Global Effects of Smoking, of Quitting, and of Taxing Tobacco

O n the basis of current smoking patterns, with a global ave rage of about 50% of young men and 10% of young women becoming smokers and relatively few stopping, annual tobacco-attributable deaths will rise from about 5 million in 2010 to more than 10 million a few decades hence, 1-3 as the young smokers of today reach middle and old age.This increase is due partly to population growth and partly to the fact that, in some large populations, generations in which few people smoked substantial numbers of cigarettes throughout adult life are being succeeded by generations in which many people did so.There were about 100 million deaths from tobacco in the 20th century, most in developed countries.2,3 If current smoking patterns persist, tobacco will kill about 1 billion people this century, mostly in low-and middle-income countries.About half of these deaths will occur before 70 years of age.[1][2][3][4] The 2013 World Health Assembly called on governments to reduce the prevalence of smoking by about a third by 2025, 5 which would avoid more than 200 million deaths from tobacco during the remainder of the century.2,3 Price is the key determinant of smoking uptake and cessation.[6][7][8][9] Worldwide, a reduction of about a third could be achieved by doubling the inflation-adjusted price of cigarettes, which in many low-and middle-income countries could be achieved by tripling the specific excise tax on tobacco.Other interventions recommended by the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and the WHO six-point MPOWER initiative 4 could also help reduce consumption 7,8 and could help make substantial increases in specific excise taxes on tobacco politically acceptable.Without large price increases, a reduction in smoking by a third would be difficult to achieve.The WHO has also called for countries to achieve a 25% reduction between 2008 and 2025 in the probability of dying from noncommunicable disease between 30 and 70 years of age. 10 Widespread cessation of smoking is the most important way to help achieve this goal, because smoking throughout adulthood substantially increases mortality from several major noncommunicable diseases (and from tuberculosis).[1][2][3][11][12][13][14][15][16][17][18][19] To help achieve a large reduction in smoking in the 2010s or 2020s, governments, health professionals, journalists, and other opinion leaders should appreciate the full eventual hazards of smoking cigarettes from early adulthood, the substantial benefits of stopping at various ages, the eventual magnitude of the epidemic of tobacco-attributable deaths if current smoking patterns persist, and the effectiveness of tax increases and other interventions to reduce cigarette consumption. Thr ee K ey Messages for Smok er s in the 21s t Cent ur yFirst, the risk is big.Large studies in the United Kingdom, the United States, Japan, and India have examined the eventual effects on mortality in populations of menThe New England Journal of Medicine Downloaded from nejm.

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