The history and epidemiology of cigarette smokingbriefly - PowerPoint PPT Presentation

Title: The history and epidemiology of cigarette smokingbriefly


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The history and epidemiology of cigarette
smoking--briefly

• Kenneth A. Perkins, Ph.D.,
• Professor of Psychiatry

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Historical Factors Increasing Cigarette Smoking

• 1850s Invention of the safety match--portable
  lighting device that enabled one to smoke
  almost anywhere.
• Late 1800s Development of tobacco
  blends--reduced harshness of smoking.
• 1880s Invention of cigarette rolling
  machine--greatly increased supply and drove
  down cost of
• cigarettes, which were previously made by
  hand.
• Early 1900s Modern marketing strategies--increased
  demand
• for cigarettes.
• from Kluger R (1996) Ashes to ashes. New York
  Knopf.
• Note that cigarettes are a highly engineered
  product continually being refined to enhance
  acceptability to smokers (e.g. ammonia to
  increase nicotine uptake, flavorings like cocoa,
  menthol).

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Cigarettes were 2 of all tobacco intake in 1900
80 in 1963
Tobacco Execs testify in Congress
1900 1910 1920 1930 1940 1950
1960 1970 1980 1990
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Recent trends in smoking prevalence and quitting
Prevalence has dropped by half since 1964 42 to
21. Men 52 to 23 Women 34 to 19 Heavy
smoking (25/day) has dropped from 29 of all
smokers in 1980 to 12 in 2004. Top Drop in
prevalence is much greater with higher education.
Bottom Quitting has increased in all age
groups, but less so for younger versus older
smokers. From Giovino et al. (2002).
 
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Characteristics of current smokers
Current smoking is associated with poverty and
low education. Men little difference by
ethnicity except higher in Native
American. Women lower prevalence in non-White
ethnicities except Native Am.
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Comorbidity of smoking and psychiatric or
substance abuse problems
Smoking prevalence is higher in those with
psychiatric or substance abuse problems
(hardening?) Depression history
30-50 Schizophrenia 70 PTSD 40-50 ADHD
elevated but little prevalence data Alcohol
dependence 80-90 Cocaine dependence 80 Opiate
dependence 90
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Lights do not reduce exposure or risk
Smoking behavior and smoke exposure after
switching to light brands (i.e. those with
lower nicotine yields). Ninety percent of
commercial brands have yields within the range of
yields across these brands, 0.4-1.1 mg nicotine.
Adapted from Zacny Stitzer (1988).
       
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Occasional smokers
Prevalence of non-daily smoking is increasing, as
overall prevalence of daily smoking is decreasing
. Non-daily are 20 of all smokers. Characteristi
cs more common in non-daily (some day) vs daily
smoking Younger age Non-white
ethnicity Higher education Higher
income Hassmiller et al. (2003) AJPH, 93 1321-7.
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Risk of dependence among those ever exposed
Top Percentage of the U.S. population ever using
various drugs of abuse at least once. Bottom
Percentage of those ever using a drug who become
dependent on that drug. Note that, although
only a minority of ever users become dependent,
the risk of dependence is highest among those
ever using tobacco and exceeds even those for
cocaine and heroin. Data from Anthony et al.
(1994).
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What accounts for high rates of dependence on
tobacco smoking?
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Time to peak arterial concentration
Nasal spray (5 min)
Smoking (Gum/Inhaler (20 min)
Patch (hrs)
IV (1-2 min)
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INSERT FIG SHOWING KINETICS OF CIGS AND NRT, to
illustrate why NRT might not work that well
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Photo of woman and cig smoke
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Predictors of Sustained Abstinence
(Ockene et al. 2000, Health Psychology)

• Fewer cigs/day
• Fewer years/smoking
• Longer duration of prior abstinence
• Older age at initiation
• Ever quit before
• Fewer lapses during current quit attempt
• No comorbid conditions

Hymowitz N et al. (1997) Tobacco Control 6(suppl
2) S57-S62.
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Any smoking at all on or after quit day strongly
predicts failure
Perkins et al. (2001) Journal of Consulting
Clin Psychol 69 604-613.
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Reach for a Lucky
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Lung Cancer Risk
Women and Smoking A Report of the Surgeon
General. Washington, DC US Dept of Health and
Human Services, Public Health Service, Office of
the Surgeon General 2001.
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International Early Lung Cancer Action Program
Investigators (2006) Women's Susceptibility to
Tobacco Carcinogens and Survival After Diagnosis
of Lung CancerJAMA. 296180-184. Table 2.
Logistic Regression Analysis of 14 435 Baseline
Screenings for Lung Cancer, Prevalence Odds
Ratio, Women vs Men by Controlled
Covariates Odds Ratio (CI) P Value None
1.6 (1.2-2.0) .002 Age and smoking 1.7
(1.3-2.3) .001 Two-sided.
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Lung function COPD
Dransfield MT, Davis JJ, Gerald LB, et al. (2006)
Racial and gender differences in susceptibility
to tobacco smoke among patients with chronic
obstructive pulmonary disease. RESPIRATORY
MEDICINE 100 1110-1116 N330 smokers over 45
years old Figure 2. Susceptibility Indices (SI).
The SI represents the change in lung function
(race-adjusted predicted FEV1) per pack-year
smoked as calculated by the formula
(FEV1-100)/pack-years. Caucasians lost lung
function at a slower rate than did
African-Americans (pwomen (p.001).
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CV risk due to smoking in F vs M
Women
Men
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Relative risk of myocardial infarction for
current smokers compared with never smokers, by
sex Prescott et al. (1998) Smoking and risk of
myocardial infarction in women and men
longitudinal population study. Brit Med J 316
1043-1047
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Quit ratio (former/ever) in men vs women
Smoking and Tobacco Control Monographs, Monograph
12 Population Based Smoking Cessation
(2000) 1995-96 data (18 and older) Current For
mer Quit Ratio Men 25.66 25.80 50.14 Women
20.73 18.07 46.56
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Wetter et al. sex diffs outcome from patch, JCCP
Nicotine patch outcome at 6 months, by sex
(N632)
Adapted from Wetter DW et al. (1999) Gender
differences in smoking cessation. Journal of
Consulting and Clinical Psychology, 67555-562
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Update of Munafo et al (2004)
Update of Munafo et al (2004) meta-analysis of 11
NRT patch trials, adding 3 more trials Women do
significantly worse on NRT patch (OR of 1.45,
p.03) Study log OR (SE)
OR CI weight OR (95 CI)
See Perkins Scott (2005) Nic Tob Res 7915-916
Munafo et al. (2004) Nic Tob Res 6 769-776 and
865-867.
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Bupropion meta-analysis

• Scharf Shiffman (2004, Addiction)12 studies of
  bupropion vs placebo for smoking cessation.
• No sex diff due to bupropion vs placebo but lower
  abstinence in women overall.
• Bupropion vs placebo in men OR 2.53 (1.88-3.4)
• Bupropion vs placebo in women OR 2.47
  (1.92-3.17)
• However, overall, women were less likely than men
  to quit, whether on bupropion, OR0.79
  (0.65-0.95), or on placebo, OR0.75 (0.59-0.94)

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DRD2 Genotype and Nicotine Patch Outcome (6
months)Treatment x genotype x sex interaction
(pN307 men, 445 women (41 CT,TT A1/A1, A1/A2
59 CC A2/A2)
Yudkin, Munafo, Hey, et al. (2004) British Med J
(online version)
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Worldwide Smoking Prevalence is still rising

• Currently 1.2 billion smokers consuming 6
  trillion cigarettes per year (so, 4 of smokers
  are U.S.)
• Smoking kills 5 million per year, or one every 6
  sec (9 of smoking deaths are U.S.)
• China, with 350 million smokers, produces about
  50 of worlds tobacco (U.S. is distant second at
  about 10).
• Traditional treatment approaches (e.g.
  medications, one-on-one counseling) not likely to
  be practical. Policy and prevention are needed.
• WHO and other international orgs helping to
  reduce tobacco use (also Framework Agreement on
  curbing tobacco, advertising, etc.)
• FDA issue Regulation of nicotine levels and/or
  non-nicotine constituents responsible for health
  risks, enhancement of dependence, etc.