Chapter 1 10 Tobacco use is one of the biggest public health threats to the world, claiming the lives of 8 million people annually.1 Despite the alarming statistic that one in two tobacco users will meet a premature death, tobacco industries continue to thrive, selling to over 1.3 billion smokers worldwide. The start of the tobacco epidemic can be marked in 1880 with the invention of the first practical cigarette cutting machine.2 Since then, the spread of tobacco use and its associated adverse health impact has been described using the tobacco epidemic model (Figure 1). In Western Europe the first stage of this epidemic began in the early 1900s, predominantly among men. In the second stage, smoking rates increased sharply among men and first signs of tobacco related mortality showed. In this stage women started smoking as well. In the 1950s tobacco use peaked among men and the sharp increase in tobacco-related mortality heightened awareness of its detrimental health effects. In the fourth phase, smoking rates decreased among both men and women. Mortality rates remained high, or started to decline among men. Figure 1: Tobacco epidemic model, used from Lopez et al. Tobacco Control 1994; 3; 242-247 The emergence of stage 3 in Western countries coincided with the release of the 1964 U.S. Surgeon General’s report on lung cancer and tobacco, which was one
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