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Electronic Letters to:
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eLetters: Electronic letters published:
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Indicators and consequences of tobacco use in the FSU countries require additional research
- Tatiana I. Andreeva, Konstantin S. Krasovsky (13 January 2005)
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Tatiana I. Andreeva, Project Director Alcohol and Drug Information Center (ADIC-Ukraine), Konstantin S. Krasovsky
Send letter to journal:
Andreeva{at}globalink.org Tatiana I. Andreeva, et al.
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The published paper is a valuable source of smoking prevalence data which can be used by tobacco control advocates in the region. Discussion of the results based on inter-country comparison, knowledge of recent transition processes in this group of countries and international experience is also of a great importance for understanding the situation and developing effective measures to change it. However, it is necessary to state that tobacco related situation in the FSU region is definitely understudied and much additional research is needed to create an adequate model leading to the effective control of tobacco related problems. So we would like to express alternative views on some of the ideas expressed in the article. 1. Authors state that the former Soviet Union’s tobacco epidemic may have developed differently than Lopez et al. outlined in their 4-stage model. They find no evidence of the male smoking prevalence stabilizing and decline. Though we have to agree that there is no survey data confirming this trend (as regular and comparable surveys are absent) we have indirect indications at least for Ukraine that male smoking prevalence is declining while female smoking prevalence is on the rise. This can be seen through different smoking rates in educational groups (see Table 1). While among most educated males we have more former smokers and nonsmokers and less current smokers than in less educated, the picture is the opposite for females. Table 1. Percentage of daily smokers, experimenters, ex-smokers and never smokers among Ukrainian males and females with different level of education (national representative survey in Ukraine, 2000)
So though the authors state that tobacco epidemic among females in the FSU countries is in its initial stage we can expect that it will grow soon especially in those countries where several transnational tobacco companies are represented. 2. Another issue about the stages of smoking epidemic is related to the following authors’ statement: “In this model, such an epidemic is described as involving an initial rise in male smoking followed by a rise in female smoking 1 to 2 decades later, after which each plateaus and then falls as a result of tobacco-related mortality, finally rising to a peak decades later.” Thorough reviewing of the referred paper did not reveal any mentioning of mortality as a reason for smoking prevalence decline. Quite the opposite Lopez et al. write about quitting smoking as the main cause for smoking decline and attract attention to the fact that tobacco control measures become especially timely at the stage with high prevalence and mortality where our countries are. So we hope that these findings will serve further development of tobacco control in the region. At the same time we can support the authors’ explanation of lower smoking prevalence among males in older age groups by higher premature deaths among smokers. Data from Ukraine based on 2000 national representative smoking prevalence survey extrapolated to the whole population is shown in table 2. We see that though numbers of nonsmokers and former smokers do not differ much in different age groups, smokers are less represented in every older age group. Table 2. Numbers (million persons) of nonsmokers, ex-smokers and daily smokers among Ukrainian males according to 2000 smoking prevalence survey extrapolated to the whole population
3. Authors discuss the age differences of smoking rates among males and cite cohort effect to be the cause of smoking prevalence decline in the older age groups. They write: “However, a cohort effect has been shown in the former Soviet Union, with those who were teenagers between 1945 and 1953 carrying forward lower smoking rates because cigarettes, like other consumer goods, were in short supply in the period of postwar austerity under Stalin. This cohort effect is also thought to account for the unexpected current decline in male lung cancer deaths.” Though it is true that lung cancer mortality declines in all the countries of the former Soviet Union, we cannot agree that it is connected with lower tobacco consumption in any certain period. First objection is that this mortality rates decrease not only for those men who were teenagers in the specified period but for the younger ones, who started smoking much later, too. Second objection is that this mortality decreases not only among men but also among women both in older and middle age groups. Besides, there are no indications of tobacco use decline in 1960s or 1970s, which could account for lung cancer decline nowadays. We consider a more probable hypothesis of lung cancer mortality decline to be related to numerous premature deaths due to other reasons which actually do not let smokers live longer and die of lung cancer in their 70s or 80s as they die in their middle age because of alcohol or other reasons. |
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