Wang Hong, a Chinese government engineer, was riding a minibus in Beijing when the conductor lit up a cigarette just below the "No Smoking" sign. When Mr. Wang challenged the conductor, the man only shrugged. "He said they had only put up the sign to get their operating license. He insisted he couldn't stop because he was addicted," Wang recalls.
Wang's experience is not unique. Despite the efforts of antitobacco groups, tobacco use is growing around the world. On May 31, the Geneva-based World Health Organization said the globe is in the midst of a "tobacco epidemic." This will be theme of the 10th World Conference on Smoking or Health to be held in Beijing next August.
WHO estimates there are 1.1 billion smokers in the world - 47 percent of all men and 12 percent of all women. This number is expected to grow substantially in the future as tobacco companies around the world market their products. One target group is females. "The numbers, especially for women, are expected to grow," says Barbara Zolty of the WHO's Tobacco or Health Program.
The WHO says this increase in smoking is expected to dramatically increase mortality rates. It estimates 3 million people around the world die from smoking-related causes each year and that by 2025, 10 million people per year will die from smoking. "Those are solid numbers and probably gross underestimates," says Fran Du Melle, deputy managing director of the American Lung Association in Washington. "We are losing the war."
Antitobacco forces have had some notable successes. It is now possible to get nonsmoking airline flights to many countries. Most countries ban smoking on domestic flights. An increasing number of restaurants set aside nonsmoking sections. Some developing countries are beginning to see tobacco as a serious health threat and are trying to limit cigarette advertising and promotion. And the World Bank is no longer lending money to developing countries for tobacco projects.
The tobacco industry in the United States, meanwhile, is busy defending itself in the courts and the news media. The industry maintains it is doing nothing more than selling a legal product. It argues there is no way to verify the WHO numbers. "There is no alternative data base," says Thomas Lauria, a spokesman for the Tobacco Institute, a lobbying arm of the industry in Washington.
The industry now admits, however, that smoking is an "important risk factor" in health. However, Mr. Lauria says that risk has to be measured "case by case" as "there are so many other factors that effect the health of an individual."
While the argument continues, the industry is expanding to meet burgeoning demand. In Britain, for example, British American Tobacco, which sells 18 percent of the world's cigarettes, is spending $320 million on new equipment to expand production at one of its plants from 11 billion cigarettes per year to 48 billion per year. Almost all of the new capacity will be shipped to developing countries.
The reason for turning to developing countries is the intense battle the tobacco industry now encounters in developed countries. In Canada, for example, health groups are trying to push legislation through Parliament that would ban tobacco advertising. Last September, the Canadian Supreme Court overturned a 1988 ban on tobacco advertising on the grounds that the government had not shown why a ban was necessary. "Shortly after that ban was overturned, we started to see ads again," says Kenneth Kyle, director of public issues for the Canadian Cancer Society in Ottawa.
With a Canadian federal election looming in 1997, Mr. Kyle says the push is on to get legislation introduced this year and passed in early 1997. Antitobacco groups want to see restrictions on other forms of tobacco marketing, such as sports promotions and the sale of brand-name goods, such as baseball caps. There are already policy proposals in Ottawa that would ban mail-order sales, self-service displays of cigarettes, and require more information about chemicals in cigarettes. Recently, Parliament passed legislation banning "kiddie" packs of fewer than 20 cigarettes.
Grass-roots efforts in Canada are continuing as well. Toronto recently passed legislation banning smoking in bars and taverns, not just restaurants. The province of Ontario also banned the sale of tobacco in drug stores.
Despite these efforts, teenage smoking is rising in Canada. This does not surprise antitobacco groups. The government reduced its excise taxes on cigarettes last year to cut down on smuggling. From a 1990 low of 21 percent, the rate of adolescent (15-to-19 year olds) smoking is up to 30 percent among young women and 28 percent among young men. "This has gotten everyone alarmed," Kyle says.
The same trend is true in the US, where the number of young smokers is rising. According to a recent survey, 34 percent of all high school students smoked, a number that jumped to 40 percent among white girls in high school. "This blows you away in this day and age," says Michael Eriksen, director of the Office on Smoking and Health, part of the Atlanta-based Centers for Disease Control (CDC).
Teen smoking: US campaign issue
President Clinton has made teenage smoking an issue in the presidential race. His opponent, Bob Dole, who is also opposed to teenage smoking, has gotten himself in political hot water by declaring that smoking may not be addictive.
However, tobacco money is addictive to politicians. Last week, the Campaign for Tobacco-Free Kids, an advocacy group in Washington, reported that in the first quarter of 1996, the tobacco industry gave $1 million to the Republican Party and $75,000 to the Democratic Party. The money given to the Republicans is the most ever given to one party in any quarter of an election year.
The rise in teenage smoking is also reflected in the smoking rates among adults. According to a CDC survey released July 12, more than 25 percent of all Americans were smokers in 1994. This is about the same rate as 1993. "I view these numbers as discouraging; we thought we were making some progress with adults," Mr. Eriksen says. He blames the increase on the rise of inexpensive generic cigarettes, which constitute about 40 percent of the US market. To try to defend its market share Philip Morris dropped its prices about 10 percent for its premium brands, such as Marlboro. "We know there is a good relationship between price and consumption," Eriksen says.
In France, coexistence
Across the Atlantic, nonsmoking has been a low-key issue in France, where the approach is to try to let smokers and nonsmokers coexist.
Since November 1993, it has been against the law to smoke in Paris subways. Subway smokers can be fined $20 on the spot, $40 if the offense generates any paperwork, and $240 if there is any resistance.
"We try to gently encourage people ... You could say that the ban is more or less respected," says Michel Dubois, a spokesman for the RATP, Paris's subway system. One sign of progress: The RATP sweeps up about 660 pounds a week of cigarette-related trash compared with 10 tons a week before the 1993 ban.
Last month, French officials took Philip Morris Companies to court over a series of full-page ads that asserted that the dangers of passive smoking were statistically less significant than eating a cookie or drinking a glass of water. Cookie bakers sued, and on June 25, a Paris court ordered the ad campaign to end and fined the company $200,000 per infraction.
In France, as in other countries, there is concern about the rising number of young female smokers. If current trends continue, the number of women who die from smoking-related ailments in France could increase from 5,000 to 55,000 per year by the year 2025, says Philippe Boucher, director of the Paris-based National Committee Against Smoking.
In neighboring Germany, 27 percent of the adult population smokes. Designated nonsmoking areas in restaurants, offices, and public areas are still rare. However, that may change soon. A multipartisan bill before parliament would ban smoking in workplaces, public buildings, and public transportation facilities.
Labor laws require employers to provide clean air in the workplace, but this "isn't enough," says Jrgen Hasler, an aide to Roland Sauer, a sponsor of the bill. Mr. Hasler points out that only 60 percent of the work force is covered by the law. He cites a recent poll found that 80 percent of Germans approve of a smoking ban at work.
Farther east, smoking is more popular in former East Bloc countries such as Poland, Romania, Bulgaria, and the Czech Republic. Their smoking habits mirror those of Russia, where more than 55 percent of adults smoke, and the numbers are rising, says Galina Kamenko of Russia's Health Ministry. The Russian government is finally taking steps to try to limit smoking. On Jan. 1, tobacco advertising was banned on TV and daytime radio, and kept off the front and back pages of newspapers and magazines.
However, Russians are determined smokers. Even in the dead of winter, they huddle in clusters outside airport entrances, freezing their fingers rather than breach the rules against smoking inside. In theaters and cinemas, smokers stick to special rooms next to the lavatories. At work, if there is even one nonsmoker in a room, the smokers depart for ashtrays positioned on staircase landings.
After the Soviet Union collapsed, the Russian government opened up its borders to imports. US cigarette manufacturers were among the first firms to rush in. They have picked up market share by offering milder, more sophisticated cigarettes to smokers.
Asia: a 'smoker's paradise'
Like Russia, Asia is generally considered a "smoker's paradise." In the burgeoning economies of Vietnam and Cambodia, US tobacco companies have plastered billboards with their advertisements promising the allures of the West - all attainable in a cigarette. They are competing with Japanese Tobacco Inc., which is selling its flagship cigarette, Mild Seven.
Singapore, Australia, and New Zealand have enacted tough antismoking regulations that limit advertising and promotion. From these countries, it is now possible to get transpacific nonsmoking flights.
But the smoke-free attitude has not spread to Japan, where lighting up starts at the top. An antismoking group recently named Prime Minister Ryutaro Hashimoto as Japan's "worst smoker." In recent years, the percentage of Japanese adults who smoke has stabilized at about 36 percent, although the number of cigarettes sold has risen steadily since 1988. Fumisato Watanabe, the country's leading antismoking campaigner, estimates that 10 percent of the cigarettes sold in Japan in 1995 were consumed by those under 20.
It's a lot easier to encounter a gust of secondhand smoke in Japan than in most other developed countries. All Nippon Airways, the nation's leading domestic carrier, maintains smoking sections even on short domestic flights. Many train platforms have smoker's corners. Relatively few restaurants have nonsmoking sections, and those that do are Western-style eateries.
The government does not do much to deter smoking either. Cigarette warning labels advise consumers not to smoke "too much." Public service TV ads on "smoker's etiquette" mainly discourage littering. Businesses, however, are starting to consider the health effects on their work forces. A recent Labor Ministry survey showed 10 percent of companies provided completely smoke-free workplaces. About half had established "smokers' corners" or installed special booths with high-powered $10,000 air-filtration systems.
The Japanese government has a vested interest in the tobacco industry. Japan Tobacco Inc., the only domestic manufacturer of cigarettes, was privatized in 1985 but is still 70 percent owned by the Ministry of Finance. Tobacco taxes earn the government $18.2 billion a year.
The tobacco industry is important to China, too. It is the largest taxpayer, responsible for more than $6 billion in revenue. More than a half-million people work in the state-run tobacco industry, a monopoly. Three hundred cigarette factories and tobacco-drying plants dot major cities across China.
"In fact, you could say the biggest tobacco company is the Chinese government," says Judith Mckay, a Hong Kong doctor who runs the one-person Asian Consultancy on Tobacco Control.
"We know the government is trying to get across the message that smoking hurts people's health," says Zhu Ruizeng, an official with the State Tobacco Monopoly Administration. "But smoking is important to a lot of people in China. And if there is demand, we have to fill it."
China's smoking habit is formidable: 350 million smokers lighting up 1.7 trillion cigarettes yearly. This huge market is attracting foreign tobacco companies. At present, Western companies hold only about 6 percent of the legal Chinese market. An unknown number of smuggled foreign cigarettes adds to the foreign total.
A major target of Western companies is Chinese women. Currently, only 7 percent of women in China smoke, compared with 61 percent of Chinese men. But the ranks of women smokers are swelling as many young women turn to cigarettes as symbols of newfound independence.
The government is beginning to react to the country's serious smoking habit. Recently, major Chinese cities have imposed a smoking ban in public places. Tobacco ads have been removed from TV, magazines, and newspapers.
But China's fledgling antismoking lobby is up against a culture that promotes puffing. Mao Zedong, Deng Xiaoping, and other leaders were rarely seen without a cigarette. "Traditionally, cigarettes have been an important part of social interaction in China," says Zhang Yifang, secretary general of the Chinese Association on Smoking and Health. And, as Wang's experience on the bus in Beijing suggests, the health message has yet to get through.
*Staff writers Cameron Barr in Tokyo, Gail Russell Chaddock in Paris, Peter Ford in Moscow, Sheila Tefft in Beijing, and Ruth Walker in Bonn contributed to this report.