Stages of the cigarette epidemic on entering its second century

Abstract

Objectives A four-stage model of the cigarette epidemic was proposed in 1994 to communicate the long delay between the widespread uptake of cigarette smoking and its full effects on mortality, as had been experienced in economically developed countries where cigarette smoking became entrenched decades earlier in men than in women. In the present work, the question of whether qualitative predictions from the model have matched recent trends in smoking and deaths from smoking in countries at various levels of economic development is assessed, and possible projections to the year 2025 are considered.Methods The proportion of all deaths attributed to tobacco was estimated indirectly for 41 high-resource and medium-resource countries from 1950 to the most recent year for which data were available, generally about 2005e2009. The trends in tobacco-attributed mortality in later middle age were then projected forward to 2025, based on recent trends in tobacco-attributed mortality in early middle age. Results In developed countries the prevalence of smoking has continued to decrease in both sexes, although the rate of decrease has slowed and is less than that predicted by the original version of the model. Over the past 20 years the proportionate contribution of smoking to all deaths has decreased in men while continuing to increase or plateau among women. Although the proportion of all deaths at ages 35e69 that are attributed to smoking is still generally greater in men than in women, the male and female proportions are converging and will probably cross over in some high resource countries. Projections through to 2025 suggest that male and female smoking prevalence and smokingattributed mortality will decrease in parallel in most developed countries towards lower limits that are not yet defined. In developing countries the model seems generally applicable to men but cannot predict whether or when women will begin smoking in large numbers. Modified criteria that describe the stages of the epidemic separately for men and women would be more generalisable to developing countries. Conclusions The four-stage model of the cigarette epidemic still provides a reasonably useful description in many developed countries. Its relevance to developing countries could be improved by describing the stages of the epidemic separately for men and women.

Survival After Surgical Resection for Lung Cancer in Patients With Chronic Obstructive Pulmonary Disease

“…In elderly patients (> 66 years), the proportion of never smoking females was significantly higher, 17% versus 5% among males. The changing trends in smoking habits, indicates that the male and female proportions of deaths due to smoking induced cancers are converging and may probably cross over in some industrial countries [25]. It has been suggested that females are more susceptible to develop lung cancer from smoking than males.…”

“…The percentage of daily smokers in Norway as in other developed countries has steadily decreased since 1990, and in 2015, the age-standardized prevalence of daily smoking was 15% in both men and women [24]. However, the rates of occurrence of lung cancer related to smoking lag behind smoking rates by about 20 years [25]. Hence, the expected decrease in lung cancer incidence due to decreased smoking is now probably seen among men, but not yet in women.…”

Tracing the cigarette epidemic: An age-period-cohort study of education, gender and smoking using a pseudo-panel approach

“…Yet, there are some signs that smoking among low-SEP groups is more resilient to antismoking measures than previously predicted (Thun et al, 2012). Even though smoking has decreased among all socio-economic groups, some studies have found that differences between groups have remained stable or even increased over time (Escobedo and Peddicord, 1996;Giskes et al, 2005;Peretti-Watel et al, 2009), which suggest that that diffusion has been blocked or delayed.…”

“…The pattern was similar in Norway, although peak cigarette consumption was lower and occurred more than 10 years later (around 2100 cigarettes per year in 1975). Given the shape of the cigarette consumption and the cigarette smoking prevalence curves over time, the rise and fall of cigarette smoking has typically been described as an epidemic (Lopez et al, 1994;Thun et al, 2012).…”

Clase social, desigualdades en salud y conductas relacionadas con la salud de la población trabajadora en Chile

“…Varios estudios han comprobado la asociación entre clase social y variables como salud autopercibida, salud mental y conductas relacionadas con la salud (3,(6)(7). El tabaquismo, por ejemplo, empieza primero en hombres y en personas de clases privilegiadas, para después pasar a las mujeres y personas de clases trabajadoras (11). Sobre la actividad física, otra importante variable de salud pública, hay estudios que muestran que las personas de clases trabajadoras realizan menos ejercicio físico (12,13), mientras que otros notifican una mayor prevalencia de inactividad en las clases sociales más privilegiadas (14).…”