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Smoking causes one in ten deaths globally, major new study reveals

Efforts to control tobacco have paid off, says study, but warns tobacco epidemic is far from over, with 6.4m deaths attributed to smoking in 2015 alone

https://www.theguardian.com/society/2017/apr/05/smoking-causes-one-in-ten-deaths-globally-major-new-study-reveals

One in 10 deaths around the world is caused by smoking, according to a major new study that shows the tobacco epidemic is far from over and that the threat to lives is spreading across the globe.

There were nearly one billion smokers in 2015, in spite of tobacco control policies having been adopted by many countries. That number is expected to rise as the world’s population expands. One in every four men is a smoker and one in 20 women. Their lives are likely to be cut short – smoking is the second biggest risk factor for early death and disability after high blood pressure.

The researchers found there were 6.4m deaths attributed to smoking in 2015, of which half were in just four populous countries – China, India, USA, and Russia.

Major efforts to control tobacco have paid off, according to the study published by the Lancet medical journal. A World Health Organisation treaty in 2005 ratified by 180 countries recommends measures including smoking bans in public places, high taxes in cigarettes and curbs on advertising and marketing.

Between 1990 and 2015, smoking prevalence dropped from 35% to 25% among men and 8% to 5% among women. High income countries and Latin America – especially Brazil which brought in tough curbs on tobacco – achieved the biggest drops in numbers of smokers.

But many countries have made marginal progress since the treaty was agreed, say the authors of the study from the Institute of Health Metrics and Evaluation at the University of Washington in the US. And although far more men smoke than women, there have been bigger reductions in the proportions of men smoking also, with minimal changes among women.

Senior author Dr Emmanuela Gakidou said there were 933m daily smokers in 2015, which she called “a very shocking number”. The paper focused only on those who smoke every day. “The toll of tobacco is likely to be much larger if we include occasional smokers and former smokers and people who use other tobacco products like smokeless tobacco. This is on the low end of how important tobacco is,” she told the Guardian.

There is much more that needs to be done, she said. “There is a widespread notion that the war on tobacco has been won but I think our evidence shows that we need renewed and sustained efforts because the toll of smoking in 2015 is much larger than most people would think, so we absolutely have a lot more to do. We need new and improved strategies to do it and a lot of effort and political will.”

Traditionally there have been far fewer women smoking around the world than men, but it was a huge problem for both, she said.

“There are some really worrisome findings – for example in Russia female smoking has increased in the last 25 years significantly. There are also some western European countries where about one in three women are smoking. So it is true globally that a lot fewer women smoke than men but there are some countries where it is a big problem for women,” she said.

Dr Kelly Henning of Bloomberg Philanthropies, which is committed to tobacco control and co-funded the study with the Bill and Melinda Gates Foundation, said: “I think the study highlights the fact that the work is not finished on tobacco. The good news is the decline in daily smoking among men and women … however there are still many smokers in the world and there is still a lot of work to do. I think we have to keep our eye on the issue and really do more.”

Countries with some of the highest death tolls such as China and Indonesia “really don’t need those health problems – they have so many other issues they are trying to address. But tobacco control is critically important in those places,” she said.

“China has more than a million deaths a year from smoking related diseases and China is only beginning to see the effects of their high male smoking rate. That is only one instance of what is expected to become an extremely major epidemic,” she said.

Writing in a linked comment, Professor John Britton from the University of Nottingham said: “Responsibility for this global health disaster lies mainly with the transnational tobacco companies, which clearly hold the value of human life in very different regard to most of the rest of humanity.” British American Tobacco, for instance, sold 665bn cigarettes in 2015 and made a £5.2bn profit.

“Today, the smoking epidemic is being exported from the rich world to low-income and middle-income countries, slipping under the radar while apparently more immediate priorities occupy and absorb scarce available human and financial resources,” he writes. “The epidemic of tobacco deaths will progress inexorably throughout the world until and unless tobacco control is recognised as an immediate priority for development, investment, and research.”

Graphical health warnings on cigarette packs found effective

A recently completed sample based study done in Bangladesh claims that the health warning labels describing the harmful effects of tobacco products using text and/or pictures are found to be effective.

Health warnings on cigarette packages are among the most prominent sources of information about the harms of smoking and tobacco use.

Indeed, even in high-income countries where millions of dollars are spent on anti-tobacco mass media campaigns, smokers still report getting information about the risks of smoking from cigarette packages almost as much as from television, and much more than from other sources such as print media.

Therefore, in a country such as Bangladesh, where very little information about the harms of tobacco use appears on television and other broadcast media, warning labels on tobacco packages represent an even more important opportunity for informing the public about the harms of tobacco. Given their tremendous reach and frequency of exposure, health warnings are an extremely cost-effective public health intervention compared to other tobacco prevention efforts such as paid mass media advertising – these came out of a sample-based survey.

Findings from the survey revealed, 98.1% of the respondents opined that they supported the current practice of bothside for pictorial/graphical health warnings (GHW) and 77.5% respondent informed that they thought that the current use of GHW of 50% of the cigarette pack for warnings was good enough to demotivate and reduce the use of tobacco products. Considering up to 50% of the cigarette pack, around 89% were supporting this.

The findings revealed – about 72.7% of the respondents reported that they felt very unpleasant to see the pictorial warning on the tobacco packets (74.1% in urban and 72.7% in rural areas). The survey also reported that the pictorial warning was very realistic to 65.6% of the respondents and extremely realistic to 17.0% respondent (18.8% in rural and 15.3% in urban areas).

The psychological impact of GHW on the respondents was also examined. 13.9% of the respondents were extremely worried and 61.7% were very worried to see the pictorial warning on the cigarette package.

In summary, the study found that the graphical health warnings (GHW) were realistic to provide health-related information and are very effective in creating an unpleasant feeling and sense of worriedness among the smokers to aware them regarding the harmful effects of smoking.

A good news that the study uncovered was 75.8% respondents tried to reduce or quit smoking after seeing the pictorial warning on the cigarette packet. The rate is 76.3% in rural and 75.3% in urban areas. 83.5% respondents reported that they tried to reduce or quit smoking habit to see the pictorial warning. 74.8% recommended to include
GHW in Biri, Gul and Jorda.

Moreover, 64.2% respondents recommended that government should take initiative for mass awareness and 85.5% recommended for more visual media (TV) coverage.

Smoking rate continues to decline, survey shows

The latest Canadian Community Health Survey shows a 0.4 percentage point annual decline in the smoking rate and a nearly nine per cent drop since 2000-2001, the Canadian Press reported.

http://www.tobaccojournal.com/Smoking_rate_continues_to_decline_survey_shows.54156.0.html

Some 17.7 per cent of the population 12 years and older smoke daily or occasionally in 2015, compared with 18.1 per cent the year before, the news agency said. The rate was 26 per cent in 2000-2001. About 5.3 people smoke, of which about 3.8 million are daily smokers, Canadian Press said. Male smokers at 20.4 per cent represented a larger group than females at 15 per cent of the population in the latest survey.

Tobacco control measures found to be cost-effective, says WHO report

A report (link is external) from the National Cancer Institute in the US and the World Health Organisation has found that tobacco control measures are highly cost-effective, but under-used in some countries.

http://www.cancerresearchuk.org/about-us/cancer-news/news-report/2017-01-13-tobacco-control-measures-found-to-be-cost-effective-says-who-report

The report also states that tobacco control doesn’t harm economies, and reduces the impact smoking has on poorer communities.

“Smoking is the single most preventable cause of death in the world” – George Butterworth, Cancer Research UK

Tobacco control measures include tax increases, bans on advertising, including health warnings on packages, policies to restrict where people can smoke and programmes to help them quit.

“This valuable report highlights the substantial financial cost of tobacco,” said George Butterworth, tobacco policy manager at Cancer Research UK. “It’s good to see that the most cost effective measures – tobacco tax and price increases – are being called for as part of comprehensive tobacco control strategies.”

Smoking accounts for 1 in 4 UK cancer deaths and nearly 1 in 5 of all cancer cases.

“The human cost of the tobacco industry is enormous,” said Butterworth. “Smoking is the single most preventable cause of death in the world, killing almost 6 million people worldwide and 100,000 people in the UK each year.”

The report states that, while effective measures to reduce smoking rates are available, they don’t yet cover the vast majority of the world’s population. And where taxes are used, the money is rarely invested in health programmes.

The report also finds that people in poorer communities stand to benefit most from tobacco control measures, due to the proportion of income spent on tobacco and negative health effects it causes in these areas.

In the UK, a ban on smoking in public places as well as tobacco advertising restrictions, including picture warnings of health issues and standardised packaging, are all in place.

“Cancer Research UK’s ambition to see a Tobacco-Free country by 2035, where less than 5 per cent of adults smoke, is in line with the UK’s commitment to the World Health Organization’s Framework Convention on Tobacco Control,” Butterworth added.

But Stop Smoking Services across England are facing ongoing budget cuts after 6 in 10 local authorities were forced to reduce their funding in the last year.

Illegal trade, and the fact that 5 tobacco companies account for 85% of the global cigarette market, were both highlighted by the report as challenges for future control efforts.

The report also warns against relaxing the progress made across the world in controlling tobacco, and calls for continued research and use of evidence-based policies.

Dr Robert Croyle, Director of the National Cancer Institute’s Division of Cancer Control and Population Sciences, said: “The global scale of suffering, death, and disease from tobacco use is staggering. Millions of early deaths can be prevented if nations adopt evidence-based tobacco control policies.”

4 Tobacco Stats That Will Blow You Away

http://www.nasdaq.com/article/4-tobacco-stats-that-will-blow-you-away-cm727871

Investors in Altria Group (NYSE: MO) , Reynolds American (NYSE: RAI) , and other tobacco companies around the world understand the risks inherent in investing in the industry. Cigarettes have been demonstrated to have negative health impacts, and even big tobacco companies like Philip Morris International (NYSE: PM) have started to respond to these potential harms by looking at alternatives to traditional cigarettes that carry reduced risks for consumers.

When you look at the numbers that government agencies, consumer advocates, and other anti-smoking groups provide, it’s easier to understand some of the challenges that cigarette makers face in sustaining their businesses. Let’s look at four particularly noteworthy statistics.

1. Potential international growth of 45% in two decades

Even advocates who are trying to stamp out smoking admit that they’re losing ground on a global scale. There are about 1.1 billion smokers in the world currently, according to the nonprofit group Action on Smoking & Health, and that number is expected to grow to 1.6 billion over the next 20 years.

In part, those numbers reflect the sluggish pace of regulation in areas where smoking is most likely to rise. Only a small fraction of countries have provisions like smoke-free laws, government services to support those seeking to quit smoking, and bans on advertising on tobacco products that are most likely to keep smoking rates down. As a result, those tobacco companies focusing on the international market have plenty of potential for growth.

2. Cigarette smoking kills 480,000 Americans annually

Tobacco use has long been the single largest preventable cause of death in the U.S., according to figures from the Centers for Disease Control and Prevention. The CDC estimates that more than 480,000 Americans die each year from smoking, with 41,000 of those deaths coming from the effects of secondhand smoke.

Most people think of lung cancer as the key cause of death related to smoking, but the practice has been linked to a host of other diseases — including respiratory diseases, cardiovascular diseases, and diabetes — and other adverse health effects. Government health advocates are convinced that the costs of encouraging smoking cessation are worth the savings those efforts produce.

3. The staggering economic costs of smoking

In addition to the number of deaths, the amount of money and resources that goes toward caring for those with smoking-related illnesses is surprisingly high. The CDC estimates that the direct costs of medical care in the U.S. for adults who need it because of tobacco products add up to almost $170 billion annually. In addition, lost productivity from workers who take time off due to smoking-related ailments brings the total cost above the $300 billion mark.

Smoking is a big enough cause of economic damage that the insurance industry makes smoking one of the key factors in determining premiums for life insurance.

Moreover, the difficulty of quitting smoking makes cessation products an extremely lucrative market, adding to potential revenue for businesses related to the practice.

4. Tobacco is still big business, despite downward pressures

Even with falling smoking volume in the U.S., the sheer amount of tobacco in the market is impressive. More than 24 billion cigarettes were produced in the U.S. market in October, the most recent month for which data from the Treasury’s Alcohol and Tobacco Tax and Trade Bureau were available. So far in 2016, 233 billion cigarettes have been produced, along with almost 5.4 billion cigars, 100 million pounds of snuff, and roughly 50 million pounds of tobacco for chewing, pipe, or roll-your-own use.

Believe it or not, those figures are actually down considerably from year-ago figures. Cigarette use has dropped by about 10 billion units this year compared to this time last year; although smaller cigars have seen volumes rise, the bigger large-cigar market has seen drops of nearly 10%. That has resulted in sales-volume declines among large producers, but their ability to succeed speaks to the experience they have fighting such trends.

Tobacco companies have managed to overcome statistics like these and still produce growing profits over time. However, given the severity of some of these numbers, it’s understandable why even industry stalwarts are looking closely at reduced-risk alternatives in an effort to try to put some of these statistics behind them once and for all.

Beijing public smoking ban sees significant effect

A newly released report shows Beijing has seen a significant drop in the number of smokers by 200 thousand since the city brought in a strict smoking ban less than two years ago, The Paper reports.

http://english.cctv.com/2016/12/30/ARTIdBzgQ8OF7DnrmDC0Z11L161230.shtml

According to a report on tobacco use among adults, the smoking rate this year went down to 22.3 percent, compared with 23.4 percent in 2014, even though only about 30 percent of adults were said to understand the serious risks to disease caused by smoking.

The report also indicates that 16.8 percent of adults attempted to quit smoking this year, an increase of 1.9 percent compared with 2014.

Meanwhile, the report also shows that smoking in public spaces and second-hand smoking indoors has also been declining.

An earlier report shows that Beijing has established the most transparent law-enforcement system for smoking control in the country, with over 1,400 people among every 10,000 receiving smoking-quit services.

Kentucky leads nation in adult smoking

Once again, Kentucky ranks first for its adult smoking rates, barely inching ahead of West Virginia to take back the first place spot, according to the federal Centers for Disease Control and Prevention.

http://www.richmondregister.com/news/kentucky-leads-nation-in-adult-smoking/article_6f814c88-c8a2-11e6-aa59-4320ad1ca961.html

Kentucky’s adult smoking rate in 2015, the latest period available, is 25.9 percent; West Virginia, which ranks second, is at 25.7 percent. That means that more than one-fourth of the adults in both of these states smoke. Arkansas closely follows at 24.9 percent.

States with the lowest smoking rates are Utah at 9.1 percent and California at 11.7 percent.

“Tobacco use is the leading cause of preventable disease and death in the U.S., accounting for more than 480,000 deaths every year, or one of every five deaths,” says the CDC.

Nationwide, smoking rates have declined almost 28 percent since 2005, to 15.1 percent in 2015 from 20.9 percent in 2005, says the CDC report based on the 2015 National Health Interview Survey. Kentucky’s smoking rates declined 10 percent in the same time frame, from 28.7 percent to 25.9 percent respectively, according to the Behavioral Risk Factor Surveillance System, a constant national poll conducted by the CDC.

The report also notes that smoking is more prevalent among men, Native Americans, the poor, the less educated, Midwesterners and Southerners, people who on are Medicaid or are uninsured, and those who have a disability, are gay or bisexual, or have mental-health issues.

The CDC says we know how to reduce smoking: “Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, anti-tobacco mass media campaigns and barrier-free access to tobacco cessation counseling and medications, are critical to reducing cigarette smoking and smoking related disease and death among U.S. adults; particularly among subpopulations with the highest smoking prevalence,” said the report.

Kentucky has room for improvement in all of these areas.

Kentucky ranks in the bottom 10 states (43rd) for its cigarette tax, at 60 cents per pack, and spends only 4.4 percent of what the CDC recommends for smoking cessation efforts ($2.5 million a year). The state’s high smoking rate also comes with a hefty price tag, as the Campaign for Tobacco-Free Kids estimates Kentucky smoking-related health costs at $1.92 billion a year. The group ranks Kentucky 37th in protecting children from tobacco, and says 17 percent of its high-school students smoke.

And though Kentucky has tried to pass one in the past, Kentucky does not have a comprehensive statewide smoke-free law and isn’t likely to get one any time soon because Republican Gov. Matt Bevin does not support such a law, saying this should be a local decision. State Health Commissioner Hiram Polk said in October that he’s looking for away to get Bevin to alter his policy: “We’ve got to find some kind of landmark we can use there that would be acceptable to the governor and get through the legislature.”

About one-third of Kentuckians are protected by local comprehensive smoke-free workplace laws, according to the Kentucky Center for Smoke-free Policy.

In contrast, Utah, which has the lowest smoking rate (9.1 percent), does have a comprehensive statewide smoke-free law, has a cigarette tax of $1.70 per pack and spends $7.1 million on tobacco cessation initiatives, which is almost 37 percent of the CDC’s recommended spending. And Utah spends less on health cost caused by smoking at $542 million.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Hong Kong leads mainland in war to cut smoking

http://www.ejinsight.com/20161209-hong-kong-leads-mainland-in-war-to-cut-smoking/

When a person goes to buy a packet of cigarettes in Hong Kong, he or she faces two obstacles. One is the price — Double Happiness at HK$43 and Marlboro at HK$57 — the result of a tobacco tax up to 68 per cent of the price.

The other is the hideous image on the packet of the worst consequences of smoking.

A survey by the Economic Intelligence Unit earlier this year ranked Hong Kong as the eighth most expensive city in the world for a packet of branded cigarettes, at US$7.48.

Top was London with US$14.30, followed by New York with US$13.67 and Singapore with US$9.15.

These two measures, along with the creation of smoke-free areas in public and work places, have been effective in cutting the number of smokers.

According to government figures, the percentage of daily cigarette smokers aged 15 and above in Hong Kong in 2015 was 10.5 percent, down from 10.7 percent in 2012 and 23.3 per cent in the early 1980s.

The mainland, the world’s largest tobacco market with 316 million smokers in 2015, has only recently started to learn the lessons of Hong Kong.

Since 2010, the number of smokers has increased by 15 million and cigarette production risen by 35 per cent.

The health warnings are written, not visual, and appear modestly at the bottom of the packet. They would not frighten any first-time user.

In 2015, China increased the tobacco tax to 40 per cent. Consumption tax from tobacco in 2015 was 536 billion yuan, an increase of 60 billion from a year earlier. The recommendation of the World Health Organisation (WHO) is that the tax should be 70 per cent of the retail price.

“There is certainly room for future tobacco tax increase,” said Jian Shi, director of the information office of the Taxation Research Institute at the State Administration of Taxation in Beijing.

“In some western countries, the tobacco tax rate has reached 70-80 per cent. The room for the increase needs to be considered based on the development goal of the industry and the condition of national revenue.”

Health professionals argue that increasing the tobacco tax is the quickest and most effective way to cut smoking — by both preventing young people from starting and encouraging smokers to quit.

According to WHO figures, each increase of 10 per cent in the price will cause 3.7 per cent of adults and 9.3 per cent of teenagers to stop smoking.

Antonio Kwong Cho-shing, chairman of the Hong Kong Council on Smoking and Public Health, said that selective or modest hikes would not make much of an impression on smoker numbers in Hong Kong.

“Only a 100 per cent increase in tobacco tax would induce people to quit smoking,” he said. If the government accepted this proposal, an average pack would cost HK$119.

The Department of Health has proposed an enlargement of the health warning.

It said on Nov. 23 that the area of the graphic health warning shall be of a size that covers at least 85 percent of the two largest surfaces of the packet or the retail container and that the number of forms of health warning should be increased from six to 12.

The situation in the mainland is years behind. The biggest obstacle is that the State Tobacco Monopoly Administration (STMA), the world’s biggest manufacturer of cigarettes, is also the industry regulator.

This is despite years of lobbying by China’s health professionals, the WHO and the norms practised around the world. They argue that the two must be separate institutions.

According to WHO figures, 1.2 million die each year in China from smoking-related diseases; this number will double by 2025.

Jian Shi put it succinctly. “The major difficulty lies in that the related departments have quite different views on this matter, and it is difficult for them to reach agreement on this matter. That will cause obstruction to policy making and implementation.”

The STMA opposes graphic health warnings and higher taxes because they would hurt its sales and profits. Yet, simply due to global population expansion, there will be more smokers in 2040 than there are today, so it is difficult to believe that this concern is genuine.

The health lobby has had some success, in the modest increase in tobacco tax and restrictions on smoking in indoor public areas and workplaces and some outdoor areas introduced in Beijing in June 2015. Other mainland cities have taken similar measures at different times.

On Dec. 6, the Beijing Commission of Health and Family Planning said that more than 2,700 people had been fined for violating these restrictions, with total fines of 142,500 yuan, as of Nov. 30 this year.

Professor Dr Judith Mackay, based in Hong Kong and Asia’s leading anti-tobacco campaigner, said that the price of cigarettes in China is still extremely low.

“The latest small tobacco tax increase, while laudable, will not have a serious, sustained effect on reducing smoking. It is time to review the whole tobacco tax structure in China, significantly increase the price of cigarettes and thus protect the health of the Chinese people.

“In Australia, there is a regular increase of 12.5 per cent tobacco excise tax every year. The cost of a packet could soon rise to A$40 (HK$230). Hong Kong and China should both consider long-term tobacco tax planning in this way, so that tobacco control proceeds in an orderly form, and immense energy and time is not wasted year by year in campaigning for a tax increase. Otherwise, thousands will die.”

In Greece’s tobacco culture, passive smoke a serious problem

http://www.ekathimerini.com/214387/article/ekathimerini/news/in-greeces-tobacco-culture-passive-smoke-a-serious-problem

Nearly two-thirds of Greeks are inhaling someone else’s tobacco smoke on a daily basis, making Greece the worst nation in the European Union in exposing its people to the health risks of passive smoking.

The European Union’s statistical office Eurostat said Wednesday that 64.2 percent of Greeks suffered daily exposure to tobacco smoke indoors. Second in the EU is Croatia with 44.7 percent, followed by Bulgaria with 40.5 percent. At the other end, Sweden best protects its people from secondhand smoke with only 5.9 percent exposed, even better than Finland with 6.3 percent.

In a tally of EU smokers aged 15 and over, Bulgaria tops the rankings with 34.7 percent, ahead of Greece with 32.6 percent. Sweden only has 16.7 percent who smoke, with Britain the second-lowest with 17.2 percent.

1 in every 4 persons aged 15 or over in the European Union is a smoker

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