Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

108 III. SUBSTANCES OF ABUSEincluding bronchitis, asthmatic episodes, new cases of asthma, and suddeninfant death syndrome (SIDS). Nonsmokers exposed to ETS at work were 39%more likely to get lung cancer than nonexposed, nonsmoking workers (Carlson,1997).A Worldwide ProblemWhile tobacco consumption declined in the United States, global tobacco consumptionincreased, particularly in developing countries. According to theWorld Health Organization (WHO; 1999), cigarette smoking in developingcountries increased at a rate of about 3.4% per year. Worldwide tobacco-relateddeaths are expected to increase from about 4 million per year in 1999 to about10 million per year by the 2030s, with 70% of those deaths occurring in developingnations. This is a higher death toll than is expected from malaria, maternaland major childhood conditions, and tuberculosis combined (AmericanCancer Society, 2003).Big TobaccoIn response to mounting health concerns and declining demand, Big Tobaccospared little expense to fend off criticism and to assuage public concern. Cigaretteadvertising expenditures in the United States were estimated at more than$2 billion for 1985—twice the annual expenditures of the National CancerInstitute (American Cancer Society, 1986). In 1999, the five largest cigarettemanufacturers in the United States spent $8.24 billion on advertising and promotionalexpenditures (Federal Trade Commission, 2001), with additionalexpenditures for promoting and marketing cigarettes abroad.Safe CigarettesBig Tobacco used its vast resources to keep alive debates about whether cigarettesmoking is harmful or addictive, and whether secondhand smoke poses a dangerto nonsmokers. Tobacco companies also responded to mounting health concernsby designing and marketing safer cigarettes. They introduced cigarette filters,menthol flavoring, light and ultralight brands, and, most recently, high technologycigarettes, such as Omni, Advance, Eclipse, Accord, Quest, and, soon tobe released, the Phillip Morris product, SCOR. Innovations in manufacturingand design were heralded by expensive marketing campaigns, fostering theimpression that new and improved cigarettes offered satisfaction, flavor, andpeace of mind (Burns & Benowitz, 2001). Today, more than 80% of the cigarettessold in the United States are of the low-tar and low-nicotine variety(Myers, 2002), and most smokers believe light and ultralight cigarettes are lessharmful than regular cigarettes (Giovino et al., 1996).