There's bad news and good news in the war against smoking.
A new study by the World Health Organization and the World Bank forecasts that nearly a billion people may die early from smoking-related illness in the 21st century. That would be "10 times more" than in the 20th century.
Smoking among youths in the United States has risen precipitously since 1992. A price war among tobacco firms added to that momentum.
This reversal of 15 years of steady decline in smoking among teenagers suggests - if past health impacts of smoking hold in the future - a massive loss of "life years" for smoking Americans and a financial cost of $36 billion to $73 billion, according to a study by two economists from the Massachusetts Institute of Technology in Cambridge, Mass.
A survey of college students, reported in the Journal of the American Medical Association, found 44 percent smoking one to 10 cigarettes per day, 13 percent a pack or more per day.
So what's the good news?
Research indicates what best discourages youngsters from smoking. One factor is high taxation of tobacco products, making them expensive. Restricting youth access to cigarettes helps.
A complete ban on advertising and promotion of tobacco products would trim demand by about 7 percent.
"Partial bans don't work," says Prabhat Jha, co-editor of "Tobacco Control in Developing Countries" (Oxford Press), the 512-page outcome of a three-year research project by the two international organizations.
Further, in programs for improving health and shrinking poverty, the Rome-based WHO; the Washington-based World Bank; and the bank's sister institution, the International Monetary Fund, are pressing developing nations to discourage tobacco use. The bank won't make loans for tobacco projects.
In the US, Surgeon General David Satcher called last week for a major anti-tobacco program that includes health education, mass-media campaigns, stronger warning labels, and a sharp boost in the federal tax on cigarettes.
Thailand, which bans tobacco advertising and promotion and employs extensive counter advertising and high taxes, enjoys a low (and declining) smoking rate. In China, by contrast, 6 of 10 smokers think smoking does no harm. Mr. Jha predicts some 100 million Chinese smokers under the age of 30 will die early.
In the US, antismoking activists are delighted that the price of cigarettes rose roughly 30 percent in 1999 as tobacco companies shifted the cost of settling state lawsuits onto their customers.
This should cause a 20 percent decline in youth smoking, maintain MIT's Jonathan Gruber and Jonathan Zinman, reversing the effects of the low prices during 1992-97, which encouraged youth smoking.
That 1990s price drop explains 26 percent of the one-third rise in youth smoking between 1992 and 1997, Mr. Gruber and Mr. Zinman find.
"Joe Camel" and other advertising allegedly targeted at kids prompted another part of the increase, Gruber suspects.
Mr. Gruber was an economist in the Clinton administration's Treasury Department in 1998, helping draft a bill that would have raised cigarette taxes $1.10 a pack as an antismoking measure. Congress didn't pass it.
Gruber maintains higher cigarette prices remain essential. "We should be doing more," he says.
Steeper prices discourage high school seniors from smoking. They aren't as effective with younger, still-experimenting teens.
During the period studied, white, suburban youth with college-educated parents and good grades took up smoking as much or more than did blacks from inner cities with poor grades and less-educated parents.
The international study aims at reducing the suffering and costs from the world's "smoking epidemic." This epidemic used to be primarily a problem of rich countries. Now it is rapidly shifting to developing countries.
Already 1.1 billion people smoke. To prevent the number reaching 1.6 billion by 2025, the study calls first for more taxes. A 10 percent price hike trims demand 8 percent in developing countries, twice as much as in the rich nations. The study concludes tax hikes, with other measures, could shrink the "unprecedented" threat of smoking to global health.
(c) Copyright 2000. The Christian Science Publishing Society