The effect of tobacco additives on smoking initiation and maintenance

Abstract

Smoking prevalence in Brazil has almost halved over the last two decades. Data from the Brazil-ian Institute of Geography and Statistics (IBGE) 1 shows that smoking rates among men and women aged 15 years and over fell from 33.1% in 1989 to 17.2% in 2008. This fall in smoking prevalence has led to substantial improvements in public health in Brazil due to the strong as-sociation between smoking and morbid condi-tions, such as chronic obstructive pulmonary disease (COPD), cancer (lung, larynx and other sites), cardiovascular morbidity, and other se-vere illnesses. Levy et al. 2 estimated that 420,000 smoking-attributable deaths were prevented up to 2010, and as many as seven million projected premature deaths will be averted by 2050. This public health success story is the result of the im-plementation of strict tobacco control policies, including increases in tobacco taxes and higher cigarette prices, smoke-free air laws, tobacco in-dustry marketing bans, health warnings, mass media anti-smoking campaigns and smoking cessation treatment programs. It is anticipated that the implementation of an additional set of stricter policies would cause further reductions in tobacco-related morbidity and mortality. Us-ing simulation modelling, Levy et al. 2 found that a further 39% reduction in smoking prevalence would prevent 1.3 million of the 9 million pre-mature deaths projected up to 2050. In light of this public health scenario, the Brazilian Health Surveillance Agency (ANVISA) has banned most flavourings and additives in tobacco products.