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This chapter summarizes the conclusions and recommendations from the Task Force on interventions to reduce the initiation of tobacco use, to increase tobacco use cessation, and to reduce the exposure to environmental tobacco smoke (ETS). To reduce tobacco use initiation, the Task Force recommends increasing the unit price for tobacco products, mass media education campaigns, and community mobilization. To increase the cessation of tobacco use, the Task Force recommends increasing the unit price of tobacco products, mass media campaigns, healthcare provider reminder systems, and reducing out-of-pocket client costs for effective cessation therapies. To reduce exposure to ETS, the Task Force recommends smoking bans and restrictions.

This chapter traces the growth of the tobacco epidemic in India. Topics covered include the introduction of tobacco, evolution of tobacco use, tobacco production, tobacco use, the burden caused by tobacco, and anti-tobacco interventions.

This chapter reviews epidemiological studies on the link between oral cancer and tobacco product use, including cigarette smoking, pipe tobacco and cigar smoking, and smokeless tobacco use (snuff dipping and chewing tobacco). In most studies, ‘oral cancer’ includes cancer of the tongue, mouth, and pharynx, with a few including the larynx. In 1986, an International Agency for Research on Cancer (IARC) Working Party concluded that there was sufficient evidence that tobacco was carcinogenic to humans and that the occurrence of malignant tumours of the upper digestive tract was causally related to the smoking of different forms of tobacco. IARC has also concluded that there is sufficient evidence that oral use of snuff of the types commonly used in North America and western Europe is carcinogenic to humans, and there was sufficient evidence that the habit of chewing betel quid containing tobacco was carcinogenic in humans. More recent epidemiological studies and experimental studies further support these conclusions. There is convincing evidence that a large attributable risk can be ascribed to the joint habits of cigarette smoking and alcohol consumption.

This chapter discusses the issue of tobacco harm reduction. Tobacco harm reduction can be considered as one approach to reduce tobacco-caused mortality and morbidity, but should not be considered as the primary approach. To date the only known method for reducing population harm is to eliminate the use of tobacco products through prevention or cessation. Yet, in order to assess the potential public health impact of novel products being introduced onto the market, it is essential to continue to monitor and study the evolving characteristics of tobacco products. Some new products are advertised with either explicit or implicit claims of reduced exposure or health risks which are not evidence-based and which may mislead consumers into thinking they are using ‘safer’ or ‘safe’ products. In addition, some of these novel products are advertised to be used in situations where smokers cannot smoke which may contribute to sustained dependence and continued use of tobacco products. However, some of these products may lead to reduced health risks if smokers were able to switch completely to using these products and may lead to eventual cessation of all tobacco products.

This chapter reviews the evolving economic and social system sustaining the growing tobacco epidemic in order to identify how globalization is affecting the industry, governments, and tobacco control advocates. It is divided into four main sections. The first section recalls key historical events that led to the worldwide prominence of tobacco use and the global rise of tobacco-related death and disease. The second section examines scientific evidence regarding the health effects of active and passive smoking and reviews the globalization of the public health response to the tobacco epidemic. The third section describes the Framework Convention on Tobacco Control (FCTC) negotiating process and final treaty text. The fourth section analyzes some of the remaining major challenges resulting from working within a global system, in particular, those challenges associated with developing coherent domestic and international policies and the permanent need to anticipate the unintended consequences of national and global regulations. The chapter concludes by identifying new directions and resources for global tobacco control and predicting some of the main challenges that lie ahead.

This chapter considers the factors that transformed tobacco use from a ceremonial practice in pre-Columbian times to a global epidemic. It discusses the role of nicotine addiction in sustaining and modifying exposure to the carcinogens in tobacco, the cancers caused by various forms of tobacco use, the global burden of tobacco-attributable disease, the extent to which design changes in cigarettes have altered their pathogenicity, the influence of genetic and other factors on susceptibility to addiction or carcinogenesis, and finally the immense opportunities for prevention.

The international public health community, led by the World Health Organization (WHO), as well as other governmental and non-governmental institutions, remain committed to the containment of the tobacco epidemic. This commitment was evinced by the entry into force in 2005 of the landmark global public health Treaty, the WHO Framework Convention on Tobacco Control (WHO FCTC). With the establishment of this legally binding instrument addressing a wide range of tobacco supply and demand measures, the fight against the global spread of tobacco use driven by the tobacco industry's exploitation of globalization is now rooted in a set of baseline international norms. This chapter outlines the manner by which the tobacco industry manipulates globalization in its attempt to derail public health programmes combating tobacco consumption; and describes the WHO's efforts in formulating counteractive measures to protect public health interests from that of the tobacco industry. Specifically, the chapter focuses on measures taken in relation to the WHO FCTC's provisions concerning the mitigation of tobacco industry interference and the strengthening of a global regulatory framework for tobacco products.

This chapter assesses the role of tobacco smoking as a cause of premature mortality in Europe, and its contribution to the health gap between the EU10 and EU15 countries, using several complementary approaches. It reviews the history of tobacco smoking in the EU10 countries and analyses the patterns of tobacco smoking. Since lung cancer is the cause of death most strongly associated with tobacco smoking, the chapter also analyses temporal trends in lung cancer mortality in Europe. Finally, it estimates the mortality attributable to tobacco smoking in the EU countries.

This chapter first examines the media's smoking images and their potential effects. It then moves to understand how the media affects adolescents' smoking, place smoking in the context of adolescent development, and then examines efforts to limit adolescents' smoking strategies and the media's potential role. Overall, the analysis points to the need to consider the peculiarities of adolescents' development and their social environment to understand the media's influence and to harness media effects in intended ways.

Given the broad acceptance of the cigarette in society, the dramatic reduction in smoking over the 20th century is an extraordinary achievement. During the last third of the century, smoking rates and per capita consumption of cigarettes were cut in half, and exposure to second hand smoke declined dramatically. As a result, more than one million deaths potentially caused by tobacco were avoided, resulting in gains in life expectancy and quality. This chapter reviews the actions attributed to this achievement, including the dissemination of scientific information on the dangers of active and passive smoking, clinical strategies to help persons quit smoking, and the legal and economic strategies to create disincentives for tobacco use. The marketing of tobacco continues resulting in a continual state of action and reaction between private industry and public health. Despite the health advances, smoking remains the leading preventable cause of death for American men and women.

Tobacco exposure causes both malignant and non-malignant disease and has been estimated to be the aetiology of approximately 4% of the global burden of disease. Because of the frequency of smoking, it is predictable that smokers will be exposed to other factors that can have an independent deleterious effect on health. This chapter reviews the interaction of tobacco and four additional substances: alcohol, asbestos, radiation, and arsenic. Of these four exposures, alcohol is the commonest and has the strongest link to smoking. Alcohol is especially troublesome because a large proportion of the population has had recent exposure to both agents. For heavy smokers, dual exposure is extremely common. Synergistic effects of alcohol and tobacco exposure are seen for both malignant and non-malignant diseases.

Litigation plays at least six different roles in tobacco control. First, the most common and least dramatic role is ordinary enforcement of tobacco-control laws. Second, too frequently governments enforce tobacco-control laws sporadically or not at all, creating the opportunity for NGOs either to bring law enforcement actions directly or to sue their governments to force them to do their job, depending on whether courts will permit NGOs to take such actions. Third, tobacco companies increasingly use litigation to thwart effective tobacco control legislation and programmes, typically arguing that constitutional provisions or other controlling law pre-empts such measures. Fourth, lawsuits and administrative proceedings have been brought by smoke-sensitive individuals against employers and places of public accommodation, seeking protection from second-hand smoke or compensation for illnesses caused or exacerbated by exposure to second-hand smoke. Fifth, many lawsuits have been brought by individuals, groups or classes of individuals, and third-party health care payers against the tobacco companies, seeking compensation for tobacco-caused illness, death, and/or out-of-pocket economic costs. Sixth, governments occasionally attempt to enforce general laws (e.g., against racketeering) against tobacco companies, alleging that deceptive and illegal practices by the industry have harmed the general public. Unlike ordinary law enforcement, these cases seek court orders requiring fundamental changes in the way these companies do business. Each of these roles has implications for social change. This chapter discusses each of these in turn, with the most attention devoted to the cases against the tobacco industry. It also looks at the role that legislation can play in encouraging or discouraging tobacco litigation. It concludes with a brief discussion of how tobacco control would have been different in the past in the absence of litigation, and how litigation may affect the course and success of tobacco control in the future.

This chapter examines the contributions of several large prospective studies conducted over the second half of the 20th century to our understanding of the health hazards of tobacco use. Beginning in the early 1950s, large cohort studies played a major role in helping to identify the multitude of adverse health effects caused by tobacco use, particularly manufactured cigarettes. They demonstrated that the harmful effects applied to women as well as men, that cigarettes with low machine-measure tar and nicotine were no less hazardous with respect to lung cancer than filter-tip ‘regular’ tar cigarettes, and that the burden of disease caused by smoking increased over time as smokers initiated regular cigarette smoking at progressively earlier ages. Large cohort studies will continue to be important for monitoring the course of the epidemic as it evolves in different cultures and for sustaining the political resolve to end it.

This chapter discusses the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). The WHO FCTC is public health history in the making and has become a landmark for the future of global public health with major implications for the WHO's health goals. It represents a milestone for the global promotion of public health policies and provides new legal dimensions for international health cooperation. It corroborates the critical roles of international law in preventing disease and promoting health. While the WHO FCTC represents one huge stride forward, it is but a single step in controlling the tobacco epidemic. The success or failure of the Treaty remains highly dependent on country level implementation, and on how international, regional, and national players from different sectors employ it.

This chapter details the epidemiology of use and abuse of alcohol, tobacco, and recreational drug use among gay and bisexual men in the United States. The review highlights the history of use and abuse of these drugs over the past quarter century and identifies where there are substantial health disparities regarding use of drugs and where the evidence suggests that gay and bisexual men may not use drugs differently than heterosexual men. The chapter also reviews available programs to address substance abuse issues among gay male communities and areas where the field might best move forward.

This chapter reviews the epidemiology of tobacco use during pregnancy and then focuses on the effects of prenatal tobacco exposure (PTE). There PTE has significant effects on the growth, cognitive development, and behavior of exposed children. Children with PTE are smaller at birth, have cognitive deficits in reasoning and memory, and higher rates of activity, inattention, and impulsivity.

Chronic diseases are long-term conditions. They are typically not caused by a single infection, but by exposure to multiple, often human-produced hazards. This chapter sets out the four leading contemporary killers of the human race — heart disease, common cancers, respiratory disease, and diabetes — and their main behavioural risk factors — tobacco use, unhealthy diet, physical inactivity, and alcohol. The chapter reveals a clear picture of a world where all people in all nations, rich and poor, and young and old, will be at risk, although the consequences will be the greatest among the youngest, poorest, and most vulnerable groups.

This chapter reviews studies on the link between smoking and laryngeal cancer. Tobacco smoking plays by far the largest aetiological role in laryngeal carcinogenesis, either alone or in combination with other factors, and tobacco control remains the main avenue for prevention of this disease. The decline in recent decades in the incidence of laryngeal cancer among men in some regions in which tobacco control has been implemented more effectively suggests that prevention of this disease through the avoidance of its major cause is possible.

This chapter reviews studies on the link between smoking and cancer of the oesophagus. In 2002, it was estimated that there were 315,000 new cases of oesophageal cancer (OC) among men and 145,000 among women worldwide. The two major histologic types are squamous cell carcinoma of the oesophagus (SCCO) and adenocarcinoma of the oesophagus (ACO), which account for over 90% of OC. The vast majority of OC are SCCO. Over recent periods, however, a levelling off or decreases in SCCO incidence rates, and increases in ACO incidence rates have been observed in the United States, Canada, and several European countries, especially Northern European ones, and in a few other areas.