Population-based evidence of a strong decline in the prevalence of smokers

"Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989–2003)
Carlos Augusto Monteiroa, Tania Maria Cavalcanteb, Erly Catarina Mouraa, Rafael Moreira Claroa, Célia Landmann SzwarcwaldcIntroduction
The adverse effects of tobacco smoking on health have been known since at least the 1950s.1,2 Even the large multinational cigarette companies, who previously denied the problem and questioned the validity of scientific studies, now explicitly admit that tobacco smoking has adverse consequences. There is scientific evidence that even nonsmokers exposed to tobacco smoke (“passive smokers”) have a greater incidence of cancer, cardiovascular disease and respiratory disease.3 As well as being a risk factor for a variety of diseases, smoking is characterized by chemical dependence, and falls into a model of chronic disease with a long-term natural history and with periods of recurrence and remission.4

The accumulation of knowledge on the risks of tobacco smoking has not been enough to reduce worldwide consumption. In fact, tobacco consumption in developing countries has been increasing at an alarming rate as a result of sophisticated global promotion strategies developed by multinational cigarette companies. Favoured by the liberalization of commerce brought about by globalization, such companies are promoting the rapid transfer of the burden of tobacco consumption from rich to poor countries.5 In 1999, smoking already accounted for four million deaths per year worldwide, and half of these occurred in developing countries. At current trends, the number of deaths attributed to smoking will double by 2020, and seven of every ten tobacco-related deaths will take place in developing countries.6

In light of the adverse effects of smoking and the evidence for increased consumption of tobacco, especially in developing countries, the World Health Assembly has approved several wide-ranging resolutions to contain the global demand for tobacco. These culminated in 1999 with the sanction of the Framework Convention on Tobacco Control, a set of multisectoral actions aimed at reducing the demand for, and consequent health effects of, tobacco in the world./.../