Importance of Research on Tobacco control

From research to action

Prof. Gonghuan Yang

China CDC/PUMC

Outline

Importance of Research on Tobacco control Research proved the risk of tobacco use Research proved the effective of strategy of tobacco

control From research to action on tobacco control

Research on tobacco control has translated to global action on tobacco control

Evidence-based research to support tobacco control in China

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The Importance of Research on Tobacco Control

Established the relationship between tobacco use and disease;

Estimated disease burden and economic cost quantitatively;

Verified the efficiency of strategies on tobacco control

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MPOWER POLICIES

Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising,

promotion and sponsorship; Raise taxes on tobacco）

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Borio G. Tobacco Timeline, 1998

Early Indications that Tobacco Causes Disease: German Research

1929: Fritz Lickint publishes statistical evidence linking lung cancer and cigarettes

1939: Lickint publishes ‘Tabak und Organismus’ a 1,100 page volume, “the most comprehensive scholarly indictment of tobacco ever published”

1939: Muller presents the world’s first controlled epidemiological study of the tobacco–lung cancer relationship

Borio G. Tobacco Timeline, 1998

Survivorship of white males after 30 years of age according to smoking habits

Pearl, 1938

100

30Age in years

90

80

70

60

50

40

30

Non-users

Th

ou

sa

nd

s o

f s

urv

ivo

rs20

10

0

40 50 60 70 80 90 100

Moderate smokers

Heavy smokers

Early Indications that Tobacco Causes Disease 1938: Raymond Pearl

reports smokers do not live as long as non-smokers

1950: Three key case-control studies link smoking with lung cancer

1953: Ernst Wynder’s study showed that tobacco painted on the backs of mice produced tumors

Early Indications of Tobacco-related Disease 1954: Richard Doll and Bradford

Hill’s study of British doctors published in the British Medical Journal

1962: Royal College of Physicians Report

1964: First Surgeon General’s Report on tobacco and health

1981: First major study on passive smoking and lung cancer by Takeshi Hirayama (Japan)

Borio G. Tobacco Timeline. 1998

Surgeon General Luther Terry holding the 1964 Report

Pattern on tobacco control & Health

Epidemilogical Study on tobacco & Health in China

Smoking and lung cancer in Shanghai ， Gao YT,. IARC Sci. Rubi.1986;(74):115-21.

Early health effects of the emerging tobacco epidemic in China,（ Chen ZM JAMA, 1997, 278(18):1500-4)

Retrospective proportional mortality study of one million deaths（ Liu BQ et al ， BMJ, 1998; 317:1411-1422)

Early mortality results from a prospective study （ Niu SR et al BMJ, 1998; 317:1423-1424

Mortality attributable to smoking in China (Gu DF ， N Engl J Med 2009 Jan 8;360(2):150-9. ，

Body mass index and mortality from lung cancer in smokers and nonsmokers(Yang L, Int J Cancer. 2009 Nov 1;125(9):2136-43.

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Death numbers of Attributed tobacco use/Total Death, 1990 (1000)

  Male Female

  <30 30-69 ≥70 <30 30-69 ≥70

Cancer 0/45 146/629 47/250 0/32 11/334 10/174

COPD 0/8 66/290 140/512 0/11 19/201 48/552

TB 0/11 13/111 13/53 0/12 2/63 2/30

Stroke 0/11 30/302 15/359 0/8 0/221 0/372

CHD 0/5 24/164 6/217 0/3 5/123 5/251

Other 0/822 0/745 0/448 0/817 0/568 0/473

Total 0/870 279/2154 221/1805 0/859 37/1390 65/1807

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JAMA ， 1999 ， 282 ： 1247-53BMJ ， 1999 ， 282 ： 1247-53Tobacco Control ， 1999 ， 282 ： 1247-53

5年死亡追踪研究结果

Cohort Study on Tobacco & Health in Chinese （ 1991-95）

Alan Lopez’ comments in BMJ

These studies are important both for their concordance conclusions about tobacco and for their epidemiological methods.

This system could be extended to other countries and is particularly useful for prospective studies

These two new studies provide the first nationwide evidence of tobacco's effects in a developing country.

BMJ 1998 ； 317 ： 1423-24

Disease Burden attributed to tobacco use

The health consequences of the tobacco epidemic are very serious

Minus Net Benefits on Integrated Tobacco Social Costs and Benefits Assessment

2010年负效应已达 600亿。

Report of the Surgeon General

How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for smoking Attributable Disease

Conclusion:

1. The evidence on the mechanisms by which smoking causes disease indicates that there is no risk-free level of exposure to tobacco smoke.

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19851984 19861980 19811982 198919881987 1991199019831979

18

21

24

27

30

230

15

270

250

210

190

48

39

33

42

36

45

170

150

130

110

90

Year

Sm

oki

ng

pre

vale

nce

(%

)

Real cig

arette price in

dex

Teenage smoking

Real tobacco price index

Real cigarette prices and cigarette smoking prevalence among

Canadians aged 15–19 years

Health and Welfare Canada

Impact of Increasing Price on Smoking Among Canadian Teenagers

Region

Change in number of smokers(millions)

Change innumber of deaths

(millions)East Asia and Pacific - 16 - 4Eastern Europe and Central Asia - 6 - 1.5Latin America and the Caribbean - 4 - 1.0Middle East and North Africa - 2 - 0.4South Asia (cigarettes) - 3 - 0.7South Asia (bidis) - 2 - 0.4Sub-Saharan Africa - 3 - 0.7Low/middle Income countries - 36 - 9High Income countries - 4 - 1World - 40 - 10

Note: Numbers have been rounded

Potential number of smokers persuaded to quit, and lives saved, by a price increase of 10%

Estimated Impact of Increasing Price on Prevalence and Mortality

World Bank, 1999

From Research to Action

Research results has been translated to global action of tobacco control

Need to strengthen research on tobacco control in China.

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The State of selected tobacco control policies in the World, 2010

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Prevalence of NCD in China need to active tobacco control

Proportion of NCD in total death rates is increasing: 82% in 2005, Daly in 2005: 72%

The age-standard death rates of the major NCDs were increasing;

The NCDs prevalence in rural was still increasing;

Aging will blow up the diseases burden of NCD.

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proportion of death by death causes in different years

0

0

0

0

0

1

1

1

1

1

1

1973y 1991y 1995y 2000y 2005y

%

Unknown

Injury

Other NCD

COPD

Cardiovascular

Cancer

Martenal & perinatal

Communicable

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1991- 2000死亡率呈上升趋势的疾病，

0

15

30

45

60

75

90

105

120

135

150

1985 1990 1995 2000 2005 2010

1/10

标化

死亡

率（

万）

Increasing trend of standard death rates of 6 chronic diseases

Stroke

CHDLung Cancer

Liver cancer

Diabetes

Breast cancer

Traffic injury

NCD Control & Economy in China While China has had an enviable economic growth and

development performance for more than 30 years, its human development has lagged behind the most advanced economies.

China ranked 89th in the 2010 human development index prepared by the United Nations Development Program(UNDP).

The Chinese population’s healthy life expectancy(HALE) at birth is about 10 years shorter than in some of the leading G-20 countries .

China could narrow these gaps in human development by identifying the priority health issues affecting its population, mustering political support to overcome them, and implementing appropriate interventions, as described below.

China’s 12th Five-year Plan (2011–2015) aims to promote inclusive, equitable growth and development by placing an increased emphasis on human development .

Political declaration on the Prevention and Control of NCD

The global burden and threat of non-communicable diseases constitutes one of the major challenges for development in the twenty-first century, which undermines social and economic development throughout the world, and threatens the achievement of internationally agreed development goals;

Non-communicable diseases are a threat to the economies of many Member States, and may lead to increasing inequalities between countries and populations;

The primary role and responsibility of Governments in responding to the challenge of non-communicable diseases and the essential need for the efforts and engagement of all sectors of society to generate effective responses for the prevention and control of non-communicable diseases;

…….

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Completely promote banning smoking in Public Places in National “12.5” Social Economic Development Plan has been approved by NPC in March 2011.MOH issued the detailed rules and regulations of banning smoking in public places in March, 22, 2011.

Research on TC in China Search: tobacco use, prevalence, China 627 article, Key words: tobacco use,

prevalence, China

Resources: by Authors 31

CNTC supports academic research A research and education-oriented institute with the goals of

promoting the use of technology in tobacco farming, manufacturing and research and training tobacco researchers.

Number of Paper is as 20 times as one of tobacco control. Increasing paper on the research on less harmful and low-tar cigarettes

besides the traditional research paper ;

Resources: Relationship between the Chinese tobacco industry and academic institutions in ChinaBy Quan Gan1 and Stanton A Glantz

32

Research Fund Tobacco control:

A fewNIH Fogarty international centerCMBNational Ministry of Science & Technology

Tobacco IndustryUnclearBut for museum of tobacco: 180 million

RBM

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THANKS