Tobacco smoking is a major worldwide cause of morbidity and mortality from various diseases, including urologic diseases.
We reviewed, at global and regional levels, the prevalence and trends of tobacco smoking and legislative and regulatory efforts around tobacco control. We also provided information about electronic cigarette (e-cigarette) use.
We used several sources to present the most up-to-date information from national surveys, including the Global Adult Tobacco Survey, the Global Tobacco Control Report, and the Global Youth Tobacco Survey.
Smoking prevalence has been decreasing globally, although trends in smoking vary substantially across countries and by gender. Among men, smoking prevalence in most high-income countries started to decrease in the mid-1990s, followed after a few decades by generally smaller decreases in some low- and middle-income countries (LMICs). However, there has been no change, or there has even been an increase, in smoking prevalence in many other LMICs. Countries with the highest male smoking prevalence are located in East Asia, Southeast Asia, and Eastern Europe. Similar to men, smoking prevalence for women has been decreasing in most high-income countries and some LMICs, although the decrease began later and was slower than that for men. Except in a few countries, smoking is much less common for women than for men. Most countries with the highest smoking prevalence in women are in Europe. Countries that have implemented the best practices for tobacco control, including monitoring, smoke-free policies, cessation programs, health warnings, advertising bans, and taxation, have been able to reduce smoking rates and related harms. E-cigarette use has rapidly increased since its introduction to the market.
Health care providers should advise smoking patients about quitting smoking. Countries must improve the implementation and enforcement of tobacco control policies. Particular attention should be paid to preventing an increase in smoking among women in LMICs.
We reviewed smoking prevalence and tobacco control policies in various regions. Countries with more effective tobacco control programs have seen higher reductions in smoking prevalence and, consequently, in smoking-related mortality. Because both longer duration and higher intensity of smoking (amount of tobacco smoked per day) are associated with an increased risk of tobacco-related diseases, smokers should quit smoking as soon as possible.
Keywords: E-cigarettes, Global, Review, Smoking, Tobacco control.
The epidemic of tobacco-related diseases is the first worldwide epidemic created by humans. Tobacco use killed 100 million people globally in the 20th century and will kill 1 billion in the 21st century if current patterns persist  and . Tobacco use is also a burden on global economic development. In the United States alone, the estimated economic cost related to tobacco consumption is $289 billion per year .
Tobacco use is a known risk factor of cancer and other diseases in a number of organs. Although tobacco use has some short-term health effects, tobacco-related mortality usually peaks a few decades after smoking . Therefore, knowing patterns of tobacco smoking not only helps to understand the current epidemiology of smoking-related diseases but also can provide valuable information about the epidemiology of these diseases in the future.
In this review, we provide information on prevalence and trends of tobacco smoking at global and regional levels. We also briefly review the use of electronic cigarettes (e-cigarettes), which has been rapidly growing. Finally, we discuss legislative and regulatory efforts around tobacco control and their effects on smoking patterns.
2. Evidence acquisition
We used several sources of smoking data to present the most up-to-date information from national surveys. For current regular smoking, we used the Global Adult Tobacco Survey (GATS), an international survey using the same protocol across the surveys, as the main source of national data . When data for specific countries were not available from this survey, we used the World Health Organization (WHO) Report on the Global Tobacco Epidemic 2013 (also known as the Global Tobacco Control Report [GTCR]), which collected data (up to 2012) from various sources . We also used a subnational survey  and a few national surveys , , , , , , , , and  for more recent smoking data that were not included in GATS or the GTCR, as well as for information on e-cigarettes , , , , , , , and . For daily smoking data, we used the estimated prevalence presented in a publication from the Institute for Health Metrics and Evaluation (University of Washington, Seattle, WA, USA) . Although the main focus of this review is smoking in adults, we used data from the Global Youth Tobacco Survey, an international survey on youth tobacco use  and , to show data on youth tobacco use. We also briefly discuss smokeless tobacco use even though its associations with urologic diseases are not well established, because it is the most common form of tobacco use in certain countries.
Throughout this article, tobacco smoking refers to smoking of any tobacco product (cigarette, cigar, cigarillo, hookah, bidi, or any other product), unless stated otherwise. To combine data and show trends of smoking prevalence from 1980 to 2012 and current coverage of tobacco policies by continents, we used the United Nations (UN) list of countries in each continent . This list is slightly different from some commonly used lists: Armenia, Azerbaijan, Cyprus, Georgia, and Turkey are considered West Asian rather than European countries. Nevertheless, we used this official UN list, and this difference did not substantially change the trends/coverages in continents. The only exception to using the UN list was when we showed smoking rates for individual countries. From the above West Asian countries in the UN list, smoking rates were shown for Cyprus and Turkey, both of which are listed among European countries in Table 1. We used the World Bank databases to obtain countries’ populations and income groups . Income groups were defined by annual gross national income per capita as low, ≤$1045; lower middle, $1046–$4125; upper middle, $4126–$12 745; and high, ≥$12 746.
Prevalence of current tobacco smoking in national surveys in selected countries by continent*
|Country by continent||Population, millions, 2013||Income group||Year||Age group, yr||Male, %||Female, %||Total, %|
|Sao Tome and Principe ||0.2||Lo-mid||2009||25–64||9.7||1.7||5.5|
|South Africa ||53.0||Up-mid||2012||≥15||32.8b||10.1b||20.8b|
|Ivory Coast ||20.3||Lo-mid||2012||15–49||26.2||1.7||–|
|Sierra Leone ||6.1||Low||2009||25–64||43.1||10.5||25.8|
|United States ||316.1||High||2012–2013||≥18||22.6||14.9||19.2|
|Dominican Republic ||10.4||Up-mid||2003||≥18||17.2||12.5||14.9|
|Trinidad and Tobago ||1.3||High||2011||15–64||33.5c||9.4c||21.1c|
|Costa Rica ||4.9||Up-mid||2010||18–70||18.6||5.8||12.8|
|El Salvador ||6.3||Lo-mid||2005||12–65||21.5||3.4||11.7|
|South Korea ||48.6||High||2011||≥20||47.3||6.8||27.0|
|South and Central Asia|
|Sri Lanka ||20.5||Lo-mid||2006||15–64||29.9||0.4||15.0|
|United Kingdom ||64.1||High||2012||≥16||22.0||19.0||20.0|
|New Zealand ||4.5||High||2012–2013||≥15||18.7||16.4||17.6|
|Papua–New Guinea ||7.3||Lo-mid||2007||15–64||60.3||27.0||44.0|
* Smoking any tobacco products (excludes smokeless tobacco use). Current smoking was defined as current daily smoking or occasional smoking (less than daily smoking) in the Global Adult Tobacco Survey . This group included every day and someday smokers in the US survey and current smokers of “any amount” in the Iranian survey. Population and income group data are from the World Bank.
a Men aged 15–59 yr and women aged 15–49 yr.
b Ever smoking (current or former smoking).
c Only cigarette smoking.
Lo-mid = lower-middle income; Up-mid = upper-middle income.
3. Evidence synthesis
3.1. Global patterns of tobacco smoking
Recent estimates suggest that in 2012, 928 million men and 207 million women were current smokers of any tobacco product globally , and the majority (807 million men and 160 million women) were daily smokers . Most countries with the highest male smoking prevalence are in East Asia, Southeast Asia, and Eastern Europe. The highest female smoking rates are mostly in European countries.
3.1.1. Tobacco epidemic
Trends in smoking prevalence in most high-income countries have followed a pattern that is commonly termed the tobacco epidemic or the cigarette epidemic and . In this model, smoking prevalence first increases among men, followed by an increase in women. Smoking-related cancer mortality starts to increase substantially after approximately three to five decades (Fig. 1)  and .
The estimated age-standardized smoking prevalence in men and women has been decreasing on all continents (Fig. 2). From 1980 to 2012, smoking rates in both men and women substantially decreased in Oceania and the Americas, chiefly in New Zealand, Australia, and North America. In Europe, although male smoking has also substantially decreased, female smoking has started to show a modest decrease only recently. In Asia, male smoking rates were increasing in the 1980s and started to decrease in the mid-1990s; nevertheless, the smoking prevalence in men was >35% in 2012, the highest of all continents. The smoking prevalence in African men has been lower than that of men in other continents. Smoking by women in Africa and Asia has been traditionally low (chiefly <5%) and changed little from 1980 to 2012. As male smoking in many African countries and female smoking in many low- and middle-income countries (LMICs) have not yet followed the tobacco epidemic pattern, a major priority for health authorities in LMICs must be to prevent a surge in smoking similar to what happened in high-income countries.
Estimated age-standardized daily smoking prevalence in (a) men and (b) women (aged ≥15 yr) by continent (age-standardized to the 2000 world standard population) .
3.1.2. Duration and intensity of smoking
Increased harm from smoking is associated with longer duration of smoking, higher smoking intensity (the average number of cigarettes smoked per day) , and greater nicotine dependency (measured by time to first cigarette after waking)  and . When smoking prevalence is high, the mean initiation age is generally <20 yr  and . Those who start smoking at earlier ages are generally exposed to smoke for longer durations, unless they quit early . Before the tobacco epidemic starts in a population, the mean age of initiation is usually higher than after the epidemic is established; in the United States, for example, the mean initiation age was 35 yr among women born in 1900 and <20 yr in women born in 1940 and afterward . Smoking initiation in earlier ages, an increase in smoking intensity, or a combination of both can substantially increase the magnitude of associations between smoking and diseases in a population over time. For example, the relative risk of lung cancer in women associated with current smoking in the United States increased from 2.7 to 12.7 to 25.7 in cohorts in the 1960s, 1980s, and 2000s, respectively .
Patterns of smoking intensity vary across countries. In some Latin American countries, including Chile and Bolivia, smoking intensity has remained relatively low (average <10 cigarettes per day) despite high smoking prevalence in those countries . In contrast, average smoking intensity increased dramatically in China, from 15 cigarettes per day in 1980 to 22 cigarettes per day in 2012 . The latter pattern might be seen more commonly in LMICs as a result of increases in income and/or broader cigarette affordability. In some countries that have managed to reduce smoking prevalence through successful tobacco control polices, such as Canada, Denmark, Iceland, New Zealand, and Uruguay, persons who continue to smoke are usually heavy smokers . These intense tobacco users, who are at a higher risk of smoking-related diseases, may need more sustained help from health professionals to quit or at least reduce intensity of smoking.
3.1.3. Socioeconomic status and smoking
Increases in smoking prevalence in both men and women in high-income countries started mainly in higher socioeconomic groups  and . Over time, high smoking prevalence shifted to lower socioeconomic groups as evidence about the health effects of smoking emerged in the 1950s and early 1960s . In the United States, for example, smoking prevalence in 1940 was 36% in those with less than a high school education and 40% in people with education levels of college and above ; the corresponding rates were 35% and 13% in 2009–2010 . Similar patterns of smoking prevalence by socioeconomic status have been reported in LMICs , , and . When specific ethnic groups show high smoking prevalence, it is likely because they are disproportionately represented in lower socioeconomic groups  and .
3.2. Regional patterns of tobacco smoking
Updated information on tobacco smoking in Africa is limited , but similar to other LMICs, in Africa smoking is substantially more common among men than women (Table 1). The slight decrease in prevalence of daily smoking from 1980 to 2012 (Fig. 2) was chiefly prominent in countries in which the tobacco epidemic started earlier and had relatively higher smoking rates (eg, South Africa, Lesotho, Madagascar, and Algeria) . In parallel with rapidly growing incomes, which often make cigarettes more affordable , and without major tobacco control interventions, it has been projected that the prevalence of current smoking will increase from 15.8% in 2010 to 21.9% in 2030 in the WHO African region (Africa excluding Djibouti, Egypt, Libya, Morocco, Somalia, Sudan, and Tunisia) if current trends continue . Most of this increase is expected to be among men.
The consequences of the tobacco epidemic in Africa will be exacerbated by rapid population growth, which, although slowing, is among the highest in the world. By current trends, the estimated population of Africa will increase from 1.2 billion in 2015 to 1.7 billion in 2030 and to 4.2 billion (or 40% of the world's population) in 2100, with the highest increase in East Africa and West Africa . Without appropriate tobacco control policies, including prevention strategies across the continent, Africa will lose many millions of lives in this century due to tobacco smoking .
3.2.2. The Americas
Smoking prevalence in Canada and the United States has decreased from >55% in men in the 1950s and >35% in women in the 1970s and 1980s  and  to <20% in men and <15% in women in 2012 (Table 1). Also, the daily smoking prevalence decreased by approximately 60% in both men and women in Mexico from 1980 to 2012 . Several Caribbean, Central American, and South American countries have reduced smoking rates, though to a lesser degree and chiefly in men. However, there has been no significant change in male smoking in a few countries, including Chile, Costa Rica, Jamaica, Peru, and Suriname . Smoking is generally less prevalent in Central America than in South America, particularly among women. The smoking prevalence in many South American countries is approximately 20–30% in men and 10–20% in women . The highest smoking prevalence in South America is in Chile: 44.2% in men and 37.1% in women in 2010 (Table 1).
Approximately 60% of the world's current smokers in 2010 through 2012 lived in three Asian countries: China (317 million smokers), India (122 million smokers), and Indonesia (115 million smokers) . Chinese men smoke one in every three cigarettes smoked worldwide . In only a few Asian countries (eg, Kazakhstan, Lebanon, and Nepal) is the smoking prevalence in women >10% (Table 1). In contrast, smoking is quite common among Asian men. The male smoking prevalence is >40% in western parts of the Middle East (eg, Lebanon, Jordan, and Kuwait) but is lower (15–30%) in other West Asian countries (eg, Iran, Qatar, and Oman) and adjacent countries in South Asia and Central Asia (eg, India, Pakistan, and Uzbekistan). Moving toward the north and east, this rate increases to >40% in other South Asian and Central Asian countries (eg, Bangladesh, Kazakhstan, Kyrgyzstan, and Nepal).
Smoking prevalence in men is extremely high in many East Asian and Southeast Asian countries. The current smoking prevalence among men in 2010–2011 was 67% in Indonesia and 53% in China (Table 1). Some countries in East Asia and Southeast Asia have been able to reduce smoking rates. For example, male smoking rates halved in Hong Kong (China), Japan, and Singapore from 1980 to 2012 . Nevertheless, many other countries need to implement more effective tobacco control policies to attain similar goals. With current high smoking rates in this highly populated region, smoking will be the main cause of morbidity and mortality for several decades. Current trends suggest that smoking will kill >50 million people between 2012 and 2050 in China alone .
Smoking rates have substantially decreased in several countries in Western Europe and Northern Europe, notably in the United Kingdom and the Nordic countries . In the United Kingdom, smoking rates dropped from >80% in men in 1950 and approximately 40% in women in 1970  to approximately 20% in both sexes in 2012 (Table 1). Although smoking rates have also started to decrease in many other European countries, the rates are still very high in Eastern Europe and Southern Europe (Table 1).
The tobacco epidemic started much earlier in Western Europe than in Eastern Europe. Following an earlier decline in male smoking prevalence, tobacco-related mortality in men is decreasing in several Western European countries . A decline in smoking-related mortality in women has begun in countries with decreases in female smoking, including the United Kingdom . High smoking-related morbidity and mortality are expected for at least several decades more in the European countries that now have high smoking prevalence.
Two of the wealthiest countries in Oceania, Australia and New Zealand, have been quite successful in reducing smoking prevalence in both men and women, from >30% in the 1980s to <18% in 2013 in men and women combined  and . However, similar to the smoking pattern in Southeast Asia, the male smoking prevalence in most other countries on this continent (eg, Papua–New Guinea and Tonga) is high (Table 1).
3.3. Blond and black (dark) tobacco
Blond tobacco is flue-cured tobacco that is high in sugar and produces a milder, more inhalable smoke compared with black (dark) tobacco. More than 90% of cigarettes smoked globally in 2013 were Virginia or American blended cigarettes , both of which are blond tobacco. Black tobacco is chiefly smoked in Latin America, Spain, and France  and is processed with open-air curing or air curing in barns with no or limited artificial heat. The strong varieties are usually used to make cigars, while light varieties are used in some cigarette blends in the countries above. With blond tobacco being more popular among smokers globally, black tobacco use is decreasing . For example, the share of black tobacco in the tobacco market in Peru decreased from 17.6% in 2000 to 1.5% in 2009; the respective decrease in Spain was from 23.5% to 9.2% .
The few laboratory studies that exist on potentially carcinogenic compounds in black and blond tobacco and their effects on the human body have shown higher concentrations of N-nitrosamine and 2-napthylamine in black tobacco and higher urine mutagenicity and blood DNA adduct levels in black tobacco smokers  and . However, the clinical significance of these differences is unclear.
3.4. Tobacco products other than cigarettes
Cigarettes are the most common smoking product worldwide. However, there are other tobacco products that are relatively commonly used in some populations. Water pipe (hookah) smoking has traditionally been common in the Middle East and North Africa and in some parts of Southeast Asia . Water pipe use has increased among young people, particularly college students, in Europe and North America  and . In the United States, for example, 7–20% of college students  and 5.4% of high school students  reported past-year/current water pipe use. The use of bidi (tobacco flakes wrapped in a leaf of the tendu or temburni tree), a relatively inexpensive tobacco product, is common in South Asia, in particular in low-income groups . In India, bidi is the most commonly used smoking product (prevalence: 9.2%), followed by cigarettes (5.7%), water pipes (0.9%), and other products (1%) .
Global consumption of roll-your-own (RYO) tobacco increased by 45% from 2000 to 2013, with approximately 101 billion RYO cigarettes smoked worldwide in 2013 (compared with nearly 6 trillion regular cigarettes). Approximately 86% of RYO cigarettes were smoked in the European Union, where RYO cigarettes were much cheaper than regular cigarettes . Global consumption of cigars and cigarillos (a cigarillo is a smaller, narrower version of a cigar) has not changed since the late 2000s and is approximately 24 billion per year, nearly half of which are smoked in the United States . All smoking tobacco products are included in the smoking rates shown in this article, unless stated otherwise.
Smokeless tobacco use is common in South Asia, Central Asia, the Nordic countries, and Africa (Supplementary Table 1). For example, smokeless tobacco use in India is more common than smoking: 32.9% of men and 18.4% women are smokeless tobacco users . Among children aged 13–15 yr in South Asia, Central Asia, the Middle East, and Africa, the use of tobacco products other than cigarettes is more common than cigarette smoking .
3.5.1. What is an e-cigarette?
Electronic cigarettes (e-cigarettes), also called electronic nicotine delivery systems (ENDS), are battery-powered devices that vaporize a liquid solution called e-liquid using a heating element known as an atomizer. E-liquid generally contains nicotine, propylene glycol, vegetable glycerin, and various additives . E-cigarette smokers inhale the resulting aerosol, which some say gives the feeling of cigarette smoking. E-cigarettes are produced with various features (eg, nonrefillable or refillable), but many of these products resemble cigarettes.
As e-cigarettes do not include combustion, their potential to deliver nicotine to users in a safer way than regular cigarettes and to aid tobacco smokers in quitting are of high interest; however, significantly more research is necessary to evaluate this potential rigorously. While two randomized controlled clinical trials have shown modest effectiveness of e-cigarettes in helping smokers to quit  and , two longitudinal epidemiological studies have not shown such a benefit at the population level  or in cancer patients . In addition to research on e-cigarettes as a smoking cessation tool, there is a crucial need for more analysis on the long-term health effects of e-cigarette use , particularly because propylene glycol and other compounds in e-liquids may expose e-cigarette users to increased levels of toxic chemicals  and . Also, nicotine is an addictive substance, and e-cigarette initiation by nonsmokers may eventually lead to their taking up traditional cigarettes . For these reasons, regulations have been recommended by some health authorities to reduce the initiation of e-cigarette smoking in nonsmokers (see section 3.7, Regulating e-cigarettes).
3.5.2. Prevalence of use
As e-cigarettes have been marketed only recently, their prevalence of use is generally much lower than cigarette smoking (Table 2). However, a substantial increase in e-cigarette smoking in a short period has been reported in North American and European countries. For example, ever e-cigarette use among students in grades 6–12 in the United States increased from 3.3% in 2011 to 11.9% in 2013; the corresponding increase in current (past month) e-cigarette use was from 1.1% to 4.5% . Ever use of e-cigarettes in the French population aged ≥15 increased from 7% in 2012 to 18% in 2013 . In 2012, 1% of people in France reported regular or occasional use of e-cigarettes , but in 2013, 6% had used e-cigarettes in the last month . Similar increases have likely occurred since 2012 in many countries in the European Union, in which a survey by the European Commission reported that the prevalence of ever use of e-cigarettes varied from 2% in Sweden to 14% in Belgium .
Prevalence of e-cigarette smoking in adults and youth.
|Country||Year||Age group||Ever use, %||Current use, %|
|Canada ||2012||16–30 yr||16.1||5.7|
|France ||2013||≥15 yr||18||6|
|Italy ||2013||≥15 yr||6.8||1.2|
|Spain (Barcelona only) ||2013–2014||≥16 yr||6.5||1.6|
|United States ||2012–2013||≥18 yr||4.2a||1.9|
|Canada ||2012||16–19 yr||12.5||2.6|
|France ||2013||15–24 yr||31||7|
|Poland ||2011||15–19 yr||23.5||8.2|
|South Korea ||2011||School grade 7–12||19.7||4.7|
|United Kingdom ||2013||11–15 yr||4||1|
|United States ||2013||School grade 6–8||3.0||1.1|
|School grade 9–12||11.9||4.5|
a Every day, someday, or rarely users.
One of the primary concerns of e-cigarette use is how it affects cigarette use. E-cigarette use may not be an issue of concern if it occurs only in current smokers and only if it led to smoking cessation or at least a substantial decrease in smoking intensity. However, e-cigarette smoking in nonsmokers, or in current or former smokers, that might result in a maintenance (with no substantial decrease in smoking intensity) or surge in tobacco use is an issue that may need preventive measures. Cigarette smokers should be strongly encouraged to quit smoking using any evidence-based methods, with or without nicotine replacement therapy.
3.6. Tobacco control policies
3.6.1. MPOWER measures
Tobacco control policies reduce tobacco use and related harm. Because earlier policies usually were sporadic and isolated and could not prevent the global tobacco epidemic, in 2003 the World Health Assembly adopted the WHO Framework Convention on Tobacco Control (WHO FCTC), the first international treaty negotiated under the auspices of WHO, although the WHO FCTC did not come into force until 2005 . In 2008, WHO identified six effective evidence-based measures for reducing tobacco use and began promoting them under the acronym MPOWER . In 2011, UN member states committed to reduce premature mortality from noncommunicable diseases (a 25% reduction from 2010 levels by 2025) by addressing their major risk factors, including a 30% relative reduction in prevalence of current tobacco use in persons ≥15 yr .
The worldwide coverage of MPOWER policies is briefly described in the following sections and is summarized in Table 3 (percentage of countries with coverage) and Supplementary Table 2 (median levels of coverage). It should be noted that tobacco control policies might vary within countries in which jurisdiction is subnational for some policies and/or regulations. In the United States, for example, the northeastern and western states have generally been more successful in tobacco control than the southern states .
Percentage of countries covered by tobacco control policies at World Health Organization–recommended levels, 2012.
|Geographical region||M Monitoring||P Smoke-free policies||O Cessation programs||W Warnings||E Advertising bans||R Taxation|
|Health warnings||Mass media|
|By continent, %|
|By income group, %|
Source: World Health Organization Global Tobacco Control Report .
18.104.22.168. Monitoring tobacco use and prevention policies
Monitoring tobacco use and prevention policies is necessary to assess the effectiveness of current policies and the need for any policy modifications. Tobacco monitoring has traditionally been better in countries with developed health surveillance systems, including Australia, Canada, the United States, and most EU member states. Broader initiatives such as the Global Tobacco Surveillance System Surveys , which provide funding and training from high-income countries (notably from the US government and private foundations), can help improve tobacco monitoring in LMICs.
22.214.171.124. Protecting people from tobacco smoke
As exposure to secondhand smoke is harmful , smoking in public places has been banned to some degree in many countries. In 2012, however, only 16% of the world's population was covered by comprehensive smoke-free laws , demonstrating the need for improved implementation and/or enforcement of these laws. Middle-income countries are the best covered with smoke-free policies, with South America being the leading region in implementation .
Smoking in cars , outdoor places , and multiunit buildings  can also be sources of exposure to secondhand smoke. A few countries, including Bahrain, Cyprus, Mauritius, South Africa, and United Arab Emirates, as well as several states or provinces in Australia, Canada, and the United States, have banned smoking in vehicles carrying children, and several other countries are considering similar bans , , and .
126.96.36.199. Offering help to quit tobacco use
Personalized advice from health professionals  and access to affordable nicotine replacement therapies  help patients quit smoking. In many successful tobacco control strategies, cessation support by health care providers is accompanied by quit lines and other communication technologies such as appropriate text messaging, social networking, and phone applications , , and . These policies are best implemented in the wealthiest nations. Of 55 high-income countries in 2012, 47 countries fully covered at least one of the policies (cessation service or nicotine replacement therapy), and 14 countries covered both policies .
188.8.131.52. Warning about the dangers of tobacco
A large share of the world's population still is not fully aware of the health risks associated with tobacco use: <40% of adults in China believe that smoking causes heart attacks, and <50% of adults in India believe that smoking causes strokes . Harms of tobacco can be communicated through antitobacco campaigns and health warnings on tobacco product packages. Media campaigns can quickly reach large populations of both smokers and nonsmokers.
Health warning labels are most effective in the form of large pictures  located on the upper part of both the front and rear panels of each cigarette package. Middle-income countries are the highest-achieving country group in implementing large pictorial warning labels. The new EU Tobacco Products Directive makes using such labels mandatory in all EU member states by May 2016 . It has been shown that tobacco warning labels work best when they elicit disgust, fear, or sadness .
184.108.40.206. Enforcing bans on tobacco advertising, promotion, and sponsorship
Marketing bans protect people from alluring industry messages aimed at discouraging existing smokers from quitting and attracting new smokers, especially youth . There are now 127 countries (with 74% of the world's population) that ban all or almost all forms of direct and indirect tobacco advertising . Low-income countries are the best group in implementing these policies.
To limit the effect of appealing tobacco packages, an innovative plain packaging law was introduced in December 2012 in Australia to standardize the size, labeling, and shape of packages. For example, this law requires that brand and company names on all retail tobacco packs in Australia must be printed in a uniform, small-sized font, and packs must have a drab dark brown color . Preliminary studies have reported a boost in the number of quit line calls following the introduction of this law  and no increase in the availability of illicit tobacco, which contrasted the tobacco industry's claims and arguments . In 2015, Ireland and the United Kingdom also passed plain packaging legislations .
220.127.116.11. Raising tobacco taxes
Tobacco excise tax increases that result in higher tobacco product prices are among the most effective tobacco control measures available, particularly to reduce smoking rates in youth and lower socioeconomic groups  and . Tax rates need to be regularly revised to increase the price of tobacco products at a rate above inflation and income growth, making tobacco products less affordable over time . With a successful cigarette tax harmonization and integration regimen in the European Union, the member states have the highest tobacco excise taxes in the world . In the United States, where tobacco taxes are partly set by states, the tobacco tax in northeastern states is higher and in southern states is lower than in the rest of the country; higher taxes are associated with lower smoking prevalence in states .
In addition to decreasing tobacco use prevalence and intensity, tobacco tax increases generate sizable revenues, which can be used to fund tobacco control and other public health initiatives. For example, Costa Rica and the Philippines use a major portion of their revenues from recent cigarette tax increases in health care, including the diagnosis, treatment, and prevention of tobacco-related diseases  and 
3.6.2. The need for comprehensiveness in tobacco control policies
Tobacco control policies need to be comprehensive and include all tobacco products. Otherwise, smokers may just substitute one product for another. In Poland, for example, following a cigarette excise tax increase in January 2004, sales of manufactured cigarettes declined while sales of tobacco for RYO cigarettes increased (from a cigarette equivalent of 3.4 billion in 2003 to 5.7 billion in 2004). When tax rates were increased on both manufactured and RYO cigarettes in January 2005, pipe tobacco sales increased from a cigarette equivalent of 0.2 billion in 2004 to 2.0 billion in 2005 and 3.3 billion in 2006 .
3.6.3. Lobbying and litigation
More than 85% of all cigarettes smoked globally are being produced by only six transnational companies: China National Tobacco Corporation, Philip Morris International, British American Tobacco, Japan Tobacco International, Imperial Tobacco Group, and Altria Group . Each of these companies has a gross revenue that is comparable to the gross domestic product of a small country . These companies frequently lobby or challenge tobacco control proposals legally to block or delay their implementation. Examples include a multimillion-dollar lobbying campaign to undermine the revision of the EU Tobacco Products Directive  and a challenge to Australia's plain packaging regulations in domestic courts, at the World Trade Organization, and in international arbitration as part of a bilateral investment treaty  and . In contrast, governments, health organizations, and individuals in several countries have sued the tobacco industry for violating tobacco control regulations and for the health and environmental consequences of their products and practices  and .
3.7. Regulating e-cigarettes
How to regulate e-cigarettes is a matter for debate and research. Regulatory objectives for e-cigarettes recommended by WHO include impeding ENDS promotion to and uptake by nonsmokers, pregnant women, and youth; minimizing potential health risks to ENDS users and nonusers; prohibiting unproven health claims from being made about ENDS; and protecting existing tobacco control efforts from commercial and other vested interests of the tobacco industry . Some authorities have already taken steps to regulate e-cigarettes. For example, within the provisions of the revised EU Tobacco Products Directive, the amount of nicotine in e-cigarettes and refill containers will be limited, products will be required to carry health warnings, and e-cigarette advertising will be banned (unless approved for advertising as a smoking cessation device) in all 28 EU member states by May 2016 . In the United States, in contrast, the US Food and Drug Administration (FDA) now has no authority to regulate e-cigarettes. Although the FDA proposed a new rule in April 2014 to extend its authority to e-cigarettes, including some basic measures such as bans on e-cigarette sales to minors or on the distribution of free samples, implementation of any regulation of e-cigarettes, if adopted, may take several years .
3.8. Investing in tobacco control
Few public health investments provide greater dividends than tobacco control. Countries that have implemented the best practices reflected in the WHO FCTC are now benefiting from their actions. For example, since 1989, Brazil has reduced its smoking rates by close to half through several tobacco control initiatives. It is estimated that those combined policies averted 420 000 deaths by 2010, more than half of which were because of cigarette tax increases . The comprehensive tobacco control policies that were implemented globally from 2007 to 2010 alone prevented an estimated 7.5 million smoking-related deaths .
Tobacco control interventions are relatively inexpensive to implement. WHO estimates that delivering four population-based tobacco control measures (tobacco tax increases, smoke-free policies, package warnings, and advertising bans) to all LMICs would cost only $600 million, or $0.11 per person, annually. This amount includes the human resources and physical capital needed to plan, develop, implement, monitor, and enforce the policies . Currently, only $0.02 per person is spent annually on tobacco control in LMICs . Several tobacco control interventions have even proven to be cost saving, which means that for every dollar spent on these interventions there was more than one dollar yielded in return in saved health care costs and human productivity  and .
Data from national surveys were not available for all countries; or when available, the data might not be comparable in some cases because they were collected using different methodologies or in different years, which might not reflect recent changes in smoking prevalence or tobacco control policies. Despite these limitations, the availability of data from several countries in each region would be sufficient to illustrate the smoking prevalence, trends, and tobacco control policies in all regions.
Smoking prevalence is decreasing globally because of heightened awareness about the health hazards of smoking and the implementation of effective tobacco control policies. However, smoking is still a common habit, particularly in Asia, Eastern Europe, Southern Europe, and a number of other LMICs. Additionally, rapid population growth and the expected increase in smoking prevalence because of the adoption of Western lifestyles associated with economic development and urbanization could lead to many more smokers and tobacco-related diseases in parts of Africa and Latin America. Governments, in collaboration with the broader society, must implement effective tobacco control policies where they are lacking. Particular attention should be given to preventing an increase in smoking prevalence among women in LMICs. Although new nicotine delivery systems, such as e-cigarettes, may have the potential to help reduce tobacco-related harm by helping smokers to quit, measures need to be in place to make sure that these systems do not lead to the maintenance of, or a new surge in, tobacco use.
Support and advice about quitting smoking should be a part of all health care practices, including urologic practices, because not only does smoking cause diseases but it also can worsen the prognoses of other diseases by increasing comorbidities, including respiratory and cardiovascular problems.
Author contributions: Farhad Islami had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Islami, Stoklosa, Drope, Jemal.
Acquisition of data: Islami, Stoklosa.
Analysis and interpretation of data: Islami, Stoklosa, Drope, Jemal.
Drafting of the manuscript: Islami, Stoklosa.
Critical revision of the manuscript for important intellectual content: Islami, Stoklosa, Drope, Jemal.
Statistical analysis: None.
Obtaining funding: None.
Administrative, technical, or material support: None.
Other (specify): None.
Financial disclosures: Farhad Islami certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.
Funding/Support and role of the sponsor: None.
-  S. Asma, Y. Song, J. Cohen, et al. CDC grand rounds: global tobacco control. MMWR. 2014;63:277-280
-  M. Eriksen, J. Mackay, N. Schluger, F. Islami, J. Drope. The Tobacco Atlas. 5th ed. (American Cancer Society, Atlanta, GA, 2015)
-  US Department of Health and Human Services. The health consequences of smoking—50 years of progress: a report of the surgeon general. (Centers for Disease Control and Prevention, Atlanta, GA, 2014)
-  M. Thun, R. Peto, J. Boreham, A.D. Lopez. Stages of the cigarette epidemic on entering its second century. Tob Control. 2012;21:96-101
-  Global Tobacco Surveillance System Data (GTSSData). Centers for Disease Control and Prevention Web site. http://nccd.cdc.gov/GTSSData/default/default.aspx. Accessed September 8, 2014.
-  WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco advertising, promotion and sponsorship. (World Health Organization, Geneva, Switzerland, 2013)
-  J.M. Martínez-Sánchez, M. Ballbè, M. Fu, et al. Electronic cigarette use among adult population: a cross-sectional study in Barcelona, Spain (2013–2014). BMJ Open. 2014;4:e005894
-  I.T. Agaku, B.A. King, C.G. Husten, et al. Tobacco product use among adults—United States, 2012–2013. MMWR. 2014;63:542-547
-  Tanzania demographic and health survey 2010. National Bureau of Statistics Web site. http://www.nbs.go.tz/takwimu/references/2010TDHS.pdf. Accessed September 24, 2014.
-  The South African National Health and Nutrition Examination Survey, 2012: SANHANES-1: the health and nutritional status of the nation 2014. Human Sciences Research Council Web site. http://www.hsrc.ac.za/en/research-outputs/view/6493. Accessed September 24, 2014.
-  Canadian Tobacco Use Monitoring Survey (CTUMS) 2012: Table 1. Health Canada Web site. http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/_ctums-esutc_2012/ann-eng.php#t1. Accessed September 24, 2014.
-  A. Khattab, A. Javaid, G. Iraqi, et al. Smoking habits in the Middle East and North Africa: results of the BREATHE study. Respir Med. 2012;106(Suppl 2):S16-S24
-  Special Eurobarometer 385: attitudes of Europeans towards tobacco. European Commission Web site. http://ec.europa.eu/health/tobacco/docs/eurobaro_attitudes_towards_tobacco_2012_en.pdf. Accessed September 16, 2014.
-  Key findings from the Integrated Household Survey: January 2012 to December 2012 (experimental statistics). Office for National Statistics Web site. http://www.ons.gov.uk/ons/dcp171778_329407.pdf. Accessed September 24, 2014.
-  NDSHS 2013 data & references. Australian Institute of Health and Welfare Web site. http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/2013/data-and-references/. Accessed September 24, 2014.
-  NZ social indicators: tobacco smoking. Statistics New Zealand Web site. http://www.stats.govt.nz/browse_for_stats/snapshots-of-nz/nz-social-indicators/Home/Health/tobacco-smoking.aspx#inf03. Accessed September 16, 2014.
-  C.D. Czoli, D. Hammond, C.M. White. Electronic cigarettes in Canada: prevalence of use and perceptions among youth and young adults. Can J Public Health. 2014;105:e97-e102
-  Lermenier A, Palle C. Results of the ETINCEL–OFDT electronic cigarette survey. Observatoire français des drogues et des toxicomanies Web site. http://www.ofdt.fr/BDD/publications/docs/eisaalu2.pdf. Accessed September 16, 2014.
-  S. Gallus, A. Lugo, R. Pacifici, et al. E-cigarette awareness, use, and harm perception in Italy: a national representative survey. Nicotine Tob Res. 2014;16:1541-1548
-  M.L. Goniewicz, W. Zielinska-Danch. Electronic cigarette use among teenagers and young adults in Poland. Pediatrics. 2012;130:e879-e885
-  S. Lee, R.A. Grana, S.A. Glantz. Electronic cigarette use among Korean adolescents: a cross-sectional study of market penetration, dual use, and relationship to quit attempts and former smoking. J Adolesc Health. 2014;54:684-690
-  Use of electronic cigarettes in Great Britain 2014. Action on Smoking and Health Web site. http://www.ash.org.uk/files/documents/ASH_891.pdf. Accessed September 24, 2014.
-  R.A. Arrazola, L.J. Neff, S.M. Kennedy, E. Holder-Hayes, C.D. Jones, Centers for Disease Control and Prevention (CDC). Tobacco use among middle and high school students—United States, 2013. MMWR. 2014;63:1021-1026
-  M. Ng, M.K. Freeman, T.D. Fleming, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA. 2014;311:183-192
-  C.W. Warren, V. Lea, J. Lee, N.R. Jones, S. Asma, M. McKenna. Change in tobacco use among 13–15 year olds between 1999 and 2008: findings from the Global Youth Tobacco Survey. Glob Health Promot. 2009;16:38-90
-  Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings 2013. United Nations Web site. http://unstats.un.org/unsd/methods/m49/m49regin.htm. Accessed September 22, 2014.
-  World development indicators 2014. World Bank Web site. http://data.worldbank.org/products/wdi. Accessed September 22, 2014.
-  World Health Organization. World health statistics 2014. (WHO, Geneva, Switzerland, 2014)
-  A.D. Lopez, N.E. Collishaw, T. Piha. A descriptive model of the cigarette epidemic in developed countries. Tob Control. 1994;3:242-247
-  I.T. Agaku, B.A. King, S.R. Dube, Centers for Disease Control and Prevention. Current cigarette smoking among adults—United States, 2005–2012. MMWR. 2014;63:29-34
-  P.B. Bach, M.W. Kattan, M.D. Thornquist, et al. Variations in lung cancer risk among smokers. J Natl Cancer Inst. 2003;95:470-478
-  F. Gu, S. Wacholder, S. Kovalchik, et al. Time to smoke first morning cigarette and lung cancer in a case-control study. J Natl Cancer Inst. 2014;106:dju118
-  J.E. Muscat, K. Ahn, J.P. Richie, S.D. Stellman. Nicotine dependence phenotype and lung cancer risk. Cancer. 2011;117:5370-5376
-  G.A. Giovino, S.A. Mirza, J.M. Samet, et al. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet. 2012;380:668-679
-  M.J. Thun, B.D. Carter, D. Feskanich, et al. 50-year trends in smoking-related mortality in the United States. N Engl J Med. 2013;368:351-364
-  The health consequences of smoking for women: a report of the surgeon general 1980. National Library of Medicine Web site. http://profiles.nlm.nih.gov/ps/access/NNBBRT.pdf. Accessed September 15, 2014.
-  H. Graham. Smoking prevalence among women in the European community 1950–1990. Soc Sci Med. 1996;43:243-254
-  De Walque D. Education, information, and smoking decisions: evidence from smoking histories, 1940–2000. The World Bank Web site. http://elibrary.worldbank.org/doi/book/10.1596/1813-9450-3362. Accessed September 16, 2014.
-  B.E. Garrett, S.R. Dube, C. Winder, R.S. Caraballo, Centers for Disease Control and Prevention. Cigarette smoking—United States, 2006–2008 and 2009–2010. MMWR. 2013;62(Suppl 3):81-84
-  J.R. Bosdriesz, S. Mehmedovic, M.I. Witvliet, A.E. Kunst. Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women?. Int J Equity Health. 2014;13:14
-  C.T. Sreeramareddy, P.M.S. Pradhan, I.A. Mir, S. Sin. Smoking and smokeless tobacco use in nine South and Southeast Asian countries: prevalence estimates and social determinants from demographic and health surveys. Popul Health Metr. 2014;12:22
-  R. Hiscock, L. Bauld, A. Amos, J.A. Fidler, M. Munafò. Socioeconomic status and smoking: a review. Ann NY Acad Sci. 2012;1248:107-123
-  F. Sitas, S. Egger, D. Bradshaw, et al. Differences among the coloured, white, black, and other South African populations in smoking-attributed mortality at ages 35–74 years: a case-control study of 481,640 deaths. Lancet. 2013;382:685-693
-  E.M. Nturibi, A.K. Akinsola, A.A. Kolawole, S.A. McCurdy. Smoking prevalence and tobacco control measures in Kenya, Uganda, the Gambia and Liberia: a review. Int J Tuberc Lung Dis. 2009;13:165-170
-  E. Blecher, H. Ross. Tobacco use in Africa: tobacco control through prevention. (American Cancer Society, Atlanta, GA, 2013)
-  D. Méndez, O. Alshanqeety, K.E. Warner. The potential impact of smoking control policies on future global smoking trends. Tob Control. 2013;22:46-51
-  Generation 2030: Africa 2014. UNICEF Web site. http://www.unicef.org/publications/files/UNICEF_Africa_Generation_2030_en_11Aug.pdf. Accessed September 10, 2014.
-  Smoking in Canada. Physicians for a Smoke-Free Canada Web site. http://www.smoke-free.ca/factsheets/pdf/prevalence.pdf. Accessed September 17, 2014.
-  P. Jha, R. Peto. Global effects of smoking, of quitting, and of taxing tobacco. N Engl J Med. 2014;370:60-68
-  J. Mackay, B. Ritthiphakdee, K.S. Reddy. Tobacco control in Asia. Lancet. 2013;381:1581-1587
-  D. Levy, R.L. Rodríguez-Buño, T.-W. Hu, A.E. Moran. The potential effects of tobacco control in China: projections from the China SimSmoke simulation model. BMJ. 2014;348:g1134
-  R. Peto, S. Darby, H. Deo, P. Silcocks, E. Whitley, R. Doll. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ. 2000;321:323-329
-  A. Jemal, M.M. Center, C. DeSantis, E.M. Ward. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomark Prev. 2010;19:1893-1907
-  Tobacco trends 2008: a brief update of tobacco use in New Zealand. New Zealand Ministry of Health Web site. www.health.govt.nz/system/files/documents/publications/tobacco-trends-2008.pdf. Accessed September 30, 2014.
-  Global tobacco: key findings, I: tobacco overview, cigarettes and the future. (Euromonitor International, London, UK, 2014)
-  C. Samanic, M. Kogevinas, M. Dosemeci, et al. Smoking and bladder cancer in Spain: effects of tobacco type, timing, environmental tobacco smoke, and gender. Cancer Epidemiol Biomark Prev. 2006;15:1348-1354
-  World cigarette reports 2010. (ERC Group, Suffolk, UK, 2010)
-  H. Bartsch, C. Malaveille, M. Friesen, F.F. Kadlubar, P. Vineis. Black (air-cured) and blond (flue-cured) tobacco cancer risk, IV: molecular dosimetry studies implicate aromatic amines as bladder carcinogens. Eur J Cancer Oxf Engl. 1993;29A:1199-1207
-  W. Maziak. The waterpipe: an emerging global risk for cancer. Cancer Epidemiol. 2013;37:1-4
-  E.A. Akl, S.K. Gunukula, S. Aleem, et al. The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review. BMC Public Health. 2011;11:244
-  E.R. Grekin, D. Ayna. Waterpipe smoking among college students in the United States: a review of the literature. J Am Coll Health J. 2012;60:244-249
-  Centers for Disease Control and Prevention. Tobacco product use among middle and high school students—United States, 2011 and 2012. MMWR. 2013;62:893-897
-  Passport database. (Euromonitor International, London, UK, 2014)
-  R. Grana, N. Benowitz, S.A. Glantz. E-cigarettes: a scientific review. Circulation. 2014;129:1972-1986
-  C. Bullen, C. Howe, M. Laugesen, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013;382:1629-1637
-  P. Caponnetto, D. Campagna, F. Cibella, et al. EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS ONE. 2013;8:e66317
-  S.P. Borderud, Y. Li, J.E. Burkhalter, C.E. Sheffer, J.S. Ostroff. Electronic cigarette use among patients with cancer: characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. 2014;120:3527-3535
-  L. Kosmider, A. Sobczak, M. Fik, et al. Carbonyl compounds in electronic cigarette vapors: effects of nicotine solvent and battery output voltage. Nicotine Tob Res. 2014;16:1319-1326
-  J.F. Bertholon, M.H. Becquemin, I. Annesi-Maesano, B. Dautzenberg. Electronic cigarettes: a short review. Respir Int Rev Thorac Dis. 2013;86:433-438
-  T.J. Glynn. E-cigarettes and the future of tobacco control. CA Cancer J Clin. 2014;64:164-168
-  WHO Framework Convention on Tobacco Control. (World Health Organization, Geneva, Switzerland, 2003)
-  V. Kontis, C.D. Mathers, J. Rehm, et al. Contribution of six risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study. Lancet. 2014;384:427-437
-  P. Vineis, L. Airoldi, F. Veglia, et al. Environmental tobacco smoke and risk of respiratory cancer and chronic obstructive pulmonary disease in former smokers and never smokers in the EPIC prospective study. BMJ. 2005;330:277
-  I.A. Jones, G. St Helen, M.J. Meyers, et al. Biomarkers of secondhand smoke exposure in automobiles. Tob Control. 2014;23:51-57
-  X. Sureda, E. Fernández, M.J. López, M. Nebot. Secondhand tobacco smoke exposure in open and semi-open settings: a systematic review. Environ Health Perspect. 2013;121:766-773
-  K.M. Wilson, M. Torok, R. McMillen, S. Tanski, J.D. Klein, J.P. Winickoff. Tobacco smoke incursions in multiunit housing. Am J Public Health. 2014;104:1445-1453
-  C.A. Christophi, M. Paisi, D. Pampaka, M. Kehagias, C. Vardavas, G.N. Connolly. The impact of the Cyprus comprehensive smoking ban on air quality and economic business of hospitality venues. BMC Public Health. 2013;13:76
-  Canadian Cancer Society. Laws banning smoking in vehicles carrying children—international overview. Action on Smoking and Health Web site. http://www.ash.org.uk/files/documents/ASH_909.pdf. Accessed September 22, 2014.
-  Kids, cars and cigarettes: a brief look at policy options for smoke-free vehicles. Public Health Law Center Web site. http://publichealthlawcenter.org/sites/default/files/resources/phlc-guide-kidscarssmoke-policyoptions-2011.pdf. Accessed September 22, 2014.
-  T. Lancaster, L. Stead. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2004;:CD000165
-  MPOWER: offer help to quit tobacco use. World Health Organization Web site. www.who.int/entity/tobacco/mpower/publications/en_tfi_mpower_brochure_o.pdf?ua=1. Accessed September 8, 2014.
-  C. Free, G. Phillips, L. Galli, et al. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013;10:e1001362
-  S.-H. Zhu, C.M. Anderson, G.J. Tedeschi, et al. Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med. 2002;347:1087-1093
-  L.C. Abroms, J. Lee Westmaas, J. Bontemps-Jones, R. Ramani, J. Mellerson. A content analysis of popular smartphone apps for smoking cessation. Am J Prev Med. 2013;45:732-736
-  D. Hammond. Health warning messages on tobacco products: a review. Tob Control. 2011;20:327-337
-  European Parliament and the Council of the European Union. Directive 2014/40/EU of the European Parliament and the Council of 3 April 2014 on the approximation of the laws, regulations and administrative provisions of the member states concerning the manufacture, presentation and sale of tobacco and related products and repealing directive 2001/37/EC. European Commission Web site. http://ec.europa.eu/health/tobacco/docs/dir_201440_en.pdf.
-  M. Wakefield, M. Bayly, S. Durkin, T. Cotter, S. Mullin, C. Warne. Smokers’ responses to television advertisements about the serious harms of tobacco use: pre-testing results from 10 low- to middle-income countries. Tob Control. 2013;22:24-31
-  E. Blecher. The impact of tobacco advertising bans on consumption in developing countries. J Health Econ. 2008;27:930-942
-  Introduction of tobacco plain packaging in Australia. Australian Government Department of Health Web site. http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-plain. Accessed August 19, 2014.
-  J.M. Young, I. Stacey, T.A. Dobbins, S. Dunlop, A.L. Dessaix, D.C. Currow. Association between tobacco plain packaging and quitline calls: a population-based, interrupted time-series analysis. Med J Aust. 2014;200:29-32
-  M. Scollo, M. Bayly, M. Wakefield. Availability of illicit tobacco in small retail outlets before and after the implementation of Australian plain packaging legislation. Tob Control. 2015;24:e45-e51
-  United Kingdom to introduce plain packaging on tobacco packs. World Health Organization Regional Office for Europe Web site. http://www.euro.who.int/en/countries/united-kingdom-of-great-britain-and-northern-ireland/news/news/2015/03/united-kingdom-to-introduce-plain-packaging-on-tobacco-packs. Accessed May 4, 2015
-  WHO technical manual on tobacco tax administration. (World Health Organization, Geneva, Switzerland, 2010)
-  IARC handbooks of cancer prevention, tobacco control. Vol. 14, Effectiveness of tax and price policies for tobacco control. Lyon, France: International Agency for Research on Cancer; 2011.
-  E. Blecher, C.P. van Walbeek. An international analysis of cigarette affordability. Tob Control. 2004;13:339-346
-  E. Blecher, H. Ross, M. Stoklosa. Lessons learned from cigarette tax harmonisation in the European Union. Tob Control. 2014;23:e12-e14
-  S.D. Golden, K.M. Ribisl, K.M. Perreira. Economic and political influence on tobacco tax rates: a nationwide analysis of 31 years of state data. Am J Public Health. 2014;104:350-357
-  J. Drope, J.J. Chavez, R. Lencucha, B. McGrady. The political economy of foreign direct investment—evidence from the Philippines. Policy Soc. 2014;33:39-52
-  Wysokość stawki kształtuje rynek. Podat Rap Branż. 2007;123:c1
-  Looking back at the tobacco lobbying battle: Philip Morris’ allies in the European Parliament. Corporate Europe Observatory Web site. http://corporateeurope.org/power-lobbies/2014/05/looking-back-tobacco-lobbying-battle-philip-morris-allies-european-parliament. Accessed September 3, 2014.
-  L. Gruszczynski. Trade, investment and risk: Australian plain packaging law, international litigations and regulatory chilling effect. Eur J Risk Regul. 2014;2:242-247
-  R. Lencucha, J. Drope. Plain packaging: an opportunity for improved international policy coherence?. Health Promot Int. 2013;:dat038
-  Mohammed Al-hamdani. Commentary: the global tobacco litigation initiative: an effort to protect developing countries from big tobacco. J Public Health Policy. 2014;35:162-170
-  J. Alderman, R.A. Daynard. Applying lessons from tobacco litigation to obesity lawsuits. Am J Prev Med. 2006;30:82-88
-  Conference of the Parties to the WHO Framework Convention on Tobacco Control. Electronic nicotine delivery systems: FCTC/COP/6/10. (World Health Organization, Geneva, Switzerland, 2014)
-  C. Printz. Regulating e-cigarettes: a rule proposed by the FDA aims to extend authority to e-cigarettes, other tobacco products. Cancer. 2014;120:2069-2071
-  D. Levy, L.M. de Almeida, A. Szklo. The Brazil SimSmoke policy simulation model: the effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation. PLoS Med. 2012;9:e1001336
-  D.T. Levy, J.A. Ellis, D. Mays, A-T. Huang. Smoking-related deaths averted due to three years of policy progress. Bull World Health Organ. 2013;91:509-518
-  Scaling up action against noncommunicable diseases: how much will it cost?. (World Health Organization, Geneva, Switzerland, 2011)
-  M. Stoklosa, H. Ross. Tobacco control funding for low-income and middle-income countries in a time of economic hardship. Tob Control. 2014;23:e122-e126
-  H. Reed. The effects of increasing tobacco taxation: a cost benefit and public finances analysis. (Action on Smoking and Health, London, UK, 2010)
-  S.F. Hurley, J.P. Matthews. Cost-effectiveness of the Australian national tobacco campaign. Tob Control. 2008;17:379-384
a Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
b Economic and Health Policy Research, American Cancer Society, Atlanta, GA, USA
Corresponding author. Surveillance and Health Services Research, American Cancer Society, Inc., 250 Williams Street, Atlanta, GA 30303, USA. Tel. +1 404 982 3654; Fax: +1 404 321 4669.
© 2015 European Association of Urology, Published by Elsevier B.V.