Tobacco Smoking: The Leading Cause of Preventable Disease Worldwide

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Key points

  • Tobacco smoke is a rich and toxic mixture that causes disease through multiple mechanisms.

  • The burden of disease caused by smoking is enormous, with more than 6 million premature deaths annually.

  • To be effective, a package of tobacco-control measures is needed. Experience in high-income countries shows that tobacco control can be effective in reducing smoking.

Historical background

There is now an extensive body of literature describing the history of tobacco use, the rise of the tobacco industry, and the tactics that it used to sell its lethal products. This section offers a brief summary. For those wanting further information, 3 excellent books provide in-depth coverage: Ashes to Ashes by Richard Kluger (1996), The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America by Allen Brandt,6 and, most recently, The Golden Holocaust by

Patterns of tobacco use worldwide

Surveillance of causes is fundamental to disease control. In many countries, the prevalence of smoking is tracked regularly by performing surveys, typically of schoolchildren and general population samples. In the United States, for example, data are collected in multiple surveys such as the National Health Interview Survey (NHIS), the National Health and Nutrition Examination Survey (NHANES), and the Behavioral Risk Factor Surveillance System (BRFSS). The resulting data support the evaluation

How does tobacco smoke cause disease?

Worldwide tobacco is used in many forms, classifiable as smoked or smokeless. There are several hundred million users of products other than cigarettes and in some groups, for example women in India, various oral, smokeless products are much more widely used than either cigarettes or bidis (a locally made product comprising a hand-rolled cigarette with a leaf wrapper). These products also cause cancer and other health problems, although they do not increase the risk of lung cancer.

Tobacco smoke

The burden of smoking-caused disease

Active and passive smoking are causally associated with risk for numerous diseases and other adverse effects (see Fig. 2). Table 1 provides estimates of risk for mortality from major causes of death associated with smoking. The estimates come from 2 epidemiologic studies performed by the American Cancer Society: Cancer Prevention Study (CPS) I (1959–1965) and CPS II (1982–1988). These studies document the strength of smoking as a cause of multiple diseases, the higher risks in men compared with

The global effort in tobacco control

Tobacco control has had a lengthy evolution that has been closely linked to the evolution of the evidence on the health effects of active and passive smoking.34 The initial findings on lung cancer were followed by efforts to educate the public about the risks of smoking, with the expectation that they would stop. In the United States, the 1964 Surgeon General’s report led to pack warnings and the banning of tobacco advertising on television. The finding that passive smoking caused lung cancer

Summary

Tobacco smoking is the world’s leading cause of avoidable premature mortality, reflecting the potent toxicity of tobacco smoke inhaled by smokers for decades. Lung cancer was a sentinel of the emergence of the still persisting epidemic of tobacco-caused disease. Fortunately, smoking has declined in many countries, particularly the high-income countries, but the low-income and middle-income countries remain at risk because of the aggressive tactics of the multinational tobacco companies. The

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