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The causal relationship between cigarette smoking and the reduced health of active, as well as passive, smokers is well established. Global tobacco use causes nearly five million deaths per year, or one death every 6.5 seconds. Of the 1.5 billion regular smokers alive today, half are expected to die prematurely from tobacco-related disease, and half of them will do so between the ages of 35 and 69 years. Although the toll is somewhat less for nonsmokers exposed to secondhand smoke at home or work, their risk of developing lung cancer or heart disease is approximately 25 percent higher than that experienced by people who are not routinely exposed to secondhand smoke. Tobacco is the only consumer product that causes death to the primary and secondhand consumer when used as intended by its manufacturers.
Globally, about 15 billion cigarettes are sold daily, or 10 million every minute. One in five teens, aged 13-15 years, smoke. Roughly 100,000 children start smoking every day, half of whom live in Asia. Evidence shows that about half of the people who start smoking in adolescence will go on to smoke for the next 15-20 years of their lives. East Asia and the Pacific have the highest smoking rate, where nearly two-thirds of the male population smokes.
A vast majority of the world’s smokers-900 million people (84 percent of the world’s total)-live in developing and transitional economy countries. A directly proportional relationship between the lung cancer incidence rate and the cigarette consumption rate has been reported in data for 61 nations.
China is the world’s largest consumer and producer of unmanufactured tobacco, producing roughly 2.2 million tons (two million metric tons) of dry weight tobacco annually, and consuming slightly more at 2.4 million tons (2.2 metric tons). Brazil is the second largest producer at about 880,000 tons (800,000 metric tons) but is a lower than average consumer. Brazil is followed by India at about 660,000 tons (600,000 metric tons), and the United States at 440,000 tons (400,000 metric tons). Both India and the United States exhibit a 20 percent approximate differential between what they produce and what they consume, with India consuming slightly less than they produce, and the United States consuming slightly more.
China is also the world’s largest cigarette producer, producing roughly 30 percent of the cigarettes manufactured annually, followed by the United States at 13 percent, Japan at 4.5 percent, and Indonesia at 3.8 percent.
Although cigarette smoking was definitively linked to increased lung cancer risk in the 1950s, it was not until 1964 that the U.S. Surgeon General released a report stating that smoking causes cancer and other diseases. At that time, public health professionals proposed the logical hypothesis that reducing the exposure of smokers to particulate matter in cigarette smoke would reduce the risk of developing lung cancer. The report concluded that those smokers who were unable to quit should make every effort to lower their dose of tobacco smoke. Cigarette manufacturers initially responded to this new public perception of health risk by adding filters to cigarettes, and then offering filtered cigarettes that delivered less tar. The term tar is an industry-coined term used to describe the total particulate matter in smoke, minus the water and nicotine.
In order to evaluate objectively the tobacco industry’s unsubstantiated health benefit claims made in the 1960s for low-tar cigarettes, the Federal Trade Commission (FTC) developed a method of testing cigarettes for their tar and nicotine content that was based on methods developed and used by the tobacco industry in the 1930s to compare cigarettes for developmental and manufacturing purposes. In 1970, the FTC proposed rules that would have required disclosure of tar and nicotine yields in advertising, and cigarette manufacturers agreed to voluntarily include FTC tar and nicotine ratings in advertising and even on some of the cigarette packaging. Unwittingly, the FTC provided the tobacco industry with a very persuasive marketing tool to reassure concerned smokers and provide them with an easier alternative to quitting smoking.
It is now known that the FTC method does not differentiate between the disease risk caused by different brands or types of cigarettes in any meaningful way, a fact made more poignant by the immediate and sustained popularity of the low-tar cigarettes upon their introduction to the public in the 1960s, which were coined “light” and “ultralight” by the tobacco industry. Epidemiologic data gathered before and after the introduction of light and ultra-light cigarettes show no accompanying reduction in smoking-related disease. In fact, overall rates of lung cancer have increased, specifically in the deep airway adenocarcinoma type of cancer, suggesting that smoking such cigarettes may have actually increased the risk of some cancers.
Many cigarette smokers become addicted to nicotine and thus require dosing at levels that are high enough to satisfy cravings, but not so high as to cause acute noxious effects. Unlike the smoking machines used to generate the cigarette yield data for the FTC method, addicted smokers will adjust their smoking behavior to sustain their preferred level of nicotine intake; this behavior is called “compensatory smoking.” Tobacco industry documents that were disclosed to the public as part of the United States’s 1998 multi-billion-dollar tobacco industrysettlement indicate that tobacco industry scientists specifically engineered cigarettes to facilitate compensatory smoking and ensure consumers could get much higher levels of tar and nicotine than indicated in their advertising. Three of these cigarette design features include: the use of chemical additives to increase the bioavailability of nicotine, burn accelerants that produce less smoke when the cigarette is smoked on slow-puffing machines versus fasterpuffing humans, and virtually invisible ventilation holes that are not blocked by smoking machines, but unconsciously blocked by smokers, thus providing the smoker a higher dose of tar and nicotine than what is measured using the FTC method.
The World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC), developed in 2003 in response to the global tobacco epidemic, is charged with developing and implementing worldwide tobacco demand reduction strategies. The WHO’s FCTC is one of the most widely endorsed treaties in United Nations history, ratified by more than 130 countries.
- K. Hatsukami, J.E. Henningfield, and M. Kotlyar, “Harm Reduction Approaches to Reducing Tobacco-Related Mortality,” Annual Review of Public Health (v.25, 2004);
- Mackay and M.P. Eriksen, The Tobacco Atlas (World Health Organization, 2002);
- Stratton, P. Shetty, R. Wallace, and S. Bondurant, Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction (National Academic Press, 2001);
- Tobacco Control Research, Monograph 13: Risks Associated with Smoking Cigarettes with Low Machine-Measure Yields of Tar and Nicotine (2001);
- S. Department of Agriculture, Tobacco: World Market Trade (Foreign Agricultural Service, 2005);
- S. Department of Health, Education, and Welfare, Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service (DHEW Publication No. 1103, 1964);
- S. Department of Health and Human Services, The Health Consequences of Smoking: A Report of the Surgeon General (Office on Smoking and Health, 2004);
- S. Department of Health and Human Services, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General (Office on Smoking and Health, 2006);
- Wilkenfeld et al., “It’s Time for a Change: Cigarette Smokers Deserve Meaningful Information About Their Cigarettes,” Journal of the National Cancer Institute (v.92/2, 2000);
- World Health Organization, WHO Framework Convention on Tobacco Control (WHO, 2005);
- World Health Organization Framework Convention on Tobacco Control, Facts and Figures About Tobacco (WHO, 2006).