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The epidemic of tobacco use

To study global tobacco use, it helps to characterize tobacco use as an epidemic occurring in four stages.[6]

Stage 1 is characterized by low initiation and cessation rates.

Western countries were at this stage in the early 20th century. Countries currently at this stage include Nigeria, Ghana and Democratic Republic of Congo.

Stage 2 occurs when smoking rates among women increase and increase 50% or more among men.

Tobacco related mortality is high among men but remains low among women. Countries at this stage include the Philippines, China and Mexico. At this stage, the adverse health effects of tobacco are not well known and there is little support for tobacco control measures. The wealthy and upper classes tend to smoke in the countries at this stage.

Interestingly, doctors in these countries have a high smoking rate. In China, for example, 61% of male physicians and 12% of female physicians smoke.

In Stage 3, smoking among men decreases and plateaus, then decreases among women.

Mortality remains high among men. Luxembourg, Switzerland and Turkey are at this stage. Also, at this stage, tobacco is seen as unacceptable among the educated part of society.

In Stage 4, prevalence continues to decrease for both men and women, and the number of new smokers starts to decrease.

Mortality among men begins to decrease, while it continues to increase for women. Canada, the United States, the United Kingdom and Australia are at this stage in the epidemic.


6. Lopez AD, Collishaw NE, Piha T. A descriptive model of the cigarette epidemic in developed countries. Tobacco Control 1994;3:242-247 &author1=lopez&fulltext=tobacco+epidemic &searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT accessed March 26, 2006

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