A descriptive model of the cigarette epidemic in developed countries

It has been estimated that cigarettes are the cause of the deaths of one in two of their persistent users, and that approxi mately half a billion people currently alive-8% of the world's population could eventually be killed by tobacco if current smoking patterns persist. De spite this pandemic, tobacco consump tion 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 lag 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 consump tion 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 ex periencing. Tobacco control policy im plications for countries at each of the four stages of the cigarette epidemic are also discussed.