014