Welcome to Tobacco & Health:

from Cells to Society

Roberta Ferrence, PhDRoberta Ferrence, PhD

Ontario Tobacco Research UnitOntario Tobacco Research UnitSept 11, 2013Sept 11, 2013

Ontario Tobacco Research Unit

History of the Course

Early1990s: module of Non-communicable Diseases

Became so popular, developed full half course 1998

Joanna Cohen and I first co-instructorsMichael Chaiton involved for several years -

now Course leadAdded sites in second year; now across

Canada

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Uses of Epidemiological Data on Tobacco Use

Identify target groups for prevention Evaluate policies and interventions Impact of industry marketing and

promotion Basis for predicting disease outcomes Data for testing causal hypotheses Expert testimony for litigation

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Key Messages

Dynamic Model Observations are deceiving

Sex differences Effects of bans Tourist effect

Level of smoking: not just prevalence Latent period for health effects

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Diffusion ProcessDiffusion of Innovation Model

(Rogers & Schumaker) New behaviours & products tend to follow a

predictable curve after introduced into a population

“S-shaped” curve slowly at first, then sharply finally slows and levels off or declines

Same as epidemic curve that describes the spread of infectious diseases

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The “S” Shaped Curve

Early Adopters

Late Adopters

DIFFUSION

DISCONTINUANCE

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Diffusion of Tobacco Use WWI prime event in diffusion to

widespread useEarly adopters: men, high SES,

urban, developed countries Early adopters also early quitters

BC, ON Rates may decrease faster in late

adopter groups at certain points

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International Trends in Cigarette Consumption

An example of diffusion:Developed Countries

Peaked in 1980s, subsequent decline Small sex differences

Developing Countries Steady increase in prevalence and #/day

for several decades Large but decreasing sex differences

Net Effect: Little change in Global consumption over time

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Trends in Tobacco Use among Canadian Adults

After leveling off in the early 90s, cigarette use has continued its long-term decline

Both prevalence and level of smoking are decreasing in the long term

Increasing proportions of smokers smoke less than daily

Significant but declining differences by province

Increase in use of alternative nicotine products (e.g., e-cigarettes, Hookah)

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Trends in Tobacco Use among Canadian Youth

Substantial decreases in youth prevalence (while marijuana use increasing)

No significant sex differences Males more likely to be daily smokers

and to smoke more cigarettes per day

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The Future of Smoking Depends on many factors:

Taxes, availability, acceptability, restrictions, disincentives, cessation support, stability of industry due to litigation

FCTC Further declines likely among all groups in

developed world Experience in developing world will vary

depending on tobacco controls, industry marketing and other factors

Other forms of nicotine increasing in marketplace