Tobacco and Public Health - TCSC Indonesia

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THE FUTURE WORLDWIDE HEALTH EFFECTS OF CURRENT SMOKING PATTERNS
the risk of death from tobacco in middle or old age is really substantial (about 1 in 2)
only for those who start smoking in early adult life (Doll and Peto 1981; Peto et al.
1986, 1994; Doll et al. 1994, 2004). Hence, when there is a large upsurge in cigarette
smoking among the young adults in a particular country, this will produce a large
upsurge in tobacco deaths half a century later; the numbers of deaths from tobacco
around the year 2000 were strongly influenced by the numbers of young adults who
took up smoking around 1950, while the numbers of young adults who took up smoking
around the year 2000 will strongly influence the numbers of deaths from tobacco
around the year 2050 (and beyond).
The main increase in cigarette use by young adults took place during the first
half of the twentieth century for men in developed countries, but it took place
during the second half of the century for women in developed countries and for men
in developing countries (Doll et al. 1994; Peto et al. 1994; World Health Organization
1997). Thus far, relatively few women in developing countries have begun to smoke.
For men in developed countries the epidemic of tobacco deaths may already be
about as large as it will ever be, with tobacco now responsible for about one-third of all
male deaths in middle age (Peto et al. 1994). Continuing increases in male tobacco
deaths in developed countries such as Greece or Portugal are offset by recent decreases
elsewhere, e.g., the UK. For women in most developed countries, however, the epidemic
still has far to go—indeed, in many European countries such as France or Spain the
main increase in tobacco deaths is only just beginning, although in the United States
the proportion of deaths in middle age that is due to tobacco is now almost as great in
women as in men (Peto et al. 1994).
In North America, taking both sexes together, US cigarette consumption per adult
was 1, 4, and 10 per day in 1910, 1930, and 1950, after which it remained relatively
constant for some decades. As a delayed result of this pre-1950 increase in cigarette
consumption, the proportion of all US deaths at ages 35–69 attributed to tobacco rose
from 12% in 1950 to 33% in 1990 (Peto et al. 1994).
In China, which is the largest and best studied of the developing countries (Liu et al.
1998; Niu et al. 1998; Peto et al. 1999), the increase in male cigarette consumption and
in tobacco deaths both lag almost exactly 40 years behind the US. At present, few of
the young women in China become smokers, but adult Chinese male cigarette consumption
averaged 1, 4, and 10 per day in 1952, 1972, and 1992, with no further
increase during the past few years, and the proportion of Chinese male deaths at ages
35–69 attributed to tobacco was measured to be 12% in 1990 and is projected to be
about 33% in 2030. Two-thirds of the young men in China become persistent smokers,
and about half of those who do so will eventually be killed by the habit: so, about onethird
of all the young men in China will eventually be killed by tobacco, if current
smoking patterns persist.
China, with 20 per cent of the world’s population, produces and consumes about
30% of the world’s cigarettes, and a large nationwide study has now shown that China