Changes in Patterns of Substance Use ─ Tobacco

Lars RamströmInstitute for Tobacco Studies

Stockholm, Sweden

49th International ICAA Conference on Dependencies Edinburgh (Scotland, UK) Sept 2006

BEFORE CHRISTOFER COLUMBUS

Smoking tobacco played a prominent role in the religious life of many indian tribes in America.

Tobacco was also smoked for pleasure, and the medicine men used it to cure a range of illnesses.

BEFORE CHRISTOFER COLUMBUS

Smoking tobacco played a prominent role in the religious life of many indian tribes in America.

Tobacco was also smoked for pleasure, and the medicine men used it to cure a range of illnesses.

AFTER COLUMBUS had brought home tobacco seeds,

cultivation of tobacco started in Europe.

THE 16TH CENTURY

Jean Nicot (1530-1600) French ambassador in Lisbon, Portugal from 1559 to 1561.

He brought tobacco plants to France and in 1560 he introduced tobacco in the form of snuff to the French court. The queen mother, Catherine de’ Medici, became an instant tobacco convert.

The tobacco plant, Nicotiana, is named after him, as is nicotine.

THE 17TH CENTURYSnuff (DRY for NASAL use) use is popular among members of the upper classes. Pipe smoking is gaining popularity and there is also some manufacturing of cigars. Cigarettes, are ”invented” in Spain as a means of using waste tobacco to make cheap smoking products.”

THE 17TH CENTURYSnuff (DRY for NASAL use) use is popular among members of the upper classes. Pipe smoking is gaining popularity and there is also some manufacturing of cigars. Cigarettes, are ”invented” in Spain as a means of using waste tobacco to make cheap smoking products.

THE 18TH CENTURYSnuff holds its leading position, and the various kinds of smoking remain less dominant.

THE 19TH CENTURY

The cigar becomes increasingly popular among members of the upper classes.

MOIST snuff, for ORAL use, is introduced and reaches its way to broader population groups, especially in Sweden.

In the late 1870s the first machine for cigarette manufacturing is constructed. This makes it possible to start mass production – and mass consumption.

18801890

19001910

19201930

19401950

19601970

19801990

20000

1000

2000

3000

4000

5000

6000

10 20 50 100300

600

1000

1686

2150

3112

4388

5415 5557

Global cigarette consumption 1880 - 2000billions of sticks

Source: The Tobacco Atlas, Second Edition, American Cancer Society, 2006

CHANGES IN GLOBAL PATTERNS OF CIGARETTE CONSUMPTION

1970/72 1980/82 1990/92 2000/20020

1000

2000

3000

4000

TunisiaIcelandUnited Kingdom

Patterns of changes Annual per capita consumption of cigarettes

Sources: 1970-1992 data derived from Tobacco or Health. First Global Status Report, WHO,1997. 2000/2002 data derived from The Tobacco Atlas, second edition, American Cancer Society, 2006

0

10

20

30

40

0 10 20 30 40 50 60 70 80 90 100

0

20

40

60

80

Typical pattern of dissemination of the cigarette epidemic in a country

Stage 1 Stage 4Stage 3Stage 2

% OF DEATHS CAUSED BY SMOKING% SMOKERS

% male smokers

% female smokers

% male deaths

% female deaths

Years after start of male smokingDerived from: Ramström L. Prevalence and Other Dimensions of Smoking in the World, Prog. Respir. Res 1997;28:66-73.

According to a recent Nationwide survey:

More Doctors smoke Camels than any other cigarette

Quoted from the text:  "Doctors in every branch of medicine - 113,597 in all - were queried in this nationwide study of cigarette preference”

US advertisement in 1951

US advertisement in 1951

US advertisement in 1951

CountryCigarette consumption

Smoking prevalence

Men at large Physicians

Ethiopia Low, rising 6 % 9 %

Bulgaria High, still rising 44 % 52 %

Luxembourg High, falling 39 % 5 %

Australia Low, falling 19 % 3 %

Physicians vs men at large

Examples of patterns in different countries

according to the stage of the smoking epidemic

Proportion of daily smokers in:

Swedish population Swedish physicians

%

Source: Bolinder et al. Svenska läkare röker minst i världen. (Smoking doctors – a rarity in Sweden). Läkartidningen 2002;99:3311-7.

Advertisements USA 1948/1950

1972 advertisement USA.

Carlton is lowest. U.S. Government laboratory tests confirm, no cigarette lower in tar than Carlton

1976 advertisement USA.

In the mid 1970s manufacturing of smokeless tobacco started to go up. (See Surgeon General’s report 1986, Figure 1).

Major types of Smokeless Tobacco (in the Western world)

CHEWING TOBACCO

(LOOSE-LEAF TYPE)

MOIST SNUFF (SNUS)

(LOOSE GRAINS)

MOIST SNUFF (SNUS)

(PORTION PACKS)

Changing patterns of Smokeless tobacco use,

USA 1997 - 2005

• Chewing tobacco: down 5.2 % a year

• Moist snuff: up 3.6 % a year

• Source: US Alcohol and Tobacco Tax and Trade Bureau

1980/81 1984/85 1988/89 1992/93 1996/97 2000/2001 2004/2005

0

10

20

30

40

50

Daily smoking, womenDaily smoking, men

Daily smoking in Sweden 1980-2005Point observations and least square regression lines

Sources: STATISTICS SWEDEN suveys of Living Conditions

%

1980/81 1984/85 1988/89 1992/93 1996/97 2000/2001 2004/2005

0

10

20

30

40

50

Daily snus use, womenDaily snus use, menDaily smoking, womenDaily smoking, men

Daily tobacco use in Sweden 1980-2005Point observations and least square regression lines

Sources: Smoking data from STATISTICS SWEDEN suveys of Living Conditions Snus use data from NTS-suveys (1980-1987) and ITS/FSI-surveys (2000-2005)

%

1920s 1930s 1940s 1950s 1960s 1970s 1980s0

20

40

60

Daily tobacco use, MENDifferent birth cohorts in Sweden

Ever daily smoking (rate of initiation)Ever daily snus use (rate of initiation)

%

Born in the:

Current rate of daily smokingCurrent rate of daily snus use

Source: FSI/ITS surveys 2003/2004

1920s 1930s 1940s 1950s 1960s 1970s 1980s0

20

40

60

Daily tobacco use, WOMENDifferent birth cohorts in Sweden

Ever daily smoking (rate of initiation)Ever daily snus use (rate of initiation)

%

Born in the:

Current rate of daily smokingCurrent rate of daily snus use

Source: FSI/ITS surveys 2003/2004

1920s 1930s 1940s 1950s 1960s 1970s 1980s0

20

40

60

Daily tobacco use, MENDifferent birth cohorts in Sweden

Ever daily smoking (rate of initiation)Ever daily snus use (rate of initiation)

%

Born in the:

Current rate of daily smokingCurrent rate of daily snus use

Source: FSI/ITS surveys 2003/2004

1920s 1930s 1940s 1950s 1960s 1970s 1980s0

20

40

60

Daily tobacco use, WOMENDifferent birth cohorts in Sweden

Ever daily smoking (rate of initiation)Ever daily snus use (rate of initiation)

%

Born in the:

Current rate of daily smokingCurrent rate of daily snus use

Source: FSI/ITS surveys 2003/2004

EXAMPLES OF NEW SMOKELESS TOBACCO PRODUCS

the bowl or head, which contains the tobacco, the heating apparatus is placed on top

the pipe, which connects the bowl to the base by a tube that plunges into the water

the hose, which connects to a second tube in the pipe and does not plunge into the water, but only the air of the smoke chamber

the base or smoke chamber, which is partially filled with water

the mouthpiece

Hookah (Hubble-Bubble, Waterpipe) Egyptian type

SUMMARY (1)

• DURING 16TH THROUGH 18TH CENTURY tobacco use, occurring mainly in the upper classes, is dominated by dry oral snuff and there is also pipe and cigar smoking.

• IN THE 19TH CENTURY moist oral snuff is introduced and reaches broader population groups.

• DURING THE 20TH CENTURYcigarette consumption incraeses 100-fold and the epidemic is spread all over the world.

SUMMARY (2)• Global cigarette consumption is still going up, despite

decrease in developed countries since the 1980s.

• In individual countries the smoking epidemic usually follows a pattern of prevalence rising, passing a peak and then falling.

• Typically, men are passing through these stages earlier than women, and high educated earlier than low educated people.

• Around 1950 filter cigarettes started a rapid increase, from around 1970 focusing on low tar delivery (later found useless from health risk reduction point of view).

• Along with decreasing cigarette smoking there has been an increased interest for smokeless tobacco.

• Among smokeless tobaccos chewing tobacco is going down, moist snuff is going up, especially in Sweden, where more men use snuff (in Swedish ”snus”) than smoke.

• New habits, e.g. water-pipe smoking, may be coming.