Tobacco International Perspective (A2, A7)

A2. Retrospective studies of smoking and death in several very different populations around the world To assess patterns of mortality from tobacco in various parts of China, India, Russia and elsewhere, and in the Russian study sites to assess the effects of alcoholism. Our findings should bring forward the time when uptake rates fall substantially and adult cessation becomes common in many parts of the world. As yet this has been achieved only in certain developed countries (e.g. Britain), but it is at last beginning in some other countries (such as China, though not yet India). They have also helped substantially with tobacco control in other developed countries (e.g. Poland) over the last 20 years. A7. Prospective studies of tobacco, alcohol, blood pressure, obesity and cause-specific mortality in several very different populations The main objectives are (i) To assess the relevance of tobacco, alcohol, blood pressure, obesity and other factors to cause-specific mortality in different populations (China, Cuba, Egypt, India and Russia) in recent years; and (ii) To monitor the evolution over the next 1 or 2 decades of the age-specific relevance of such factors to cause-specific mortality.These studies will generate reliable information about the recent magnitude but also about the evolution of the worldwide epidemics of death from tobacco, alcohol, obesity, diabetes and blood pressure, and this will affect public consciousness, public health and future research strategies.

A2. Retrospective studies of smoking and death in several very different populations around the world Objectives: To assess patterns of mortality from tobacco in various parts of China, India, Russia and elsewhere, and in the Russian study sites to assess the effects of alcoholism. Design: Retrospective studies of the tobacco smoking habits, determined posthumously, of large representative samples of adults who have died recently have been, or are being, conducted in several very different populations around the world by or with the CTSU, yielding data on a total of 2 million deaths. In India questions asked about quid chewing habits (for tobacco and/or betel quids), and in Russia questions asked about alcohol drinking habits. Techniques: Interviews with family members of several tens of thousands of recently deceased adults in each of several different populations, relating the smoking (and, in some cases, chewing or drinking) habits to the disease that caused death. Measurements: Age at death, certified cause of death (supplemented, in some populations, by other records or by a verbal autopsy to determine the disease that caused death), certain confounders, and habits before any major illness (as described by a surviving family member who had lived with the dead person for some years before death). Anticipated implications: Our findings should bring forward the time when uptake rates fall substantially and adult cessation becomes common in many parts of the world. As yet this has been achieved only in certain developed countries (such as Britain), but it is at last beginning in some other countries (such as China, though not yet India). They have also helped substantially with tobacco control in several other developed countries (e.g. Poland) over the last 20 years. A7. Prospective studies of tobacco, alcohol, blood pressure, obesity and cause-specific mortality in several very different populations Objectives: (i) To assess the relevance of tobacco, alcohol, blood pressure, obesity and certain other factors to cause-specific mortality in several very different populations (China, Cuba, Egypt, India and Russia) in recent years; and (ii) To monitor the evolution over the next 1 or 2 decades of the age-specific relevance of such factors to cause-specific mortality in these populations. Techniques: Large prospective studies, each involving 150,000 to 500,000 adults (total: 2 million) recruited mainly during the 1990s and now being followed actively for cause-specific mortality. Measurements: At the initial survey in each population, we record tobacco habits and alcohol use (by locally appropriate questions), blood pressure, weight, height (hence, body mass index), peak expiratory airflow rate, personal identifiers and previous history of 20 particular diseases, plus a few additional country-specifid questions specific (e.g. indoor air pollution and green tea use in China, bidi smoking and quid-chewing in India, extra questions on alcohol in Russia, water pipe [but not alcohol, to avoid offence] in Egypt, etc). Long-term follow-up involves monitoring the date and cause of deaths and cancer incidence. Anticipated implications: These prospective studies will generate reliable information not only about the recent magnitude but also about the evolution of the worldwide epidemics of death from tobacco, alcohol, obesity, diabetes and blood pressure, and this will affect public consciousness, public health and future research strategies.