Who's smoking now? The epidemiology of tobacco use in the United States and abroad

Numerous epidemiological studies have linked tobacco use with a wide variety of diseases. Strong government-supported anti-smoking campaigns have decreased the prevalence of smoking in many developed countries, including the United States. However, it remains a major public health pariah. In developing countries, such as China, cigarette smoking and other forms of tobacco use continue to increase. If unchecked this will eventually lead to 10 million deaths per year worldwide. Even in the United States, the prevalence of smoking is rising in crucial population groups such as adolescents. Recent advances have made physicians more able to help patients quit smoking, but organized campaigns must be further strengthened to prevent the initiation of tobacco use, especially in the young.     

Smoking and Drinking Behaviors among Older Adults: A Comparative Analysis of Three Southeast Asian Countries

Studies on the two major health-risk behaviors of smoking tobacco and drinking alcohol among older populations, particularly in Southeast Asia, are limited. This paper provides comparative analyses of the prevalences and correlates of smoking tobacco and drinking alcohol among older people in Myanmar, Vietnam, and Thailand, using data from the latest available national aging surveys in the three countries. The analyses were conducted within a multivariate framework. Gender-specific results show that smoking tobacco and drinking alcohol are more common among older men than women in all three countries. However, the prevalence of smoking and drinking among men declines at older ages. The multivariate analyses reveal that a higher level of education has a significant negative association with smoking and drinking in all three settings, but the magnitude and the direction of associations vary considerably between countries and genders. Area of residence is correlated with smoking among men in all three countries, whereas co-residential arrangements with spouse, children, or both significantly reduce alcohol consumption among men in Myanmar and among men and women in Thailand. In all three settings a significant complementary relationship between smoking and drinking is observed. From a policy perspective this implies that a successful reduction in smoking could be achieved through anti-drinking campaigns and vice versa.

     

Designing cigarettes for women: new findings from the tobacco industry documents

AIMS: To examine internal tobacco industry research on female smoking patterns and product preferences, and how this research has informed the design of female-targeted cigarettes and impacted smoking behavior among this target population. DESIGN: Research was conducted through a systematic web-based search of previously secret industry documents made publicly available through the 1998 Master Settlement Agreement. FINDINGS: This study provides evidence that the tobacco industry has conducted extensive research on female smoking patterns, needs and product preferences, and has intentionally modified product design for promotion of cigarette smoking among women. Cigarette manufacturers responded to changing female trends by focusing on social and health concerns as well as promoting dual-sex brands that also featured traditional female style characteristics. CONCLUSIONS: Product features responsive to female-identified needs and preferences may contribute to differences in female smoking patterns. Assessment of female-targeted product differences should inform smoking cessation and prevention programs tailored to women. Overall, these findings underscore the need for further investigation of effects of targeting on smoking behavior, health outcomes and regulation of tobacco products by public health agencies.     

Women and tobacco

Smoking prevalence is lower among women than men in most countries, yet there are about 200 million women in the world who smoke, and in addition, there are millions more who chew tobacco. Approximately 22% of women in developed countries and 9% of women in developing countries smoke, but because most women live in developing countries, there are numerically more women smokers in developing countries. Unless effective, comprehensive and sustained initiatives are implemented to reduce smoking uptake among young women and increase cessation rates among women, the prevalence of female smoking in developed and developing countries is likely to rise to 20% by 2025. This would mean that by 2025 there could be 532 million women smokers. Even if prevalence levels do not rise, the number of women who smoke will increase because the population of women in the world is predicted to rise from the current 3.1 billion to 4.2 billion by 2025. Thus, while the epidemic of tobacco use among men is in slow decline, the epidemic among women will not reach its peak until well into the 21st century. This will have enormous consequences not only for women's health and economic wellbeing but also for that of their families. The health effects of smoking for women are more serious than for men. In addition to the general health problems common to both genders, women face additional hazards in pregnancy, female-specific cancers such as cancer of the cervix, and exposure to passive smoking. In Asia, although there are currently lower levels of tobacco use among women, smoking among girls is already on the rise in some areas. The spending power of girls and women is increasing so that cigarettes are becoming more affordable. The social and cultural constraints that previously prevented many women from smoking are weakening; and women-specific health education and quitting programmes are rare. Furthermore, evidence suggests that women find it harder to quit smoking. The tobacco companies are targeting women by marketing light, mild, and menthol cigarettes, and introducing advertising directed at women. The greatest challenge and opportunity in primary preventive health in Asia and in other developing areas is to avert the predicted rise in smoking among women.     

Alcohol, smoking, and obesity epidemiology in Japan

The health impact of alcohol drinking, cigarette smoking and obesity differs between Asian and Western countries. The epidemiology of cancer and death related to these lifestyles are described in this article. In Japan, heavy alcohol drinking and cigarette smoking are rather high in men. While there is a worldwide anti-smoking policy, Japan is still on the way to aiming at this goal, and this delay in health promotion has maintained the high impact of smoking, whether active or passive, on people's health in that country. Public health policy should focus more strongly on the control of smoking and heavy drinking, especially among men. Maintaining the consumption of alcohol at a level below 46 g a day in men and 23 g a day in women appears to minimize the risks of mortality and cancer in the Japanese population. On the other hand, the obesity rate is low and being underweight is common both in men and women. Proportions of cancer attributable to a body mass index of 25 or more are only 0.5% in men and 1.1% in women. Given that many previous studies in Japanese and Asian populations have associated a low body mass index with an increased risk of cancer, the impact of being underweight--not only obese--may warrant further investigation.     

Tobacco policies in Austria during the Third Reich.

BACKGROUND: The anti-smoking stance taken by Adolf Hitler, coupled with Nazi support for research on smoking and lung cancer and campaigns to discourage smoking, have encouraged pro-smoking groups to equate tobacco control activities with totalitarianism. Previous work has described the situation in Germany. OBJECTIVE: To examine the situation in Austria, also part of the Reich after 1938. DESIGN: Iterative analysis of documents and reports about the situation in Austria in the 1930s and 1940s, supplemented by a review of Reich legal ordinances, party newspapers, health behaviour guidelines issued by Nazi party organisations and interviews with expert informants. RESULTS: In contrast to the situation in Germany where, albeit to a much lesser degree than is commonly believed, some anti-smoking policies were adopted, the Nazi authorities in Austria made almost no attempt to discourage smoking and the Austrian tobacco company worked closely with the Nazi authorities to ensure that supplies were maintained. CONCLUSION: Especially when looked at in the Austrian context, the much-cited link between anti-smoking policies and Nazism is a gross over-simplification. This purported link should not be used to justify the continued failure to act effectively against smoking in Germany and Austria.     

Explaining the convergence of male and female smoking prevalence in Australia

OBJECTIVE: To examine changes in age of tobacco experimentation and progression to daily smoking in men and women between birth cohorts that differ in exposure to public health programmes that aim to discourage smoking. DESIGN: Analysis of national cross-sectional household surveys of smoking patterns, conducted in Australia in 2001 and 2004. SETTING AND PARTICIPANTS Australian adults aged 22 years and over in 2001 and 2004 who responded to the National Drug Strategy Household Survey. MAIN OUTCOME MEASURES: Prevalence of tobacco experimentation and progression to daily smoking by age 21, estimated by sex and birth cohort. Odds of tobacco experimentation and progression to daily smoking by age 21 estimated by sex for each birth cohort, with corrections for the effects of 'forward telescoping' in recalling age of use. RESULTS: Sex differences in smoking prevalence are smaller in younger birth cohorts. Tobacco experimentation has increased among women, while progression to daily smoking has decreased among men. CONCLUSIONS: Sex differences in smoking experimentation and progression to daily smoking have decreased in younger birth cohorts. However, a significant proportion of younger males and females continue to experiment with tobacco and become daily smokers despite strong public health efforts to discourage smoking. More research is needed to determine why sex differences in smoking behaviour are not evident in younger birth cohorts.     

Global perspective on tobacco control. Part I. The global state of the tobacco epidemic.

Tobacco smoking is losing adherents in some countries, and a number of international developments may dramatically change the choices people make concerning tobacco. However, the growth of chronic obstructive pulmonary disease (COPD) in the world is nevertheless assured-tobacco consumption is rising globally because of increased consumption in many low-income countries. Risk of COPD is strong wherever smokers are found, and even among former smokers, it remains high for decades. Both COPD and smoking produce lower measurable quality of life assessment, but little attention is given to the association, apart from noting that cessation rates are poor among COPD patients. Tobacco smoking rates vary; men usually smoke more than women in overall consumption and in prevalence. Current available estimates are 49% for men and 8% for women in low- and middle-income countries, and 37% for men and 21% for women in high-income countries. These figures give little information, however, because there can be variations within and across populations. What is important is that about a third of all adults in the world currently smoke, and that it will take a tremendous turnaround to put a halt to the overall growth of tobacco use. Smoking-related COPD rates will continue to be high for some time. The future of COPD is related most dramatically to low- or middle-income countries, where more than four in five current smokers in the world live. The predictable health consequences of smoking, including an enormous burden in COPD, have only begun to emerge.     

Smoking and cardiovascular disease

Mainstream and ETS exposure are strong risk factors for cardiovascular disease in men and women. The relationships between smoking and cardiovascular disease result from multiple mechanisms that interact to contribute to atherosclerosis, vascular injury, thrombosis, and vascular dysfunction. We are only now beginning to understand how smoking contributes to the genesis and progression of cardiovascular disease. Because of the complexity of the interactions between nicotine and the components of MSS, ETS, and sidestream smoke with the vasculature, it will take a great deal of time and effort to fully unravel the mechanisms by which smoking contributes to cardiovascular disease. In addition, cardiovascular risk in female smokers is complicated by hormonal variables that may contribute to greater relative risk. It is important that health care providers, educators, and policy makers recognize the changing patterns of smoking and the impact of smoking on cardiovascular disease, and continue campaigns aimed at enhancing smoking cessation in the general population and in teens. Rigorous research is needed on the changing cultural, psychosocial, and environmental factors that influence tobacco use to improve our understanding of racial/ethnic smoking patterns, and identify strategic tobacco control opportunities. The capacity of tobacco control efforts to keep pace with patterns of tobacco use and cessation depends on timely recognition of emerging prevalence and cessation patterns and the resulting development of appropriate community-based programs to address the factors involved. Smoking trends today will determine how heavy the health burden of cardiovascular disease and others will be among communities tomorrow. Programs that aim at early intervention and reflect cultural diversity will be the cornerstone in the battle against tobacco use. Continued interest in research, educational, and prevention efforts are needed to help curb the risk of cardiovascular disease from smoking in men and women.     

The impact of tobacco on lung health in China

China has the largest production and consumption of tobacco worldwide. It has witnessed a dramatic increase in tobacco consumption over the past two decades, with more than 34.8 million cartons of cigarettes being produced and 34.7 million sold annually. Approximately 67% of males and 4% of females aged over 15 years in China are smokers, and the total of over 320 million Chinese smokers represents about one-third of all smokers worldwide. The continuous, rapid increase in the number of Chinese smokers is largely due to teenagers taking up smoking. Among teenagers aged 15-19 years, 18% of men and 0.28% of women (making a total of 9 million teenagers) are smokers. The prevalence of passive smoking is very high at 53.5%, about 0.3 billion people aged above 15 years were affected. The average daily consumption of tobacco per person in China rose from one cigarette in 1952 to 10 cigarettes in 1990, a rate similar to that of the USA 40 years earlier. It seems inevitable that China will witness a substantial increase in mortality following this increase in smoking. Based on current smoking rates, the predicted deaths attributed to smoking in China will rise to 3 million in 2050. If the current smoking pattern in China remains unchanged, 100 million men now under 30 years will die from smoking-related diseases. The respiratory system is harmed most by tobacco smoke. Over two-thirds of all deaths related to smoking in China are attributed to chronic obstructive pulmonary disease (COPD), lung cancer and pulmonary tuberculosis. The morbidity of COPD alone in China is estimated at over 3%, or 25 million people, of whom 72% were smokers. The Chinese government consistently supports smoking control and advocates smoking abstinence via laws to restrain the sale and advertising of tobacco. These actions have been successful in some aspects, and in particular, more people are aware that 'cigarette smoking is harmful to health'. In future, the emphasis of smoking control should be directed at restraining teenagers and adolescents from smoking. Cigarette smoking has already caused significant ill-health to the Chinese population with over 1 million people dying each year of various disorders caused by smoking. However, the peak of smoking-induced diseases is still to come and therefore, it is very important to strengthen anti-smoking measures so as to have a far-reaching effect on the future health of the Chinese population.     

Impact of smokeless tobacco use on smoking in northern Sweden

BACKGROUND AND OBJECTIVES: For many years Swedish men have had the world's lowest rates of smoking and smoking-related mortality. Despite these facts, a thorough analysis of tobacco use patterns in Sweden has not been performed. The purpose of this study was to examine the prevalence and interaction of cigarette smoking and use of Swedish moist snuff (snus) in the population of northern Sweden. DESIGN: The study cohort of 2998 men and 3092 women aged 25-64 was derived from the northern Sweden MONICA study, consisting of population-based surveys in 1986, 1990, 1994 and 1999. Detailed information on tobacco use was used to develop prevalence data, and the prevalence ratio was used to compare rates amongst various subgroups. RESULTS: Amongst men ever-tobacco use was stable in all survey years at about 65%, but the prevalence of smoking declined from 23% in 1986 to 14% in 1999, whilst snus use increased from 22% to 30%. In women the prevalence of smoking was more stable in the first three surveys (approximately 27%) but was 22% in 1999, when snus use was 6%. In all years men showed higher prevalence of ex-smoking than women. A dominant factor was a history of snus (PR = 6.18, CI = 4.96-7.70), which was more prevalent at younger ages. CONCLUSIONS: The recent transition from smoking to snus use amongst men, and incipiently amongst women, in northern Sweden is remarkable and relevant to the global discussion on strategies to reduce smoking.     

The female smoker: from addiction to recovery

Millions of American girls and women have been drawn to smoking by an industry that has been clearly and systematically targeting women of all ages and life circumstances. Big tobacco's well-timed marketing strategies skillfully link cigarette use to typical female values: independence, self-reliance, weight control, stress management, social progress and popularity, personal attractiveness, autonomy, self-fulfillment, youth, happiness, personal success, health, and active, vigorous, and strenuous lifestyles. Biologically speaking, women are especially vulnerable to the legion of health problems of tobacco use. Smoking is a critical hazard for women in their reproductive years, particularly when they are pregnant. The US Public Health Service 2000 Clinical Practice Guideline provides helpful guidance and sound general recommendations for the treatment of women of all ages for tobacco use and dependence. Women and girls who smoke represent diverse subgroups of the population with unique issues and needs. The 2001 Surgeon General's Report on Women and Smoking stresses the importance of multistrategy programs for treating female smokers. This approach includes antitobacco media campaigns, increases in tobacco prices, promotion of nonsmoking in public places, curbs on tobacco advertising and promotion, enforcement of legislation to reduce youth access to tobacco products, and effective tobacco use treatment programs.     

Gender and Smoking: Do Women Really Find it Harder to Give Up?

Data are cited from national surveys of smoking in Great Britain and the United States which challenge the widely held belief that women find it harder to give up smoking than men. Men have higher cigarette cessation rates than women, but when smoking and ex-smoking prevalences are adjusted to take account of switching to cigars, which in ex-cigarette smokers appears to be an equally hazardous and addictive form of tobacco use, the sex difference in cessation is almost eliminated. In Great Britain in 1982 the cigarette cessation rates of 44 per cent in men and 32 per cent in women became 37 and 32 per cent respectively after adjustment for secondary cigar smoking, and there was no difference in adjusted cessation between men and women below the age of 50 (26 per cent in each case). Similarly in the U.S. in 1975 the male excess of 9 percentage points in cigarette cessation reduced to 3 per cent after adjustment. Allowance for secondary pipe smoking, tobacco chewing and snuff taking would probably reduce this difference still further. It is concluded that there is at present little evidence of a sex difference in ease of smoking cessation in the general population and it is recommended that future discussions of this issue should take into account forms of tobacco use other than cigarettes.     

Smoking trends in hypertensive and normotensive Finns during 1982-1997

Despite the evidence that smoking is one of the main predictors of the cardiovascular disease risk among hypertensive subjects, there are very few data available of the smoking trends of these subjects at public health level. This study assesses the trends in smoking and in smoking cessation advice given by physicians in the hypertensive and normotensive population in Finland during 1982-1997. The data were derived from four independent cross-sectional standardised population surveys conducted in 1982, 1987, 1992 and 1997 in the provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in south-western Finland. Men and women aged 25-64 years, selected randomly from the national population register, were classified to four groups according to their blood pressure level and antihypertensive treatment status: normotensive, unaware hypertensive, aware but not treated hypertensive and treated hypertensive. The total number of participants was 24 083. In men, the prevalence of smoking decreased significantly in both treated hypertensive patients and normotensive subjects during 1982-1997, whereas it increased significantly in treated hypertensive women. The proportion of current smokers who had been advised to stop smoking by their physician was significantly higher in treated hypertensive men compared to the other subgroups of men (P < 0.001). The observed decreasing trend in smoking in men is encouraging, but the increase in smoking among hypertensive women taking antihypertensive medication warrants concern. In the future, the methods used for smoking cessation advice given by health care personnel should be intensified to make this effort more effective.     

Tobacco smoking and risk of bladder cancer

Tobacco smoking is the main known cause of urinary bladder cancer in humans. In most populations, over half of cases in men and a sizeable proportion in women are attributable to this habit. Epidemiological studies conducted in different populations have shown a linear relationship between intensity and duration of smoking and risk. Quitting smoking reduces the risk of bladder cancer. Smoking black (air-cured) cigarettes results in a higher risk than smoking blond (flue-cured) tobacco cigarettes; results on inhalation patterns and use of filter are not consistent. Cigar and pipe smoking also increases the risk of bladder cancer; data on other tobacco products are limited. The evidence for non-transitional bladder carcinoma is limited, but consistent with an increased risk. The available evidence does not point towards a different carcinogenic effect of tobacco smoking in men and women or in whites and blacks. Data on involuntary smoke and use of smokeless tobacco products are limited, but do not suggest an increased risk of bladder cancer.     

Smoking and Health in Old Age

ABSTRACT. The implications for health of smoking habits at entry were evaluated in a 10-year longitudinal study of a population of men and women aged exactly 70 at entry and otherwise selected only according to geography. Seventy-six per cent of the men and 39% of the women were smokers at 70, 32% of the male and 20% of the female smokers were inhalers. In men, heavy smoking (≥15 g tobacco per day and inhalation) was statistically associated with low systolic blood pressure, intermittent claudication, chronic bronchitis, low body mass index and low serum insulin, but not with forced expiratory volume in first second (FEV₁). In the 10-year follow-up period heavy smoking in men was associated with excess total mortality, excess mortality from malignant neoplasms, excess mortality from non-malignant pulmonary diseases and increased decrease in FEV₁. In women, but not in men, inhalation was statistically associated with excess total mortality.     

A latent class typology of young women smokers

AIMS: Despite aggressive anti-smoking campaigns, smoking rates are increasing among young women, suggesting the need for new approaches to reach this population. Segmenting audiences can facilitate targeting interventions to specific populations, based on association of smoking behaviors with other health behaviors and psychological and social antecedents. Using latent class analysis, we sought to profile patterns of behavioral, attitudinal and cognitive variables related to tobacco use among young women. DESIGN: This study is part of an ongoing Midwestern longitudinal self-report survey of the natural history of cigarette smoking. PARTICIPANTS: Participants were 18-25-year-old women smokers (n = 443). MEASUREMENTS: Variables included a comprehensive range of demographic characteristics, smoking-related variables and general attitudinal variables. FINDINGS: Three distinct classes emerged with the following characteristics: (1) working women who tended to smoke daily but reported high levels of positive affect and life satisfaction (n = 212); (2) light-smoking college students who exercised regularly, began smoking after high school and quit successfully at follow-up 5 years later (n = 86); and (3) heavy smokers who were more likely to have children, report high levels of negative affect and smoke for addictive reasons, for stimulation and to control affect (n = 145). Differences in smoking cessation at a 5-year follow-up were significant across the classes (18.1%, 34.4% and 13.0% had quit for at least 6 months, respectively). CONCLUSIONS: The psychosocial and behavioral profiles of these classes can potentially be used to tailor smoking interventions more effectively within this population.     

Prevention of coronary heart disease: smoking

Smoking is the leading preventable cause of illness and premature death in Germany, claiming over 110,000 lives a year because it directly increases the risk of dying from heart disease, stroke, emphysema and a variety of cancers. The overwhelming majority of smokers begin tobacco use before they reach adulthood. Among those young people who smoke, the average age is now 13-14. In Germany, about 39% of male and 31% of female adults (age 18-60 years) continue to smoke, despite information about the unequivocally negative health consequences of smoking. The exact mechanisms of smoking-related vascular disease are not yet known. Smoking causes acute hemodynamic alterations such as increase in heart rate, systematic and coronary vascular resistance, myocardial contractility, and myocardial oxygen demand. These short-term effects could lower the ischemic threshold in smokers with coronary artery disease and contribute to the increased risk for acute cardiovascular events. Endothelial damage is thought to be an initiating event in atherosclerosis and early studies have demonstrated that long-term smoking has direct toxic effects with structural changes of human endothelial cells. Recent research has shown the importance of the functional role of the endothelium in regulating vascular tone, platelet-endothelial interactions, leukocyte adhesion and smooth muscle cell proliferation via synthesis and release of a variety of substances such as nitric oxide. There is strong evidence that smoking leads to endothelial dysfunction mainly by increased inactivation of nitric oxide by oxygen-derived free radicals. Smoking also increases oxidative modification of LDL and is associated with lower HDL plasma levels. Smoking induces a systemic inflammatory response with increased leukocyte count and elevation of the C-reactive protein level. Importantly, the prothrombotic effects of smoking have been repeatedly demonstrated to cause alterations in platelet function, imbalance of antithrombotic vs prothrombotic factors, and decrease of fibrinolytic activity. Given the enormous health hazard of tobacco use, complete abstinence from smoking should be achieved. Smoking cessation counselling should be given to healthy subjects and even more vigorously to patients with manifested disease. Every effort should be undertaken to prevent children and adolescents from starting to smoke. Brief tobacco dependence treatment is effective, and every smoker should be offered at least brief treatment at every office visit. More intensive treatment is more effective in producing long-term abstinence from tobacco. Nicotine replacement therapy (nicotine patches or gum), clinician-delivered social support, and skills training are the three most effective components of smoking cessation treatment. A framework for tobacco control measures is necessary to reduce tobacco consumption and exposure to tobacco smoke. Recommendations on specific tobacco control interventions are: 1. increase in tobacco taxes; 2. comprehensive tobacco advertising bans; 3. legislation prohibiting smoking in work and public places; 4. prohibiting the sales of tobacco products to persons under 18; 5. comprehensive disclosure of the physical, chemical and design characteristics of all tobacco products; 6. training of health professionals to promote smoking prevention and cessation interventions; and 7. development of a national network of smoking cessation treatment services.     

Stroke mortality and morbidity attributable to passive smoking in Germany.

BACKGROUND: Passive smoking is an established risk factor for coronary heart disease (CHD). Epidemiological studies suggest that passive smoking may also be associated with an increased risk of stroke. We estimate the burden of stroke due to passive smoking in Germany. METHODS: Frequency of passive smoking was derived from the German national health survey. Nonsmokers who reported exposure to environmental tobacco smoke (ETS) at home were considered for analyses. The relative risk for stroke and passive smoking was derived by means of a meta-analysis from available cohort studies. We computed attributable risks for passive smoking and used data from official statistics to estimate stroke mortality due to ETS. Attributable stroke morbidity was calculated using the WHO-Global-Burden-of-Disease approach. RESULTS: Passive smoking may account for 774 stroke-related deaths and 1837 incident first ever strokes in Germany every year. More strokes owing to passive smoking occur among women (1248) than among men (589). The majority of strokes attributable to ETS happen at the age of 65-84 years. CONCLUSION: ETS is a common exposure and stroke is a frequent disease. Though the relative risk of passive smoking on stroke mortality and morbidity is small, the impact on population health is substantial.     

Lung cancer epidemiology and risk factors in Asia and Africa.

In industrialised countries, lung cancer is the most common form of cancer among males and it is growing among females. For both sexes, rates reflect smoking behaviours. The pattern appears to be different in Asia, particularly in China, where lung cancer rates in men reflect high smoking rates but high rates among non-smoking women appear to be related to other factors. The incidence of lung cancer is low in most African countries, but it is increasing. In addition to tobacco smoking, a number of etiological factors have been identified for lung cancer: indoor exposure to environmental tobacco smoke, cooking oil vapour, coal burning, or radon, outdoor air pollution and occupational exposure to asbestos and other carcinogens. Recent studies have shown that dietary factors may be important, with high consumption of vegetables and fruits being protective while preserved food and fatty food are harmful, and certain infections such as Mycobacterium tuberculosis, human papilloma virus and Microsporum canis are associated with a high risk of lung cancer. Among non-smokers, the probable role of genetic predisposition in lung cancer by increasing the individual's susceptibility to environmental carcinogens is currently being studied actively. As the single most important cause for lung cancer is tobacco smoke and, with increased sales, a major epidemic is predicted for both Asia and Africa, all health care professionals, government health authorities and national and international health organisations must join in a concerted effort against tobacco.