Transcript WHO/SRNT Treatment Database

Demographics and
Health Effects
Revised 05/06
Last updated February 2011

Demographics and Health Effects Section
Chair
Ann Malarcher
Centers for Disease Control
and Prevention, Atlanta, USA
Peter Anderson
Indept. Consultant in Public Health, Spain
Mary-Jane Ashley
University of Toronto, Canada
Shanta R Dube
Centers for Disease Control and
Prevention, Atlanta, USA
Linda Pederson
Centers for Disease Control and
Prevention, Atlanta, USA
Jonathan Samet
Johns Hopkins University, School of
Hygiene and Public Health, Baltimore,
USA
Michael Thun
American Cancer Society, Atlanta,Revised
USA
Last updated February 2011

05/06
Health and Economic Costs
of Tobacco Use
Last updated February 2011

Global burden of disease and injury attributable
to selected risk factors, 2000 (Total in thousands)
Deaths
(thousands)
% of total
deaths
YLLs1
(thousands)
As % of total
YLLs1
Childhood and maternal under
nutrition*
6,156
11.0
205,372
22.4
Tobacco
4,907
8.8
45,622
5.0
Blood Pressure
7,141
12.5
55,548
6.0
Physical Inactivity
1,922
3.4
15,841
1.7
Occupation
784
1.4
9,975
1.1
Unsafe sex
2,886
5.2
76,970
8.4
Alcohol
1,800
3.2
32,697
3.6
Unsafe water, sanitation and
hygiene
1,730
3.1
49,232
5.4
Illicit drugs
204
.4
4,819
.5
Urban air pollution
799
1.4
6,404
.7
Risk Factor
Estimates are based on data and information from the World Health Organization
* Childhood and maternal under nutrition includes: vitamin A Deficiency, zinc, iron; under weight
1
Years of life lost
Last updated February 2011

AFRO
AMERO
EMRO
EURO
SEARO
WPRO
Last updated February 2011
African Region
Region of the Americas
Eastern Mediterranean Region
European Region
South-East Asia Region
Western Pacific Region
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Projected global burden of lung cancer in 2030
Region
Total deaths
(thousands)
Male
Female
AFRO
39
31
8
AMRO
288
185
103
EMRO
76
61
16
EURO
362
226
137
SEARO
467
364
103
WPRO
984
656
328
WORLD
2,216
1,522
694
Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data
sources, methods and results. World Health Organization
Last updated February 2011

Projected global burden of ischemic heart disease
in 2030
Region
Total deaths
(thousands)
Male
Female
AFRO
610
312
298
AMRO
1,321
638
683
EMRO
1,026
539
487
EURO
2,223
982
1,241
SEARO
3,187
1,627
1,559
WPRO
1,369
604
765
WORLD
9,737
4,702
5,034
Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data
sources, methods and results. World Health Organization
Last updated February 2011

Projected global burden of COPD in 2030
Region
Total deaths
(thousands)
Male
Female
AFRO
243
159
84
AMRO
379
216
163
EMRO
236
131
105
EURO
354
165
189
SEARO
1,537
886
651
WPRO
3,148
1,425
1,723
WORLD
5,896
2,981
2,915
Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data
sources, methods and results. World Health Organization
Last updated February 2011
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Projected global burden of cerebrovascular
disease in 2030
Region
Total deaths
(thousands)
Male
Female
AFRO
672
269
402
AMRO
659
277
382
EMRO
451
208
243
EURO
1,400
510
890
SEARO
1,816
807
1,009
WPRO
2,679
1,189
1,491
WORLD
7,677
3,260
4,417
Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data
sources, methods and results. World Health Organization
Last updated February 2011

Burden of disease and injury attributable
to tobacco use, 2000
YLLs1
As % of total
(thousands)
YLLs1
Region
Deaths
(thousands)
As % of total
deaths
AFRO
160
1.5
2,002
.7
AMRO
873
14.9
6,548
9.7
EMRO
186
4.6
2,279
2.6
EURO
1,605
16.7
14,839
17.7
SEARO
1,110
7.8
12,264
4.6
WPRO
975
8.4
7,692
5.5
WORLD
4,907
8.8
45,622
5.0
Estimates are based on data and information from the World Health Organization
1 Years of life lost
Last updated February 2011

Cancer Death Rates*, for Men, US,1930-2003
Rate Per 100,000
100
Lung
80
60
Stomach
Prostate
Colon & rectum
40
Pancreas
20
2000
1995
1990
1985
1980
1975
1970
1965
Liver
1960
1955
1950
1945
1940
1935
Leukemia
1930
0
*Age-adjusted to the 2000 US standard population. US Mortality Public Use Data Tapes 1960-2003, US Mortality Volumes 19301959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
Last updated February 2011
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Cancer Death Rates*, for Women, US,1930-2003
100
Rate Per 100,000
80
60
Lung
Uterus
40
Breast
Colon & rectum
Stomach
20
Ovary
2000
1995
1990
1985
1980
1975
1970
1965
1960
1955
1950
1945
1940
1935
Pancreas
1930
0
*Age-adjusted to the 2000 US standard population. US Mortality Public Use Data Tapes 1960-2003, US Mortality
Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
Last updated February 2011

Smoking-Attributable Mortality Fractions
Among Males in the United States, 2001
100
35-64 yrs
65+ yrs
Infants
Percentage
80
60
40
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CDC, Adult SAMMEC, http://apps.nccd.cdc.gov/sammec/
Last updated February 2011

Smoking-Attributable Mortality Fractions
Among Females in the United States, 2001
100
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65+ yrs
Infants
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CDC, Adult SAMMEC, http://apps.nccd.cdc.gov/sammec/
Last updated February 2011

S
Nearly 440,000 Average Annual Deaths Attributable
to Cigarette Smoking – United States, 1997-2001
Other Diagnosis;
35,502
Ischemic Heart
Ischmeic Heart
Disease; 86,801
Disease; 86,801
Secon Hand Smoke
Deaths; 38,112
Other Cancers;
34,693
Lung Cancer; 123,836
Stroke
(Cerbovascular
Disease); 17,436
Respiratory
Diseases; 101,454
CDC. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, 19972001. MMWR 2005;54(25): 625-628
Last updated February 2011

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440
400
360
320
280
240
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160
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Number of death (thousands)
Annual Deaths from Smoking Compared with
Selected Other Causes in the United States
National Center for Health Statistics, Deaths: Final Deaths 2003. National Vital Statistics Report, 2006; 54(13); Annual
Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses- United States, 1997-2001; MMWR.
2005:54(25):625-628.
Last updated February 2011

One out of two lifelong
adult smokers will die
from a smoking related
disease.
CDC. Projected smoking-related deaths among youth – United States. MMWR 1996;45(44):971-974
Last updated February 2011

Smoking and Health Among Adolescents
• Rapid addiction to nicotine from early smoking
• More likely to use other drugs (alcohol, marijuana, &
cocaine)
• More likely to be involved in other risky behaviors
• Poorer overall health
• Increased resting heart rates
USDHHS. Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994;
Arday, DR, et al. Cigarette smoking and self-reported health problems among US high school seniors, 1982-1989
Am J of Health Promotion 1995;10(2):111-116.
Last updated February 2011

Smoking and Health Among Adolescents
Increased effects on the respiratory system
• Increased wheezing, gasping and shortness of
breath
• Increased coughing and phlegm production
• Decreased physical performance
• Decreased endurance
• Reduced lung function
• Slowed growth of lung function
USDHHS. Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994;
Arday et al. Cigarette smoking and self-reported health problems among US high school seniors, 1982-1989.
Am J Health Promot 1995;10: 111-116.
Last updated February 2011

Effects of Smoking and Pregnancy/Reproduction
•
•
•
•
Reduced Fertility
Reduced risk for preclampsia
Fetal growth restriction
Increased risk of premature rupture of the membranes,
placenta previa, & placental abruption
• Increased risk of preterm delivery & shortened gestation
USDHHS. The Health Consequences of Smoking: A Report of the Surgeon General, 2004.
Last updated February 2011

Effects of Smoking and Pregnancy/Reproduction
• Increased risk of low birth weight
• Increased risk of perinatal mortality (stillbirth & neonatal
deaths)
• Increased risk of reduction of lung function in infants
• Increased risk of sudden infant death syndrome (SIDS)
USDHHS. The Health Consequences of Smoking: A Report of the Surgeon General, 2004.
Last updated February 2011

Health Effects of
Secondhand Smoke
Last updated February 2011

Contents of Secondhand Smoke (SHS)
• Cigarette smoke contains more than 7000 chemical
compounds
• Sixty nine chemicals in tobacco smoke are known or
probable carcinogens
• SHS is a known human carcinogen
USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.
Last updated February 2011
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“An hour a day in a room with smoke is nearly a hundred
times more likely to cause lung cancer in a non-smoker
than 20 years spent in a building containing asbestos.”
-Sir Richard Doll, 1985
Last updated February 2011

Health Effects of Secondhand Smoke - Adults
• SHS exposure causes lung cancer among lifetime
nonsmokers
• SHS exposure associated with living with a smoker
increases risk of lung cancer by 20%-30%.
• SHS exposure causes coronary heart disease morbidity
and mortality
• SHS exposure increases risk of heart disease by 25%30%
• SHS exposure causes increased respiratory symptoms
of odor annoyance & nasal irritation
USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.
Last updated February 2011

Health Effects of Secondhand Smoke -Children
• SHS exposure causes sudden infant death syndrome
(SIDS)
• Maternal exposure to SHS during pregnancy causes a
small reduction in birth weight
• SHS exposure after birth causes a lower level of lung
function
• SHS exposure from parental smoking causes lower
respiratory illness in infants and children
USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.
Last updated February 2011

Health Effects of Secondhand Smoke -Children
• SHS from parental smoking causes cough, phlegm,
wheeze and breathlessness in school age children
• SHS from parental smoking causes exacerbations of
asthma
• SHS exposure from parental smoking causes the onset
of wheeze illness in early childhood
• SHS exposure from parental smoking causes middle ear
disease (acute and recurrent otitis media, chronic middle
ear effusion)
USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.
Last updated February 2011

Approximately, 5 million people will die from tobacco
related illness this year. By 2030, 10 million people will
die each year.
World Health Organization. The Tobacco Atlas (2002). http://www.who.int/tobacco/en/atlas11.pdf
Ezzati & Lopez. Estimates of Global Mortality Attributable to Smoking in 2000. Lancet 2003; 362: 847-852.
Last updated February 2011

Benefits of Cessation
Last updated February 2011

Benefits of Cessation Overall
• Former smokers live longer compared with continuing
smokers
• Smoking cessation reduces risk of premature death
• Risk of death decrease shortly after quitting
• Smoking cessation benefits almost every part of the body
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011

Smoking Cessation and Lungs
• Lung function starts to improve 2-3 months after quitting
• Smoking cessation reduces risk of lung cancer, 10 years
after quitting, the risk of lung cancer decreases to 3050% that of a continuing smoker
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011

Smoking Cessation and the Respiratory System
• Risk of death from Chronic Obstructive Pulmonary
Disease is decreased after quitting
• Risk of upper and lower respiratory illness such as colds,
flu, bronchitis and pneumonia is lowered
• Coughing, sinus congestion, fatigue and shortness of
breath decrease 2-3 months after quitting
• Smoking cessation lowers risk of larynx cancer
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011

Smoking Cessation and the Heart
• Smoking cessation reduces the excess risk of dying from
abdominal aortic aneurysm by 50% among former
smokers
• Risk of coronary heart disease decreases by half 1-2
years after quitting
• After 15 years of quitting, coronary heart disease risk is
nearly that of a non-smoker
• Among persons diagnosed with cardiovascular heart
disease, smoking cessation reduces risk of recurrent
infarction and cardiovascular death
• After quitting peripheral artery disease decreases
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011

Smoking Cessation and Other Parts of the Body
• Stroke risk is reduced to that of a never smoker after 5 to
15 years of cessation
• Risk of mouth, throat, and esophagus cancers are halved
five years after quitting
• Bladder cancer risk is halved a few years after quitting
• Smoking cessation lowers the risk of kidney, stomach,
pancreatic and cervical cancer
• Smoking cessation lowers risk of peptic ulcers
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011

Smoking Cessation and Pregnancy
• Quitting smoking before or early during pregnancy lowers
risk of miscarriage, low birth weight of baby and SIDS
• Although abstinence early in pregnancy will produce the
greatest benefits to the fetus and expectant mother,
quitting at any point in pregnancy can yield benefits
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011

Summary: Health Benefits of Smoking Cessation
• Smoking cessation has major and immediate health
benefits for men and women of all ages
• Benefits apply to persons with and without smokingrelated diseases
• Former smokers live longer than continuing smokers
• Smoking cessation decreases the risk of lung and other
cancers, heart attack, stroke, and chronic lung disease
• Smoking cessation improves reproductive outcomes
USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990
Last updated February 2011

Tobacco Dependence
Last updated February 2011

"In a sense, the tobacco industry may be thought of as
being a specialized, highly ritualized, and stylized
segment of the pharmaceutical industry. Tobacco
products uniquely contain and deliver nicotine, a potent
drug with a variety of physiological effects."
-1972 Claude Teague memo "RJR Confidential
Research Planning Memorandum on the Nature of the
Tobacco Business and the Crucial Role of Nicotine
Therein”
Last updated February 2011

Percentage
Frequency of Cigarette Use, 2004
18
16
14
12
10
8
6
4
2
0
Avg CPD
12
17
24
30-34
40-49
50-65
Age
SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health
Last updated February 2011

Tobacco Dependence in the United States, 2004
• 35.5 million Americans 12 years or older met the criteria
for nicotine dependence in the past month based on their
cigarette use
• 1.1 million youth 12 to 17 years old are nicotine
dependent cigarette smokers
• The rate of dependence is higher for those who start
smoking at an earlier age than for those who initiate
cigarette use later in life
SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health
Last updated February 2011

Nicotine Dependence among Past Month Smokers, by age,
2004
SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health
Last updated February 2011

Relapse Rate Over Time
100
Heroin
90
Smoking
80
Alcohol
Abstainers (%)
70
60
50
40
30
20
10
0
0
1
2 Weeks
2
3
4
5
6
7
8
9
10
11
12
Time (Months)
USDHHS. The Health and Consequences of Tobacco: Nicotine Addiction. A Report of the Surgeon General, 1988.
Last updated February 2011

80,000 to 100,000 young people around the world
become addicted to tobacco, everyday.
World Bank, Curbing the Epidemic: Governments and the Economics of Tobacco Control (Washington: World Bank, 1999).
Last updated February 2011

Effective Treatment
Interventions
Last updated February 2011

Effective Treatment Interventions
• Brief advice to quit from doctors, nurses and other
healthcare providers
• Group counseling
• Individual counseling
• Telephone counseling
• Pharmacotherapy
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.
Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Last updated February 2011

Identification and Assessment of Tobacco Use
• Assisting the patient in quitting (5A’s)
– Ask – Systematically identify all tobacco users at
every visit
– Advise – Strongly urge all tobacco users to quit
– Assess – Determine willingness to make a quit
attempt
– Assist – Aid the patient in quitting
– Arrange – Schedule follow-up contact
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.
Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Last updated February 2011

Effective counseling treatment for tobacco use
and dependence
• Practical counseling (problem solving/skills training)
• Intra-treatment social support
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.
Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Last updated February 2011

Elements of counseling
• Practical Counseling
– Recognize danger situations
– Develop coping skills
– Provide basic information
• Supportive Counseling
– Encourage the patient in the quit attempt
– Communicate caring and concern
– Encourage the patient to talk about the quitting
process
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.
Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Last updated February 2011

Effective pharmacotherapy for smoking cessation
• Pharmacotherapy that reliably increase long term
smoking abstinence rates
• Bupropion
• Nicotine gum, inhaler, nasal spray, lozenge and
patch
• Varenicline
• Clonidine and Nortriptyline can be used if other
pharmacotherapy is not effective
Last updated February 2011

Motivational intervention for those unwilling
to quit consist of the 5 R’s
• Relevance – Encourage patient to identify why quitting is
relevant
• Risks – Ask patient to identify potential negative
consequences of tobacco use
• Rewards – Ask patient to identify potential benefits of
quitting
• Roadblocks – Ask patient to identify barriers to quitting
• Repetition – Repeat motivational intervention every time
unmotivated patient enters a clinical setting
Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.
Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Last updated February 2011

Recommendations for increasing tobacco cessation
• Increase the unit price for tobacco products
• Mass media education campaigns combined with other
interventions to inform and motivate tobacco users to quit
• Provider reminder systems that identify patients who use
tobacco products and prompt providers to discuss
cessation with their client or advise client to quit at every
encounter
Task Force on Community Preventative Services. Zaza S, Briss PA, Harris, KW (eds). The Guide to Community
Preventative Services. Oxford University Press. New York, New York, 2005.
Last updated February 2011

Recommendations for increasing tobacco cessation
• Provider reminder plus provider education, with or
without client education
• Reduction of out-of pocket costs for effective cessation
therapies
• Multi-component interventions that include client
telephone support
Task Force on Community Preventative Services. Zaza S, Briss PA, Harris, KW (eds). The Guide to Community
Preventative Services. Oxford University Press. New York, New York, 2005.
Last updated February 2011

Recommendations for increasing tobacco cessation
• Standardization of care for routine, effective treatment of
tobacco use needs
• Continuous screening of tobacco use among those who
enter the health care system
• Availability of effective intensive treatments that includes
counseling and pharmacotherapy
Last updated February 2011

Recommendations for increasing tobacco cessation
• Treatment that emphasizes problem-solving and withintreatment social support
• Extended or augmented psychosocial interventions
beyond minimal advice to quit for pregnant smokers
• Institutionalize system changes that are essential to
ensure that clinical interventions occur
Last updated February 2011
