A descriptive model of the cigarette epidemic in developed countries

Abstract

It has been estimated that cigarettes are the cause of the deaths of one in two of their persistent users, and that approximately half a billion people currently alive- 8% of the world's population- could eventually be killed by tobacco if current smoking patterns persist. Despite this pandemic,tobacco consumption continues and is increasing in many countries, especially in Asia and in Southern and Eastern Europe. A major factor affecting public awareness of the substantial health hazards of tobacco use is the three- to four- decade laf between the peak in smoking prevalence and the subsequent peak in smoking- related mortality. Based on nearly 100 years of observations in countries with the longest history of widespread cigarette use, a four-stage model of cigarette consumption and subsequent mortality among men and women is proposed. From the model it is clear that, during certain periods of evolution of this epidemic, it is to be expected that smoking- attributable mortality will rise at the same time that smoking prevalence might be decreasing. This is because current mortality is most closely related to previous, not current, levels of cigarette consumption. Broad geographic classifications of regions are given, according to the stage of the epidemic that they are currently experiencing. Tobacco control policy implications for countries at each of the four stages of the cigarette epidemic are also discussed.