Who smokes tobacco?

Stages of worldwide tobacco epidemic. Adapted from Lopez et al. A
descriptive model of the cigarette epidemic in developed countries. Tobacco
Control 1994;3:242-7

Who smokes tobacco?

Cigarette smoking first became a mass phenomenon in the United Kingdom and other more affluent countries in the early 20th century after the introduction of cheap, mass produced, manufactured cigarettes. Typically, a “smoking epidemic” in a population develops in four stages: a rise and then decline in smoking prevalence, followed two to three decades later by a similar trend in smoking related diseases. Usually, the uptake and consequent adverse effects of smoking occur earlier and to a greater degree among men.

Prevalence of smoking of manufactured cigarettes in Great Britain. Data
from Tobacco Advisory Council (1948-70) and general household survey
(1972-2001)

In the United Kingdom there are about 13 million smokers, and worldwide an estimated 1.2 billion. Half of these smokers will die prematurely of a disease caused by their smoking, losing an average of eight years of life; this currently represents four million smokers each year worldwide. Deaths from smoking are projected to increase to more than 10 million a year by 2030, by which time 70% of deaths will be in developing countries.
The prevalence of smoking among adults in the United Kingdom has declined steadily from peaks in the 1940s in men and the late 1960s in women. However, this reduction in overall prevalence during stage 4 of the epidemic disguises relatively static levels of smoking among socioeconomically disadvantaged groups, making smoking one of the most important determinants of social inequalities in health in the developed world. Smoking has also declined much more slowly among young adults in the United Kingdom. The decline in smoking in the United Kingdom and some other developed countries may now be coming to an end. For example, since 1994 the prevalence of smoking in UK adults has remained at about 28%.

Cigarette smoking by deprivation level in Great Britain. Data from general
household survey

Whereas countries in western Europe, Australasia, and the United States may be in stage 4 of the smoking epidemic, in
many developing countries the epidemic is just beginning.
Smoking in low and middle income countries is increasing
rapidly—for example, the prevalence of smoking among male in populous Asian countries is now far higher than in Western countries—45% in India, 53% in Japan, 63% in China, 69% in Indonesia, and 73% in Vietnam.

The problem of tobacco smoking

Cigarette smoking is the single biggest avoidable cause of death and disability in developed countries. Smoking is now increasing rapidly throughout the developing world and is one of the biggest threats to current and future world health. For most smokers, quitting smoking is the single most important thing they can do to improve their health. Encouraging smoking cessation is one of the most effective and cost effective things that doctors and other health professionals can do to improve health and prolong their patients’ lives. This Blog will explore the reasons why smokers smoke, how to help them to quit, and how to reduce the prevalence of smoking more generally.

Preface for SMOKING CESSATION

Smoking kills more people than any other avoidable factor in developed countries. Smoking cessation has a substantial positive impact on quantity and quality of life expectancy in all smokers, and smoking cessation interventions are among the most cost effective interventions available in medicine. It is therefore surprising that in many countries, smoking cessation measures are not routinely available or are not widely used to help smokers to quit smoking. Most medical schools do not train doctors properly to treat smoking, and many doctors and other health professionals are still unfamiliar with the basic underlying principles of smoking as an addictive behaviour, and with methods of intervening to help smokers to quit.

This Blog is intended to provide the basic, simple information needed to equip all health professionals to intervene effectively, efficiently, and constructively to help their patients to stop smoking. The Blog describes how and why people start smoking, why they continue to smoke, and what to do to help them to stop. We describe methods of ensuring that identifying and treating smoking becomes a routine component of health care, and because the best results are generally achieved by specialist smoking cessation services we describe some of the challenges and difficulties of establishing these facilities. As prevention of smoking in populations is such an important determinant of individual motivation to quit or avoid smoking, the authors summarise the population strategies and political policies that can help drive down the prevalence of smoking. For our managers, this Blog covers the cost-effectiveness
of these initiatives.

One of the tragedies of modern clinical medicine is that treating smoking is so simple, has so much to offer, and so often is not done. The methods are not difficult. This Blog explains them.