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Globally, about 47% of men and 12% of women smoke. In developing countries, it is estimated that 48% of men and 7% of women smoke, while in developed countries, 42% of men and 24% of women smoke, indicating that different countries are at different stages in the tobacco epidemic.
In 1998, it was estimated that there were over 1.2 billion smokers in the world, approximately one-third of the global population aged 15 or older. 800 million of these smokers are in developing countries.
Tobacco is a known or probable cause of at least 25 diseases, including lung and other cancers, heart disease, stroke, emphysema and other chronic lung diseases. On average, lifelong smokers have a 50% chance of dying from a tobacco-related disease, and half of these deaths occur in middle age (45-54 years). In 1990, smoking was responsible for 35% of all deaths among middle-aged men in developed countries.
In developed countries, smoking is estimated to cause 87% of lung cancer deaths, 82% of emphysema deaths, 40% of heart disease deaths among people less than age 65, 21% of all heart disease deaths, 33% of all cancers, and 10% of infant deaths.
Before the widespread use of cigarettes, lung cancer was a rare disease. In 1912, only 374 cases of lung cancer were reported in the world literature. Now more than 150,000 deaths from cancer of the lung and bronchus per year are reported in the United States alone. Globally, smoking caused 29% of all cancer deaths among men and 6% among women in 1990.
Currently, an estimated four million deaths per year worldwide are attributed to tobacco use (about 7% of all deaths). It is estimated that by the year 2020, tobacco will cause 18% of all deaths in developed countries, and 11% of all deaths in developing countries.
Tobacco use is also a major cause of morbidity and disability. In high-income countries, smoking-related diseases account for between 6% and 15% of all annual healthcare costs. These figures may not necessarily apply to low- and middle-income countries, whose epidemics of smoking-related diseases are at earlier stages. There have been few reliable studies of the economic costs of smoking in these countries.
Tobacco use does not cause health problems only for adults. In adolescence, smoking is associated with increased susceptibility to, and severity of: respiratory infections; reduced lung function and rate of lung growth; increased likelihood of coughing spells and coughing up phlegm or blood; increased likelihood of wheezing and gasping; increased likelihood of shortness of breath when not exercising; decreased physical activity; and decreased endurance.
If current smoking patterns continue, it is projected that by 2030, ten million deaths per year will occur because of tobacco use, and that 70% of these deaths will occur in developing countries. Tobacco will then be the leading cause of fatal disease in the world, responsible for one in every eight deaths.
Most people who become regular smokers become physically, behaviourally, and psychologically dependent on continued smoking and have difficulty quitting even when seriously motivated to stop. The relapse rates for smokers making unassisted quit attempts are comparable to those of persons quitting heroin use. Fortunately, treatment can help people achieve lasting abstinence from tobacco.
Most regular smokers in the United States are dependent on nicotine, including most adolescent smokers. The frequency of reporting symptoms of nicotine dependence increases as the number of cigarettes smoked per day increases. Even among persons smoking five or fewer cigarettes per day, more than half report at least one indicator of nicotine dependence. Similar patterns are found for young smokers: 80% of young people who smoke five or fewer cigarettes per day report at least one indicator of nicotine dependence.
Environmental tobacco smoke causes lung cancer and heart disease in adults, and causes and aggravates asthma in children. It has been estimated that in the United States, 5%–14% of lung cancers in lifetime non-smokers are potentially preventable by eliminating environmental tobacco smoke exposure.
Parental smoking is also associated with sudden infant death syndrome (crib death or cot death). Children exposed to environmental tobacco smoke are more likely to develop bronchitis, pneumonia, and middle ear disease. Exposed children with asthma have more frequent and severe asthma attacks, and exposure to environmental tobacco smoke increases the chances of a child’s developing asthma.
A national study in the United States found that, even with an adult smoking prevalence rate of 25%, almost 90% of non-smokers had some exposure to environmental tobacco smoke.
Smokers who quit before age 50 have half the risk of dying within the next 15 years compared to those who continue to smoke. Former smokers experience better health than continuing smokers.
