Page 0047

RISK FACTORS

46 CANCER CONTROL 2014

teenage female smokers continue their addiction as adults. In

fact, securing youth smokers in this way is a survival strategy

of the tobacco industry, as most adult smokers begin their

addiction before the age of 18. Of significant concern are lowand middle-income countries in which the smoking rates

of

teenage boys are alarmingly high; in some countries, virtually

half of all boys aged 13-15 are smokers (Figure 6).

The tobacco industry

The global tobacco industry represents big business. Tobacco

is grown in at least 124 countries in the world and is grown on

more than 3.8 million hectares of agricultural land. Tobacco is

grown with little benefit to farmers, who are often trapped in

a cycle of poverty and are victims of farming-related illness

from exposure to tobacco leaves and nicotine. Additionally,

tobacco is grown on land that could be used for other food

products, and in 2009, six of the world's top 10 tobaccoproducing countries had undernourishment rates

between

5% and 27%. Tobacco companies and manufacturers are the

winners of tobacco production. In 2010, the six leading

tobacco companies in the world had combined revenues of

more than US$ 346 billion and combined profits over US$ 35

billion. These companies profit greatly from the addiction of

others and work diligently to keep customers as lifetime

addicts.

Tobacco marketing is one avenue of attracting and

maintaining tobacco users, and tobacco companies market

their products heavily. In 2008 in the United States, tobacco

companies spent more than US$ 9.9 billion on cigarette

marketing and an additional US$ 548 million on smokeless

tobacco marketing, equating to US$ 34 being spent on

tobacco marketing for every man, woman and child in the

United States. Marketing restrictions have increased in highincome countries, but many

low- and middle-income

countries do not have

tobacco marketing bans or

restrictions and adults and

children are exposed daily to

pro-tobacco propaganda and

messages (Figure 7).

Tobacco-related costs and

affordability of cigarettes

The results of the tobacco

epidemic are costly and

include both direct and

indirect costs to society. Direct medical costs are incurred to

treat tobacco-related illness and indirect costs include the

loss of labour productivity, pollution and other environmental

harm, and fire damage, not to mention the costs of human

suffering that victims and their families face. In some

countries, such as Egypt and Mexico, tobacco-related health

care costs exceed 10% of total health care expenditures.

Cigarette smokers in developing countries face personal

opportunity costs that can involve the sacrifice of basic needs

like food and education to satisfy their addictions. Cigarette

prices vary widely from country to country with a tendency

toward more affordability in low- and middle-income

countries (Figure 8), with "affordability" expressed as a

percentage of income or duration of work time it takes to

purchase a product. The fact that cigarettes may be more

affordable compounds the problem, as low costs make it

easier for smokers to justify the purchase of cigarettes over

basic necessities. Essentially, increases in cigarette

affordability confound tobacco control efforts.

Countries With the Highest

Smoking Rates Among Boys

Ages 13-15, 2011 or latest available

30.7%Madagascar

33.8%Lithuania 36.3%Latvia

36.3%Malaysia

36.9%Fed. States of Micronesia

33.2%Tuvalu

37.5%Tonga

52.1%Papua New Guinea

50.6%Timor-Leste

31.0%Palau

31.2%Belarus

Africa Europe Western Pacific

South-East Asia

Figure 6: Countries with the highest smoking rates among boys

"If you're not allowed it, but you

really want it, then you can have it!"

Advertisement slogan for Kiss Cigarettes in Russia, 2011

Figure 7: Pro-tobacco propaganda

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