Tobacco and health

Professor Judith Mackay

MBChB (Edin), FRCP (Edin), FRCP (Lon)
Senior Senior Advisor, World Lung
Foundation
Senior Advisor, Gates Foundation
Director, Asian Consultancy on
Tobacco Control
Senior Policy Advisor, WHO
National Press Foundation
10WCTOH; March 2015

This lecture will cover

History

of knowledge of harm
Types of tobacco and harmful ingredients
Deaths caused by smoking
Harm smoking
Harm e-cigarettes
Harm SHS, THS
Harm of smokeless tobacco
Health professionals
Harm to youth
Interventions

History of knowledge of
harm
1604:

England King James I in 'A Counterblaste to

Tobacco: A custome lothsome to the eye, hatefull to the
Nose, harmefull to the braine, dangerous to the
Lungs
1962: England: Smoking and health. A report of the
Royal College of Physicians of London on smoking in
relation to cancer of the lung and other diseases
1964: Luther L. Terry, M.D., 9th USSG, released 1st
report on Smoking and Health: Report of the Advisory
Committee of the Surgeon General of the Public Health
Service
1981: Hirayama T. Non-smoking wives of heavy smokers
have a higher risk of lung cancer: a study from Japan.
Br Med J (Clin Res Ed). 1981 Jan 17;282(6259):183-5.

Let us not forget

Historically it takes at least a century from
scientific identification to eradication of
other pandemics, e.g. smallpox , polio.

Tobacco Atlas
TYPES OF TOBACCO USE
CHAPTER 04

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Tobacco Atlas
DEATHS
CHAPTER 01

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Tobacco pandemic
increasing
More

people in world 7b->9b in 2040

More people living longer . therefore
Therefore more:
smokers
cigarettes
consumption
disease and deaths
burden on health systems
jobs for farmers, manufacturers
tax for governments
profits for tobacco industry

More peoplemore
smokers

2010: 6.9 billion

2040: 8.8 billion

Future: more smokers

Smoking
Prevalence

Tobacco
Consumptio
n

#
Smokers
1.4b
1.6b in
2030

Tobacco
annual
deaths
6m 810m

Smoking deaths
8 to
10m
2030
5.4
m
200
5

die;
half in middle
age

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Tobacco deaths if no
quitting

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Tobacco Atlas
HARM FROM SMOKING
CHAPTER 02

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Addiction
Most

adult smokers would prefer to quit and

they know it is an expensive, dangerous and
dirty habit.
They do not want their children to smoke
But they are by now addicted to nicotine (all it
takes is 100 cigarettes)

1/5

LACK Awareness among smokers that smoking

causes heart disease, stroke, lung cancer (ITC)

Lack of awareness that smoking causes heart disease: 3% in France to 46% in China
Lack of awareness that smoking causes stroke is higher: 8% in Germany to 70% in China
Awareness that smoking causes lung cancer is higher almost everywhere.

The Oral Health Atlas. Roby Beaglehole, Habib Benzian, Jon Crail,
Judith Mackay. Published by FDI World Dental Federation 2009.
Myriad Editions.

COPD
75% due
to tobacco

Smokeless
Tobacco and oral
cancer
Popular in South
Asia

Economics costs of
harm of tobacco
1. Costs of smoking
a) Costs to government, society
b) Costs to smokers
3. Costs of tobacco control

Increasing cost to
govts & employers
HEALTH COSTS

OTHER ECONOMIC
COSTS

Time off for smoke

Medical and healthcare
breaks
costs
Lower productivity
Higher absence rates
Fires caused by careless
Loss of skilled workers by
smoking
premature death
Damage to building fabric
Increased early
Litter of billions of
retirement due to ill
cigarettes, matches,
health
packets, lighters
Secondhand smoke risks
Risk of being sued

Economic burden of
smoking to govts,
workplace & individuals

MONITOR

Ho Chi Minh
Cancer
Hospital:
Health Care
Unable to
Cope

More costs to
governments
Deforestation

as trees are cut down to cure

tobacco
Cost of the use of arable land that could grow
food
Loss of foreign exchange if cigarettes are
imported

Costs to smokers &

families
Premature
Ill

death

health
Health care costs
Costs of second-hand smoke on family health
Costs of purchasing cigarettes

Harm of e-cigarettes?
Immense

harm v immense good?

Independent Scientific
Committee on Drugs

E-cigarettes
More or less harm?
Immense

good or immense harm: Not yet clear

Health effects: Not yet enough evidence
Ingredients: Mostly unknown, some toxic.
Some containing nicotine, some not.
Smokefree: Need research on exposure levels
of chemicals
Smokefree: confusion on law
Cessation: Not yet enough evidence on their
effectiveness (but more acceptable to quitters)

Ads for e-cigs Women

Ads for e-cig Men

What to do about e-cig?

GLOBAL E-CIGARETTE REGULATORY MAP

Countries where E-CIGS

Are Legal to sell
Countries with
Restriction on E-CIGS
with Nicotine
Countries with Complete
Ban on import,
advertising and sale of
E-CIGS
Countries where
regulation is Not Clear

Tobacco Atlas
SECONDHAND SMOKING
CHAPTER 03

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3. SHS: LACK Awareness

among non-smokers that
second-hand smoke
causes heart disease
(GATS)
Lack of awareness that SHS
causes heart disease:
5% Thailand - 88% Vietnam
In all countries surveyed
(except Ukraine), awareness
that SHS causes heart disease
and was lower than knowledge
that SHS causes lung cancer.

PROTECT

People From Tobacco

Smoke

Smoke-Free Laws Protect

Employees

Smoke-free restaurants (and bars):

1. Frame as protection of workers health
2. Address economic argument: business
improves
3. Banning smoking decreases third-hand
smoke
Hong Kong
Restaurant
Tax Receipts
Before ban and
2 years later:

31%

Third hand smoke

Third-hand

smoke is contamination by
tobacco smoke that lingers following the
extinguishing of a cigarette.
Nicotine and other components of the smoke
tend to coat a space's surfaces and continue to
emit toxins.
Eleven carcinogens found in third hand smoke
including nitrosamines and radioactive
polonium.
It may linger for months, especially in soft
furnishings.

Tobacco Atlas
SMOKELESS TOBACCO
CHAPTER 11

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Smokeless
Tobacco and oral
cancer
Popular in South
Asia

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Tobacco Atlas
HEALTH PROFESSIONALS
CHAPTER 12

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Childrens Health

Never born
Some

children are never

born because of tobacco,
which causes:
Sperm deformity
Sperm loss of motility
Sperm reduced number
Impotence
Infertility in men and
women

Smoking in
pregnancy
Children

are affected by
tobacco from the moment of
conception.
Smoking in pregnancy
causes complications
affecting mother and foetus,
such as stillbirth and
prematurity.

Exposure to SHS
Exposure

of the foetus,
infant & child to secondhand smoke increases:
Risk of stunted
development, SIDS
Exacerbation asthma &
respiratory infection
Childhood cancers
Cleft palate
Risk of allergic diseases
Possible risk of learning
disability

Early poster HK

Third hand smoke

Research

has identified harm to children

associated with third-hand smoke - the
invisible residue containing many of the same
toxic chemicals left on surfaces and clothing
that lingers long after second-hand smoke has
cleared from a room.

Starting to smoke
Globally,

the average age of starting to

smoke is
under 20 years, many before
the age of 10

Why do young people

start?
Studies

have shown:
Peer pressure
Curiosity
Rebellion
Wanting to look grown up
Think smoking cool
Being targeted &
manipulated by tobacco
industry
Belief that most adults
smoke

Teen brain maturation

The frontal lobes of
the brain, the seat of
long-term judgment,
are not fully mature
until the early
twenties, so it is
imperative to prevent
smoking during
childhood.

Which youth smokes?

Boys

more than girls

Less intelligent and less educated
Lowest socio-economic class
Youth whose parents smoke
Experimenters of just ONE cigarette (delayed 3
years)
N.B. Health knowledge almost the same
between smokers and non-smokers (or those
to become so) the main difference is
whether you think it is:
a) cool or
b) a dirty, dangerous and expensive habit

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Prevalence BOYS

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Prevalence GIRLS

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What are the harms of

smoking during youth?
Addiction
Impaired

fitness and sports performance

Unattractive to opposite sex who wants to
kiss an ashtray?
Worsening of asthma and other respiratory
problems
Genetic damage predisposing to later cancer
Hardening of artery walls predisposing to heart
disease
Genetic abnormalities in the sperm of teenage
boys

From the mouth of the

tobacco industry

....if our company is to survive and prosper,

over the long term we must get our share of
the youth market. In my opinion this will
require new brands tailored to the youth
market.
Claude Teague, RJ Reynolds, Researcher, 1973
WHO Tobacco Free Initiative Initiative pour un monde sans tabac

Tobacco industry
promotion
Tobacco

advertising promises health,

attractiveness, popularity, slimness, macho,
emancipation, adulthood all designed to
manipulate children into bondage, the
opposite of the freedom they promise.
Tobacco industry school programmes are
designed to buy a good corporate image and
prevent regulation of the industry, and are
not effective in reducing youth smoking.

Movies: PAID product

placement

Where are my goddamn cigarettes?

Guys? Whats wrong with this picture?
Sigourney Weaver in Avatar, set in 2154 (3 tobacco

A program to
discourage teens
from smoking
(an adult
decision) might
prevent or delay
further
regulation of the
tobacco
industry.
US Tobacco Institute
April 1982
Bates 03673753-03673762

HK
1995

Industry: schools programmes

Buy good image we dont want youth to smoke
Same internationally: 60 + countries
Funded by the tobacco industry
Say nothing about smoking risks or industry conduct
Say nothing about persuading parents to quit

Tobacco industry youth groups

Industry-funded front
groups

What needs to be
done?

Action: Industry scream

test
Tax

*** Children very price sensitive

Smoke-free areas
Bans on all advertising, promotion
and sponsorship
Industry

ignores: (so we know these do

not work)
Traditional schools programmes
Ban on sales to minors

Impact of Interventions

Source: Ross et al, 2001

Next Steps
Fully implement
FCTC
Provide adequate
funding
Set targets
Novel ideas

The fight against the harm of

tobacco will continue!

Thank You
Professor Judith Mackay
Senior Advisor
jmackay@worldlungfoundation
.org