A.N.Zubritsky
Department of Pathology, Taldom Territorial Medical Union, Taldom, Russian Federation
Introduction
In early times, smoking was controlled by severe punishment. For example, under the first Romanoff tzar, Michael Fedorovich, people caught smoking for the first time were punished with 60 lashes on the feet, and when they were caught for the second time their nose and ears were cut off (Zaikin et al., 1990). In the former Soviet Union, there were no State programmes devoted to smoking control and no effective medical help for smokers. The only actions were warnings on cigarette packs by the Ministry of Public Health, a few articles in newspapers and chapters in school biology textbooks that were meant once and for all to persuade young people to hate this harmful habit.
Nowadays, physicians join their foreign colleagues in preventing smoking. One example is an international seminar on smoking control held in the Cancer Research Centre of the Russian Academy of Medical Sciences, at which the medical and sociological aspects of smoking were discussed. Dr. D.Zaridze presented the project for legislation on smoking developed by specialists at the Research Institute for Cancerogenesis to reduce the maximum tar content of cigarettes to that in the European community, 15 mg, to increase prices of cigarettes and to restrict production of new forms of tobacco and other products containing nicotine on Russian territory.
Tobacco smoking has become a socioeconomic problem and requires preventive measures (Raw et al., 1990; Zubritsky, 1995). The measures taken to date by national governments have been partial and gradual. Poland has proposed laws restricting the purchase of tobacco products to persons under 18 and imposing a fine for smoking in restricted places; it noted that one of the best measures against smoking is sports, especially running. Singapore is attempting to become the first no-smoking nation in the world. One large district of Manila, in the Philippines is smoke-free; a fine is imposed for carrying a cigarette in public places and 10 days’ imprisonment for repeated violations.
The International Union against Cancer has suggested the following measures for tobacco control (Committee on Tobacco or Health, 1990): restrictions on all advertisements and sponsorship by the tobacco industry; government warnings on all tobacco products; reduced tar and nicotine in tobacco products; tax and price policies for tobacco products; policy of economic choice; restriction on the purchase of tobacco products by young people; protection of the rights of non-smokers by designating smoking areas; introduction of new sources of nicotine and a future trade strategy; and guaranteeing help for tobacco users who want to give up.
More and more demands are being heard throughout the world for a full ban on tobacco advertising (Amos, 1990; Crofton, 1990; Mackay, 1990). The European Community has suggested that all advertisements carry warnings, like “Tobacco is a serious threat to your health”, “Protect children from tobacco smoke”, Give up smoking and become rich” and “Smoking kills”. In countries such as Norway and Finland, where advertising of tobacco products has been banned for more that 10 years and the prices are increasing, the number of smokers has decreased. The European Community has taken the following legislative measures:
Since January 1992, all packs of cigarettes must show the tar and nicotine content and a warning in the official language of the country of final sale.
Restrictions have been imposed on smokeless tobacco in all European countries since July 1992. Smokeless tobacco was used by less than 10% of young men in the United States 20 years ago and by 25% today; in Sweden, its consumption accounts for 30% of all tobacco use. More than 100 million persons in India and Pakistan use smokeless tobacco, and in Africa it has cultural significance.
The tar content of cigarettes must not exceed 15 mg since 31 December 1992 and 12 mg since December 1997.
Smoking has been restricted in all public places since July 1989.
Since October 1991 advertising of tobacco products on television has been restricted in all European countries.
Since 1 January 1993, the minimum level of taxation is not less than 70% of the final retail price.
The European action plan for tobacco smoking control includes: establishment of alliances of representatives of international, national and community organizations to strengthen social and political support; multisectoral policy on tobacco; no smoking in all public places, transport and workplaces; teaching youngsters to be non-smokers, by education, role models, particularly physicians; support for smokers who want to give up smoking; strong management and human and financial resources for tobacco control. This action plan is based on the recommendations of external consultants and specialists from other WHO programmes. Activity within the programme of tobacco control is based on three main principles:
support of national programmes on tobacco prevention and control;
campaigns and community involvement to establish refusal of tobacco consumption
as a norm of public behaviour;
collection, processing and distribution of information.
The European Charter (1989) adopted at the first European conference on tobacco policy in Madrid speaks for itself:
Fresh air free of tobacco smoke is the most important component of the right to a healthy, unpolluted environment.
Every person has the right to information on the unprecedented risk to health associated with tobacco consumption.
All people have the right to air free of tobacco smoke in closed public places and transport.
Attention must be paid to public education. National No-smoking Days are observed annually; they should take new, original forms that attract young people.
Conclusions
Analysis of the world literature shows that the development and implementation of preventive measures aimed at tobacco smoking is difficult but necessary. Effective tobacco control is possible only with adequate legislative measures, national and international programmes and the support of governmental and non-governmental organizations with the participation of specialists led by physicians. The direction of the anti-tobacco campaign should be vested with the World Health Organization. Legislation will help governments to control the epidemic of tobacco smoking, defend the rights of non-smokers to breathe pure air and create a future society free from tobacco smoke.
References
1. Amos, A. (1990) How women get involved into the sphere of the tobacco industry’s influence. World Health Forum, 11, 55–59 (in Russian).
2. Committee on Tobacco or Health (1990) Bull. Int. Union Tuberc., 65.
3. Crofton, J. (1990) WHO technical advisory group on tobacco or health. Bull. Int. Union Tuberc., 65, 58–59.
4. European Charter on Tobacco Restriction (1989) World Health Forum, 10, 118–119 (in Russian).
5. Mackay, J. (1990) First National Seminar on Smoking and Health, Hanoi, 15 March 1990. Bull. Int. Union Tuberc., 65, 70.
6. Raw, M., White, P. & McNeill, A. (1990) Clearing the Air. A Guide for Action on Tobacco, London: British Medical Association.
7. Zaikin, N. & Nikitin, A. (1990) Thanks, I don’t Smoke, Moscow (in Russian).
8. Zubritsky, A. (1995) How to prevent smoking in Russia (Abstract). Tuberc. Lung Dis., 76 (Suppl.2), 100.
From – (Russian Federation: Tobacco smoking control // R.Lu, J.Mackay, Sh.Niu and R.Peto (Eds.). Tobacco: the growing epidemic: proceedings of the Tenth World Conference on Tobacco or Health, 24–28 August, 1997, Beijing, China. – Springer, 2000. – P.476–478)
