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MexicoUnlike its neighbor to the north, Mexico is still caught in a growing tobacco epidemic. In Mexico, 32 percent of men and 16 percent of women smoke, according to Mauricio Hernandez-Avila, PhD, of Mexico’s National Institute of Public Health in Cuernavaca. And rates are increasing among the younger generation. Young women are smoking almost as much as young men. Hernandez attributes the change in smoking habits to tobacco advertising and the North American Free Trade Agreement, which reduced the cost of American cigarettes in Mexico.
Before becoming IGTC co-director, Frances Stillman led Johns Hopkins Hospital’s pioneering 1988 smoke-free campaign.
Hernandez believes incontrovertible science remains the best means to persuade the government and the public to adopt tobacco control measures. He is co-investigator in the IGTC’s Fogarty International Project, which will bring researchers from China and Latin America to the School for training and work on various research projects. In one IGTC project, Hernandez is working with Mexico’s government health insurance agency to determine how much money tobacco-related illnesses siphon from the government health care budget. Results from a pilot study in the state of Morelos indicated that 6 percent of the health insurance budget goes to tobacco-related illnesses. Taking into account the limited health care available in Morelos, Hernandez estimates the national figure will be even higher.
To preserve the nation’s resources for other threats to health, Mexico must prevent its youth from starting to smoke. “If you want to decrease the number [of smokers] you have to attack the problem at the entry, and the entry is 12 to 18 years old,” he says. “That’s the window where 90 percent of Mexicans get hooked on tobacco.”
Hernandez wants to persuade Mexican politicians to increase the cigarette tax, a proven means of lowering consumption. However, that will prove difficult because industry lobbyists routinely defend the status quo. To counter the industry arguments, Hernandez holds frequent training sessions for Mexican state government officials. “You’d be surprised how little information there is in Mexico on how tobacco companies trick everybody, how they directly advertise to specific targets of the population,” Hernandez says. “I just think people need to have all information at hand when making decisions. Right now they have only false statements of what tobacco is.”
Witold Zatonski admits he’s not a typical Pole. He’s never smoked.
In the late 1950s, he and his two brothers tried to persuade their mother to stop smoking after she was diagnosed with tuberculosis. “Unfortunately, she was not able to stop,” says Zatonski, who believes the habit cut 10 years from her life. The experience made him a committed nonsmoker in a country that at one time had the highest smoking rates in the world. (In the mid-1970s, almost 80 percent of Polish males smoked daily.) As a young physician in the 1960s, Zatonski recalls doctors’ meetings in which nearly everyone smoked.
Zatonski, MD, PhD, a professor of cancer epidemiology at the Maria Sklodowska-Curie Memorial Cancer Centre in Warsaw, traces Poland’s affair with smoking to the 20th century wars that overran Europe. Smoking, like venereal disease, famine, and cholera, seems to follow war. In postwar Poland, cigarette smoking was viewed as a sophisticated Western behavior. The national habit became so ingrained that in the 1980s the communist government provided Polish workers with a daily stipend of free cigarettes—whether they smoked or not. “The number of people smoking increased by 1 million or more,” Zatonski says. “It was really so crazy. It was unbelievable.”
The soaring smoking rates later led to subsequent increases in lung cancer and cardiovascular disease. Lung cancer mortality in Poland was less than half that of the United Kingdom (U.K.) in the 1960s, but by the late 1970s it exceeded the U.K. rates, according to Zatonski. “I very quickly realized that the number one cancer problem was tobacco,” he says. “The only way to change cancer incidence and morbidity in Poland is to make some success in tobacco control.”
With the 1989 fall of Poland’s communist government, Zatonski and his colleagues had more freedom to pursue tobacco research. Data from that research, coupled with a powerful anti-smoking lobby, led Poland to pass a comprehensive tobacco control law in 1995 that banned smoking in hospitals, schools, and closed spaces in workplaces. It also outlawed vending machines that sold cigarettes and banned radio and TV ads for tobacco products.
In addition to his own research, Zatonski is collaborating with Samet and IGTC’s multicountry cotinine study that explores the relationship between smoking habits, cigarette content, and nicotine dose. Initial results show that the risk is similar in every population and is not connected with the quality or number of cigarettes, says Zatonski. “It is showing there is not a ‘healthier’ cigarette,” he says. “Polish or Indian or Mexican, they all are having the same unhealthy influence on your body.”