Mortalidad atribuida al consumo de tabaco en Brasil, 1996-2019 / Attributable mortality to tobacco consumption in Brazil, 1996-2019

Objetivo: Analizar la carga del consumo de tabaco en la mortalidad y en los años de esperanza de vida perdidos en población ≥35 años en Brasil en el periodo 1996-2019, e identificar cambios de tendencia en la mortalidad atribuida. Método: Para estimar la mortalidad atribuida se aplicó un método independiente de prevalencia que asume la tasa de mortalidad por cáncer de pulmón como indicador indirecto del riesgo acumulado asociado al consumo de tabaco. La mortalidad atribuida se estima a partir de la tasa de mortalidad por cáncer de pulmón y aplicando riesgos relativos de cinco cohortes estadounidenses. Se presentan la mortalidad atribuida, las tasas de mortalidad atribuida brutas y estandarizadas en global, por sexo, edad y causas de muerte. Se analizó la tendencia aplicando modelos de regresión joinpoint. Se calcularon los años de esperanza de vida perdidos a causa del tabaco. Resultados: Entre 1996 y 2019 el consumo de tabaco causó 2.389.831 muertes en Brasil. Las enfermedades cardiometabólicas fueron la primera causa de muerte en mujeres en todo el periodo y en hombres hasta 2015. Desde 2006, las tasas de mortalidad atribuida en los hombres, con independencia de la edad, muestran una tendencia decreciente, mientras que en las mujeres la evolución es diferente. Los años de esperanza de vida perdidos muestran un ligero descenso desde los primeros trienios y son más en los hombres. Conclusiones: El 8,5% de la mortalidad total en Brasil durante el periodo 1996-2019 se atribuye al consumo de tabaco. Es importante monitorizar la carga del consumo de tabaco en la mortalidad para fortalecer o implantar intervenciones frente al tabaquismo en Brasil. (AU)

Objective: To analyze the burden of tobacco consumption on mortality and years of life expectancy lost in population ≥35 years in Brazil in the period 1996-2019 and to identify trend changes in smoking-attributable mortality. Method: An independent prevalence method using the lung cancer mortality rate as a proxy for cumulative smoking risk was used to estimate smoking-attributable mortality. Smoking-attributable mortality is estimated from the lung cancer mortality rate and applying relative risks from 5 US cohorts. Smoking-attributable mortality, crude and standardized attributed mortality rates are presented overall, by sex, age and causes of death. Trend analysis was performed by applying joinpoint regression models. Years of life expectancy lost due to tobacco were calculated. Results: Tobacco consumption caused 2,389,831 deaths in Brazil between 1996-2019. Cardiometabolic diseases were the leading cause of death in women throughout the period and in men until 2015. Since 2006, smoking-attributable mortality rates in men, regardless of age, show a decreasing trend while in females the evolution is different. The years of life expectancy lost show a slight decrease since the first triennia and are higher in men. Conclusions: In Brazil, the 8.5% of total mortality between 1996-2019 is attributed to tobacco consumption. It is important to monitor the burden of the tobacco consumption on mortality in order to strengthen or implement interventions against smoking in Brazil. (AU)

Estudio comparativo de efectividad entre la Hipnosis y la intervención Cognitivo-Conductual para la Deshabituación Tabáquica / Comparative study of effectiveness between Hypnosis and Cognitive-Behavioral intervention for Smoking Cessation

Introducción: El consumo de tabaco es la primera causa de muerte evitable. A muchos fumadores les gustaría dejar el hábito. Aun así, a pesar de la eficacia demostrada de las intervenciones, muchos no están dispuestos a realizar un intento debido a las altas tasas de recaída y al miedo a los efectos secundarios de los tratamientos empleados, inclinándose a probar métodos alternativos.Objetivo: Conocer si la intervención avanzada individual (multicomponente cognitiva-conductual) es más efectiva que la intervención con hipnoterapia en pacientes fumadores, como tratamiento para dejar de fumar.Metodología: Estudio cuasiexperimental. Se incluyeron pacientes fumadores con antecedentes de patología respiratoria. Fueron asignados, según su preferencia, a un grupo de intervención avanzada individual en tabaquismo (grupo A) - al que se realizó una terapia multicomponente para dejar de fumar- o a un grupo de hipnoterapia (grupo B) en el que se realizó hipnosis para dejar de fumar.Todos los pacientes recibieron el tratamiento farmacológico y las pautas de actuación habituales que se utilizan en las consultas externas para tratar la enfermedad.Resultados: Se encontraron diferencias significativas en la cesación del consumo de tabaco a los 6 meses, encontrándose valores inferiores tanto en el abandono como en la disminución del consumo en los pacientes a los que se les realizó hipnoterapia versus terapia multicomponente (p 0,023 y p 0,031 respectivamente). Conclusiones: La intervención para el abandono del tabaco que incorpora la hipnosis no ha demostrado ser tan eficaz como la terapia multicomponente en la población estudiada. (AU)

Introduction: Tobacco use is the number one preventable cause of death. Many smokers would like to kick the habit. Still, despite the proven efficacy of the interventions, many are reluctant to try due to high relapse rates and fear of side effects of the treatments used, and are inclined to try alternative approaches.Objetive: To know if the individual advanced intervention (cognitive-behavioural multicomponent) is more effective than the intervention with hypnotherapy in smokers, as a treatment to quit smoking.Methodology: Quasi-experimental study. Smokers with a history of respiratory pathology were included. They were assigned, according to their preference, to an advanced individual smoking cessation intervention group (group A) - which underwent multicomponent therapy to quit smoking - or to a hypnotherapy group (group B) in which hypnosis was performed to quit smoking. of smoking.All patients received the pharmacological treatment and the usual action guidelines that are used in outpatient clinics to treat the disease.Results: Significant differences were found in the cessation of tobacco consumption at 6 months, with lower values both in quitting and in the reduction of consumption in patients who underwent hypnotherapy versus multicomponent therapy (p 0.023 and p 0.031, respectively).Conclusions: Smoking cessation intervention incorporating hypnosis has not been shown to be as effective as multicomponent therapy in the population studied. (AU)

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019.

BACKGROUND: Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. METHODS: We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. FINDINGS: Globally in 2019, 1·14 billion (95% uncertainty interval 1·13-1·16) individuals were current smokers, who consumed 7·41 trillion (7·11-7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5-28·5] reduction) and females (37·7% [35·4-39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98-1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16-8·20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3-21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers. INTERPRETATION: In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. FUNDING: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

The United States National Cancer Institute's Coordinated Research Effort on Tobacco Use as a Major Cause of Morbidity and Mortality among People with HIV.

The use of antiretroviral therapy for people with HIV (PWH) has improved life expectancy. However, PWH now lose more life-years to tobacco use than to HIV infection. Unfortunately, PWH smoke at higher rates and have more difficulty maintaining abstinence than the general population, compounding their risk for chronic disease. In this Commentary, we describe a United States National Cancer Institute-led initiative to address the relative lack of research focused on developing, testing, and implementing smoking cessation interventions for PWH. This initiative supports seven clinical trials designed to systematically test and/or develop and test adaptations of evidence-based smoking cessation interventions for PWH (eg, combination of behavioral and pharmacological). We summarize each project, including setting/recruitment sites, inclusion/exclusion criteria, interventions being tested, and outcomes. This initiative provides critical opportunities for collaboration and data harmonization across projects. The knowledge gained will inform strategies to assist PWH to promote and maintain abstinence, and ensure that these efforts are adaptable and scalable, thereby addressing one of the major threats to the health of PWH. Reducing smoking behavior may be particularly important during the COVID-19 pandemic given that smokers who become infected with SARS-CoV-2 may be at risk for more severe disease. IMPLICATIONS: This Commentary describes a National Cancer Institute-led initiative to advance the science and practice of treating tobacco use among PWH, which is now responsible for more life years lost than HIV. We describe the scope of the problem, the objectives of the initiative, and a summary of the seven funded studies. Harmonization of data across projects will provide information related to treatment mediators and moderators that was not previously possible. Stakeholders interested in tobacco cessation, including researchers, clinicians and public health officials, should be aware of this initiative and the evidence-base it will generate to advance tobacco treatment among this high-risk population.

Tobacco and COVID-19: a crisis within a crisis?

During the pandemic, the world's media have publicized preliminary findings suggesting that tobacco use is protective against COVID-19. An ad hoc multidisciplinary group was created to address the major public health implications of this messaging. Key messages of this commentary are as follows: 1) The COVID-19 crisis may increase tobacco consumption and decrease access to healthcare. As a result, smoking-related morbidity and mortality could increase in the coming months and years; 2) Smoking and tobacco-related diseases are prognostic factors for severe COVID-19; and 3) In theory, smokers may be at lower risk of COVID-19 infection because of having fewer social contacts. In conclusion, tobacco control is a greater challenge than ever in the context of the COVID-19 pandemic. Public decision-makers must be vigilant in ensuring that public health practices are consistent and compliant with the principles of the WHO Framework Convention on Tobacco Control. In addition, researchers and the media have a responsibility to be cautious in communicating preliminary results that may promote non-evidence-based research, self-destructive individual behaviours, and commercial agendas.

RéSUMé: Pendant la pandémie, des résultats préliminaires sur l'effet protecteur du tabac sur la COVID-19 ont été largement diffusés dans le monde entier. Dans ce contexte, et en raison des questions de santé publique liées à ce sujet, un groupe multidisciplinaire ad hoc a été créé en réponse aux demandes des institutions de santé publique. Les messages clés de ce commentaire sont les suivants : 1) La crise de la COVID-19 pourrait entraîner une augmentation de la consommation de tabac et une diminution de l'accès aux soins. En conséquence, la morbidité et la mortalité liées au tabagisme pourraient augmenter dans les mois et les années à venir; 2) Le tabagisme et les maladies liées au tabac sont des facteurs pronostiques de formes graves de la COVID-19; et 3) Hypothétiquement, les fumeurs, notamment en réduisant la fréquence et la durée des contacts sociaux, pourraient être moins susceptibles d'être contaminés. En conclusion, même pendant et malgré la crise sanitaire due à la pandémie de la COVID-19, la lutte contre le tabagisme reste plus que jamais un défi. Les décideurs publics doivent être particulièrement vigilants pour assurer la cohérence des pratiques publiques, y compris le respect des principes de la Convention-cadre de l'OMS pour la lutte antitabac. Il incombe également aux chercheurs et aux médias de communiquer avec prudence des résultats préliminaires susceptibles de générer des comportements individuels contre-productifs et d'être instrumentalisés à des fins commerciales.

Impact of tobacco use on health and work productivity in Malaysia.

BACKGROUND: The loss of productivity arising from tobacco use in low/middle-income countries has not been well described. We sought to examine the impact of cigarette smoking on population health and work productivity in Malaysia using a recently published measure, the productivity-adjusted life year (PALY). METHODS: A life table model was constructed using published Malaysian demographic and mortality data. Our analysis was limited to male smokers due to the low smoking prevalence in females (1.1%). Male smokers aged 15-64 years were followed up until 65 years or until death. The population attributable risk, health-related quality of life decrements and relative reduction in productivity due to smoking were sourced from published data. The analysis was repeated assuming the cohorts were never smokers, and the differences in outcomes represented the health and productivity burden conferred by smoking. The cost of productivity loss was estimated based on the gross domestic product per equivalent full-time worker in Malaysia. RESULTS: Tobacco use is highly prevalent among working-age males in Malaysia, with 4.2 million (37.5%) daily smokers among men aged between 15 and 64 years. Overall, our model estimated that smoking resulted in the loss of over 2.1 million life years (2.9%), 5.5 million (8.2%) quality-adjusted life years (QALYs) and 3.0 million (4.8%) PALYs. Smoking was estimated to incur RM275.3 billion (US$69.4 billion) in loss of productivity. CONCLUSION: Tobacco use imposes a significant public health and economic burden among working-age males in Malaysia. This study highlights the need of effective public health interventions to reduce tobacco use.

Speed kills: Associations between methamphetamine use, HIV infection, tobacco use, and accelerated mortality among gay and bisexual men in Los Angeles, CA 20years after methamphetamine dependence treatment.

BACKGROUND: To better characterize mortality among methamphetamine users, we estimated rates of all-cause mortality by HIV serostatus and smoking history in gay and bisexual men (GBM) treated for methamphetamine dependence, and explored associated clinical and socio-behavioral characteristics. METHODS: We searched public records to identify deaths among men screened between 1998-2000 for a trial of outpatient therapy for GBM with methamphetamine dependence. Crude mortality rates (CMRs) were calculated, and standardized mortality ratios (SMRs) estimated, comparing data with historical information from CDC WONDER. Associations of mortality with HIV infection, tobacco use, and other factors were explored using Kaplan-Meier survival analysis and Cox proportional hazards models. RESULTS: Of 191 methamphetamine-dependent GBM (median age 35 years; majority Caucasian), 62.8% had HIV infection, and 31.4% smoked tobacco at baseline. During the 20-year follow-up period, 12.6% died. Relative to controls, methamphetamine-dependent GBM had a three-fold higher 20-year SMR: 3.39, 95% CI: 2.69-4.09. Especially high mortality was observed among participants reporting tobacco use (adjusted HR 3.48, 95% CI: 1.54-7.89), club drug use prior to starting methamphetamine (2.63, 1.15-6.00), or other clinical diagnoses at baseline (3.89, 1.15-13.22). At 20 years, the CMR for HIV infected participants (7.7 per 1000 PY) was 1.5 times that for men without HIV (5.2 per 1000 PY; p = 0.22) and there was a 5-fold difference in CMRs for HIV infected tobacco smokers (16.9 per 1000 PY) compared to non-smokers (3.4 per 1000 PY; p < 0.01). CONCLUSION: In our sample of methamphetamine-dependent GBM, concomitant HIV infection and tobacco use were associated with dramatic increases in mortality.

Global burden of all-cause and cause-specific mortality due to smokeless tobacco use: systematic review and meta-analysis.

OBJECTIVES: To systematically review and meta-analyse the studies investigating the association between smokeless tobacco (SLT) use and all-cause mortality and cause-specific mortality outcomes among adult users of SLT and estimate the number of attributable deaths worldwide. METHODS: Random-effects meta-analysis was used to estimate the pooled risk of death due to SLT use. Population attributable fractions were derived and used to calculate the number of attributable deaths. Observational studies published upto 2015 were identified through MEDLINE, IndMED, Google Scholar and other databases. Data on the prevalence of SLT use was obtained from latest reports or national surveys. Data on the disease burden were obtained from the Global Burden of Disease Study. Hospital-based or community-based case-control and cohort studies that adjusted for the smoking status were included. RESULTS: 16 studies that provided estimates for mortality due to all cause, all cancer, upper aerodigestive tract (UADT) cancer, stomach cancer, cervical cancer, ischaemic heart disease (IHD) and stroke were included. A significant association was found for mortality due to all cause (1.22; 1.11-1.34), all cancer (1.31; 1.16-1.47), UADT cancer (2.17; 1.47-3.22), stomach cancer (1.33; 1.12-1.59), cervical cancer (2.07; 1.64-2.61), IHD (1.10; 1.04-1.17) and stroke (1.37; 1.24-1.51). Subgroup analysis showed major regional differences. Globally, the number of attributable deaths from all-cause mortality was 652 494 (234 008-1 081 437), of which 88% was borne by the South-East Asian region. CONCLUSIONS: SLT is responsible for a large number of deaths worldwide with the South-East Asian region bearing a substantial share of the burden.

ETAP: una escala de tabaquismo para la atención primaria de salud / ETAP: a smoking scale for Primary Health Care

OBJETIVO: Obtener una escala de exposición al tabaco para abordar la deshabituación. DISEÑO: Seguimiento de una cohorte. Validación de una escala. Emplazamiento: Unidad de investigación de atención primaria. Tenerife. PARTICIPANTES: Seis mil setecientos veintinueve participantes de la cohorte «CDC de Canarias». MÉTODOS: Se construyó una escala bajo la hipótesis de que el tiempo de exposición al tabaco es el factor clave para expresar riego acumulado; su validez discriminante fue probada sobre casos prevalentes de infarto agudo de miocardio (IAM) (n = 171) y se obtuvo su mejor punto de corte para cribado preventivo. Se comprobó su validez predictiva con casos incidentes de IAM (n = 46), comparándose el poder predictivo con factores (hipertensión, diabetes, dislipemia) clásicos de riesgo de IAM, incluido el índice años a paquete diario (APD). RESULTADOS: La escala obtenida fue la suma del triple de años que se había fumado, más los expuestos al tabaco en casa y en el trabajo. La frecuencia de IAM aumentó con los valores de la escala, siendo el valor 20 años de exposición el mejor punto de corte para la actuación preventiva puesto que presentó adecuados valores predictivos para el IAM incidente. La escala superó a APD en la predicción del IAM y compitió con los marcadores y factores de riesgo conocidos. CONCLUSIÓN: La escala propuesta permite una medición válida de exposición al tabaco y proporciona un criterio útil y sencillo que puede ayudar a promover una disposición al cambio y realizar una prevención oportuna. Aún requiere probar su validez tomando como referente otros problemas asociados al tabaco

OBJECTIVE: To obtain a scale of tobacco exposure to address smoking cessation. DESIGN: Follow-up of a cohort. Scale validation. SETTING: Primary Care Research Unit. Tenerife. PARTICIPANTS: A total of 6729 participants from the 'CDC de Canarias' cohort. METHODS: A scale was constructed under the assumption that the time of exposure to tobacco is the key factor to express accumulated risk. Discriminant validity was tested on prevalent cases of acute myocardial infarction (AMI; n = 171), and its best cut-off for preventive screening was obtained. Its predictive validity was tested with incident cases of AMI (n = 46), comparing the predictive power with markers (age, sex) and classic risk factors of AMI (hypertension, diabetes, dyslipidaemia), including the pack-years index (PYI). RESULTS: The scale obtained was the sum of three times the years that they had smoked plus years exposed to smoking at home and at work. The frequency of AMI increased with the values of the scale, with the value 20 years of exposure being the most appropriate cut-off for preventive action, as it provided adequate predictive values for incident AMI. The scale surpassed PYI in predicting AMI, and competed with the known markers and risk factors. CONCLUSION: The proposed scale allows a valid measurement of exposure to smoking and provides a useful and simple approach that can help promote a willingness to change, as well as prevention. It still needs to demonstrate its validity, taking as reference other problems associated with smoking

[Mortality Related to Alcohol and Tobacco Consumption - A Benchmarking of Regional Trends and Levels]. / Mit Tabak- und Alkoholkonsum assoziierte Mortalität - Ein Benchmarking regionaler Trends und Niveaus.

STUDY AIM: Regional characteristics are being increasingly taken into account in studies on the determinants of health and health-care. A systematic observation and inclusion of regional particularities has, however, been absent from strategic planning and financing decisions to date. Furthermore, regional-level changes over time have, for the most part, not been considered in the existing studies. Accordingly, this article seeks to depict both the levels and trends in potentially avoidable mortality on the district level and to establish a benchmark that shows the theoretical goals for the reduction in avoidable deaths in each district. METHOD: Gender-specific and age-standardised potentially avoidable deaths were determined for each of the 413 German districts in the period from 2000 to 2008 on the basis of cause of death statistics provided by statistical agencies of the German federal states. Deaths due to lung cancer and alcohol-related diseases were taken into account as these are considered to be avoidable through primary prevention. The district-specific benchmark values were ascertained using 2 linear hierarchic nested models and tested for significance using an F-test. RESULTS: Overall, the lung cancer mortality was found to have declined amongst men and gradually increased amongst women during the time period under consideration. The benchmark for deaths from lung cancer in women shows that the increase in mortality is principally observed in West German and urban districts. In relation to the alcohol-related deaths we also see an east-west divide, with higher rates in eastern Germany. Shrinking districts in eastern Germany were able, however, to record a big reduction in rates in recent years. An unfortunate development in the trend of alcohol-related mortality in women was notably observed in regional areas of Bavaria. CONCLUSION: The analysis offers decision makers the possibility of pinpointing regions with high intervention need. Increasing lung cancer mortality rates in women living in cities points to, for example, a heightened need for anti-smoking campaigns in urban areas. In relation to alcohol-related diseases, a heightened need for target group-specific prevention was identified in East German districts as well as some districts in Bavaria.

Tabaco y salud infantil: un aspecto no suficientemente valorado / Cigarette smoking and child health: an issue that has not yet been assessed enough

La campaña que se desarrolla en Uruguay contra el consumo de tabaco enfatiza sobre los efectos nocivos que produce el cigarrillo en la salud de la población adulta que fuma y en fumadores pasivos. La disminución de afecciones cardiovasculares como el infarto de miocardio y del cáncer de pulmón ha mostrado resultados alentadores en relación a la disminución del número de consumidores, si bien aún no se ha logrado el descenso esperado. La campaña enfoca varios aspectos dirigidos a la presentación de los envoltorios, el precio, pero la que ha mostrado mejores resultados ha sido el consejo personal brindado en los consultorios a fumadores, en especial a embarazadas. Desde hace casi una década han surgido publicaciones que demuestran aspectos de la morbilidad infantil asociada al uso de tabaco por mujeres gestantes. En la etapa prenatal se han evidenciado alteraciones del desarrollo del aparato respiratorio, bajo peso al nacer, parto prematuro así como propensión al aborto. Otras investigaciones han observado que un hogar con fumadores, especialmente durante los primeros meses de la vida del niño constituye un ambiente hostil, negativo para lograr condiciones de sueño seguro, práctica que se describe asociada a la disminución del riesgo a sufrir el síndrome de la muerte súbita del lactante. Es evidente que el consumo de tabaco constituye también un problema real para la salud de la población infantil especialmente aquellos más vulnerables. Los pediatras y médicos que atienden niños podrán promover consejos sobre crianza saludable aconsejando a la madre sobre condiciones para sueño seguro y que evite los fumadores intradomiciliarios.

In Uruguay the tobacco control campaign emphasized the adverse effects of smoking for the adult population as well as secondhand smoking. A reduction in cardiovascular diseases and lung cancer has been achieved, although not as much as expected. The campaign addressed the appearance of cigarette boxes and the price of the product. But what proved the most useful resource was the advice given to pregnant women. In the last decade many articles on the consequences of smoking during pregnancy have been published. Fetal loss, low birth weight and preterm delivery have been widely accepted as consequences of maternal smoking. After birth, smoking near the infant is a risk factor for sudden infant death syndrome. Pediatricians, neonatologists and general practitioners that care for infants and children, should advice mothers and family on smoking and health.

Trends in tobacco-attributable mortality in France.

BACKGROUND: In 2010, the prevalence of tobacco use in France was 33% and reached 39% in the population aged 18-44. The purpose of this article is to describe the trends in tobacco-attributable mortality in France between 1980 and 2010. METHODS: Using data from the national mortality statistics and relative risks of death, we estimated the tobacco-attributable fractions (AF) by sex and age using the method developed by Peto et al. and used recently by the World Health Organization with improved relative risk estimates. The tobacco-attributable mortality by age and sex is obtained by multiplying the AFs by the number of deaths. They are estimated in 5-year intervals from 1980 to 2010. RESULTS: In 2010, a total of 78,000 deaths were attributable to tobacco use in France. The number of deaths attributable to tobacco use among men decreased from 66,000 deaths in 1985 to 59,000 deaths in 2010, and the tobacco-AF decreased from 23% in 1985 to 21% in 2010. The number of deaths attributable to tobacco use among women increased from 2700 in 1980 (1% of all deaths) to 19,000 in 2010 (7% of all deaths). In the population aged 35-69, one in three deaths among men and one in seven deaths among women are attributable to tobacco use. CONCLUSION: While tobacco-attributable mortality among men has been declining during the past three decades, it has increased dramatically among women. Thus, effective preventive measures are urgently needed to stem the tobacco epidemic.