Smoke Alarm

Should there be global campaigns against smoking in the same way there are now international HIV education and outreach programs?
Samet: There's not a one-size-fits-all here in terms of how to deal with the epidemic and how to slow it. There has to be an understanding of local issues. In India, for example, they use bidi, which is hand-rolled tobacco.

How much of a difference can WHO make? Isn't its budget tiny compared to the marketing budgets of most tobacco companies?
Samet: Certainly the tobacco industry collectively has spent billions of dollars on advertising and promotion. On the other hand, there's extraordinary power in the evidence on the epidemic, documenting how the industry uses advertising and marketing. To put this in perspective, there are far more resources available to WHO and other groups moving against the tobacco epidemic now than before. Yes, it's a bit of a David and Goliath story, but in this case, the tobacco control community has some pretty good weapons. That's in part what this MPOWER initiative is about.

Wipfli: WHO has just an incredible reach into countries, and it gets a lot of respect. Reports such as these coming out of WHO make a huge difference.

How do you think the tobacco companies undermine WHO efforts?
Wipfli: They do a number of activities to increase their access through investments and through corporate responsibility programs, through youth prevention programs. They are increasingly going into smokeless tobacco products. They're making shorter cigarettes that can be smoked during short smoking breaks. They continue to change their tactics. They continue to invest highly in advertising and promotion, and they're very politically savvy, through lobbying and foreign investment.

Samet: They've been particularly concerned about smoke-free legislation and have tried to oppose it in many states by enlisting the restaurant and hospitality industry as allies, who will claim that their revenues will be reduced. 

It's hard to believe that with all the research about the dangers of cigarette smoking—how it contributes to lung cancer, heart disease and other potentially deadly diseases—more than 1 billion people worldwide still smoke. Who still smokes and why?
Samet: About 1.3 billion people around the world still smoke. They're mostly men, a ratio of 4:1. One reason many smoke is they're addicted to smoking. They started at an age when they weren't aware of addiction. Even though in the United States, most people know the diseases that are caused not only by active smoking but passive smoking, people around the world often don't have that information at hand. Often it's culturally acceptable to smoke.