Promoting a future without tobacco: also a continuing task for respiratory medicine in Europe

The eleventh World Conference on Tobacco or Health inChicago, USA with approximately 5,000 delegates, washeld during the second week of August 2000. The authorsbelieve that many of the attendants experienced a feelingof "recharging the batteries" as a result of participating inthis conference. The value of a conference which gatherspeople playing different roles in the fight against tobacco isthat personal scientific views are put into a more holisticperspective, showing that science, legislation and politicshave to work hand-in-hand to reduce the harmful effectsof tobacco. In recognition of the importance of thisconference the editors of the Journal of the AmericanMedical Association and the British Medical Journal havereleased thematic issues of their journals concerningtobacco use [1, 2]. The present contribution to the Euro-pean Respiratory Journal is an update on what is goingon scientifically and politically in the field of tobaccocontrol.Tobacco is a global product and a global problem.Smoking contributes to a death rate in excess of fourmillion people worldwide and this is suspected to increaseto 10 million by the year 2030, with the majority of thisincrease occurring in the Third World countries. Becauseof the globalization of trade, marketing and information,the actions of the individual countries in tobacco controlcannot be anything but ineffective.World Health Organization convention ontobacco controlAt the Conference, the director of the World HealthOrganisation (WHO), G.H. Brundtland, presented theFramework convention on tobacco control. This conven-tion is an "international legal agreement concluded be-tween states in written form and governed by internationallaw" and, for those countries signing it, it will be binding toimprove transnational tobacco control and cooperation."The guiding principle..... is to make it clear that tobacco isan important contributor to inequity in health in allsocieties; as a result of the addictive nature and the healthdamage associated with tobacco use it must be consideredas a harmful commodity; the public has a right to be fullyinformed about the health consequences of using tobaccoproducts; and the health sector has a leading responsibilityto combat the tobacco epidemic, but success cannot beachieved without the full contribution of all sectors of thesociety".The state parties could agree to include the followingobjectives: protection of children and adolescents fromactive and passive smoking; promoting smoke-free en-vironments; promoting healthy tobacco-free economics,especially, preventing smuggling; strengthening women’sleadership in tobacco control; enhancing the capacity of allmember states in tobacco control and exchange of infor-mation at national and international levels, and protectingvulnerable communities including indigenous people [3].The most effective elements in the antitobacco policyare increases in the tax on cigarettes, a total ban oncigarette advertisements, no-smoking policies in work andpublic places, and prominent warnings on cigarette pack-ages. As an example it has been observed that a 10%increase in the price of cigarettes would reduce smokingby 4% in high-income and by 8% in low-income countries.It seems that this effect is especially effective in teenagers,low-income groups and in those with a low educationalbackground [4].However, the opponent in this battle is very strong, thetobacco industries yearly income is more than $400 billionand it is only exceeded by the gross national product(GNP) in 15 countries. Consequently, elements with lessdocumented efficacy should, according to the WHO, beused, including counter advertisements, regulation of tob-acco products, prohibition of sponsorships from tobaccocompanies for art, music or sport events.Interventions to prevent youngsters from smokingThe two cornerstones in reducing the number ofsmokers are both the prevention of the recruitment ofsmokers among young subjects, and smoking cessationamong smokers. The tobacco industry has been targetingteenagers in their campaigns and also cigarettes have beenchanged as to be a better "starter" product. The recentincrease in smoking among young adults is both alarmingand disappointing. A recent national cross-sectional popu-lation survey, carried out in the USA and including 17,185adolescents aged 15–17 yrs, showed an association be-tween their smoking habits and household and workplacesmoking restrictions. Adolescents living in a smoke-freehome were 74% as likely to be smokers as those livingin homes with exposure to cigarette smoke. Youngsters