Smoking’s Ripple Effects

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Call To Action

Providers must routinely integrate smoking cessation services into TB, HIV, alcohol and mental health care.

Certain populations smoke at higher rates than the general population, including those who use alcohol to excess, or have mental illness, or who are affected by other diseases such as tuberculosis (TB) and HIV/AIDS. As a result, smoking has a tremendous impact on several other grave public health crises.

Most cases of TB occur in places where tobacco use is extremely common or rising rapidly. China and India alone, which have high smoking rates, account for 40% of all cases of tuberculosis in the world. A recent study showed that 21% of tuberculosis cases in adults were attributable to tobacco. As most patients with TB are relatively young, excess morbidity and mortality from tobacco-related tuberculosis takes a toll on persons in their most economically-productive years.

HIV-infected persons are even more susceptible to the dangers of tobacco than are persons without HIV infection. In settings where treatment for HIV infection has become widely available, HIV-infected tobacco smokers are losing more life-years to smoking than to HIV infection itself.

Smokers are more likely to consume excessive amounts of alcohol, and smoking may independently affect an individual’s propensity to abuse alcohol and vice versa. These people are at risk of adverse effects of both tobacco and alcohol-related diseases.

Mental health disorders are also tied closely to tobacco use. Persons with mental illness have high smoking rates, and for certain illnesses, such as anxiety disorders, tobacco use may cause or worsen the problem. Additionally, smoking is associated with increased severity of symptoms of schizophrenia and bipolar disorder. Persons with mental illness die disproportionately from smoking-related diseases. In California, USA, approximately half of deaths among people with mental illness were due to diseases caused by smoking.


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Mortality rate goal per 100,000 and estimated year of achievement with/without tobacco

Smoking will prevent countries from meeting their tuberculosis mortality Millennium Development Goal

*Subnational data


Mortality Rate Goal: 4
Without Tobacco: 2006
With Tobacco: 2029


Mortality Rate Goal: 17
Without Tobacco: 2014
With Tobacco: 2062


Mortality Rate Goal: 6
Without Tobacco: 2024
With Tobacco: 2048


Mortality Rate Goal: 16
Without Tobacco: NEVER
With Tobacco: NEVER


Mortality Rate Goal: 17
Without Tobacco: 2009
With Tobacco: NEVER


Mortality Rate Goal: 24
Without Tobacco: 2007
With Tobacco: 2033

“Tobacco control is tuberculosis control,’’ – Stanton A. Glantz, professor of medicine, University of California, San Francisco, USA, 2011

Smoking and mental illness

Smoking prevalence among people with lifetime mental illnesses: USA, 2007

Current smoking prevalence increased with greater numbers of mental illness, ranging from 18.3% for people with no illness to 61.4% for people with three or more mental illnesses.

Smoking and alcohol abuse

Smoking status for hazardous drinking: percent of hazardous drinking among different types of smokers, USA, 2002

Current smokers are more likely to be hazardous drinkers than are both never-smokers and former smokers, and at higher risk of adverse effects of both smoking- and alcohol-related diseases

In its efforts to undermine and diminish the devastating effects of smoking on health, British American Tobacco has argued, “there are other issues [besides smoking & health] which we believe should be of greater significance to the PRC [China] and the WHO including hepatitis which is very prevalent in China and a major health concern.” -British American Tobacco, 1997

Although the high smoking rates among HIV-infected patients worsen mortality outcomes, the tobacco industry boasts about its history and support for the nutritional needs of the HIV-infected community through providing grants to HIV/AIDS organizations. “It is with great pride that we have partnered with numerous organizations within the HIV/AIDS community to bring attention and additional resources to bear in this terrible disease “ -Philip Morris HIV/AIDS Grantmaking program, 1997

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Health Consequences

Governments should strive to prevent people from starting tobacco use because it is the best way to avoid the consequences tobacco inflicts on human health.