Stages of the cigarette epidemic on entering its second century

Thun, Michael, Peto, Richard, Boreham, Jillian and Lopez, Alan D. (2012) Stages of the cigarette epidemic on entering its second century. Tobacco Control, 21 2: 96-101. doi:10.1136/tobaccocontrol-2011-050294

Author Thun, Michael
Peto, Richard
Boreham, Jillian
Lopez, Alan D.
Title Stages of the cigarette epidemic on entering its second century
Journal name Tobacco Control   Check publisher's open access policy
ISSN 0964-4563
Publication date 2012-03
Sub-type Article (original research)
DOI 10.1136/tobaccocontrol-2011-050294
Volume 21
Issue 2
Start page 96
End page 101
Total pages 6
Place of publication London, United Kingdom
Publisher BMJ Group
Collection year 2013
Language eng
Formatted abstract
Objectives A four-stage model of the cigarette epidemic was proposed in 1994 to communicate the long delay between the widespread uptake of cigarette smoking and its full effects on mortality, as had been experienced in economically developed countries where cigarette smoking became entrenched decades earlier in men than in women. In the present work, the question of whether qualitative predictions from the model have matched recent trends in smoking and deaths from smoking in countries at various levels of economic development is assessed, and possible projections to the year 2025 are considered.

The proportion of all deaths attributed to tobacco was estimated indirectly for 41 high-resourceand medium-resource countries from 1950 to the most recent year for which data were available, generally about  2005e2009. The trends in tobacco-attributed mortality in later middle age were then projected forward to 2025, based on recent trends in tobacco-attributed mortality in  early middle age.

In developed countries the prevalence of smoking has  continued to decrease in both sexes, although the rate of decrease has slowed and is less than that predicted by the original version of the model. Over the past 20 years the proportionate contribution of smoking to all deaths has decreased in men while continuing to increase or plateau among women. Although the proportion of all deaths at ages 35e69 that are attributed to smoking is still generally greater in men than in women, the male and female proportions are converging and will probably cross over  in some high resource countries. Projections through to 2025 suggest that male and female smoking prevalence and smoking attributed mortality will decrease in parallel in most developed countries towards lower limits that are not yet defined. In developing countries the model seems generally applicable to men but cannot predict whether or when women will begin smoking in large numbers. Modified criteria that describe the stages of the epidemic separately for men and women would be more generalisable to developing countries.

The four-stage model of the cigarette epidemic still provides a reasonably useful description in many developed countries. Its relevance to developing countries could be improved by describing the stages of the epidemic separately for men and women.
Keyword One Million Deaths
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 109 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 125 times in Scopus Article | Citations
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