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For thousands of years, since American Indians began smoking Nicotiana tabacum, and especially since 16th century explorers brought the plant back to Europe, cultures around the world have taken to tobacco with different degrees of ritual, affection, and addiction

"I think every place is special because of the nature of the tobacco industry and what it does,” says Samet. “How people smoke and what smoking means; what the policy apparatus is like. Is there a tobacco control office? Are there regulations? Is the tobacco industry very powerful or not so powerful? And so on.

“Of course, there is some comparability everywhere,” says Samet, “because everywhere nicotine is addicting.”

The following snapshots from the United States, Mexico, Poland, India, China, and Japan comprise a kind of global tobacco tour, examining the evolving tobacco epidemic in each country and the research IGTC experts and local colleagues are conducting there.

United States
Tobacco’s story in the United States has three parts: historic leaps in scientific knowledge about tobacco’s health effects, a burgeoning tobacco control movement, and a continuing multibillion dollar cigarette business. Over the decades, science has built an irrefutable case against tobacco (one milestone dates to the mid-1930s when the School’s first Biostatistics chair, Raymond Pearl , found that nonsmokers live longer than smokers). But the American tobacco industry gave ground grudgingly. It spent billions on advertising and hired scientists to dispute studies that linked smoking to disease. Yet the percentage of U.S. men who smoked still fell from a high of 68 percent in 1955 to 26 percent in 2000. Smoking’s peak years were followed in later decades by the now-predictable epidemics of lung cancer, heart disease, emphysema, strokes, and other illnesses. Today, tobacco kills about 440,000 Americans every year and costs the economy more than $150 billion annually, according to the Centers for Disease Control and Prevention (CDC). Rounds of legal battles from the 1990s, including the Minnesota tobacco trial, have shattered any remaining tobacco industry dreams of increasing the U.S. market.

Frances Stillman

Led by state and local efforts, U.S. tobacco control has taken off in recent years. In 1988, Johns Hopkins Hospital was one of the first U.S. hospitals to go smoke-free. IGTC co-director Stillman guided that project and published its evaluation in the Journal of the American Medical Association, setting the standard for smoke-free hospitals. California banned smoking in restaurants in 1995 and in bars in 1998. And last fall New York City increased the city’s tax on cigarettes from 8 cents a pack to $1.50 and banned smoking in bars and restaurants. In advocating the legislation to the New York City Council, Mayor Michael Bloomberg (for whom the School is named) said, “Any reputable scientist will tell you that tobacco kills more New Yorkers than any other cause—roughly 10,000 people in this city each year, including some 1,000 from… ‘secondhand smoke.’ ” City health officials expect the tax increase will prevent 100,000 children from picking up the habit, help 70,000 New Yorkers quit smoking, and save 50,000 lives.

"For our leading city to do this is quite something,” says Samet, who testified in support of the regulations for the city. “I think it was quite courageous of the Mayor to move on this issue.”

Yet as tobacco use continues to fall nationwide, the United States remains one of the world’s major exporters of tobacco. Philip Morris, the world’s largest multinational tobacco company, had revenue of more than $47 billion in 1999, according to The Tobacco Atlas published by the World Health Organization (WHO). However, the diminishing U.S. market made tobacco companies like British American Tobacco and Philip Morris (maker of the world’s most popular brand, Marlboro) look to the developing world to expand their markets in the 1990s. “It is, you know, a sad story,” says Samet.

In Eastern European countries like Poland and the former Soviet republics, the multinationals discovered large markets of already addicted smokers willing to try international brands. Meanwhile, the developing world offered even greater potential. One of the millions of tobacco industry documents liberated through the Minnesota trial put it this way: “Thinking about Chinese smoking statistics is like trying to think about the limits of space.”

But the greatest frontier for tobacco companies isn’t a country but a gender: women, especially in Asia. While 60 percent of Asian men smoke, only about 5 percent of women smoke. Even slight increases in smoking by Asian women would bring fantastic fiscal rewards for tobacco companies and simultaneously deal a terrific blow to the region’s health.

For tobacco transnationals, the future is clearly not in the United States but in developing countries sufficiently prosperous to meet people’s basic needs and to afford a new addiction.

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