ABSTRACT
Smoking patterns and the demographics of smokers vary substantially across countries.1 However, despite its known risks and significant efforts in North America and many European countries to reduce tobacco use, smoking remains the number one cause of morbidity and mortality in developed countries.2 In addition, while tobacco use is on the decline in many developed countries, it is on the increase in other parts of the world as less developed countries are becoming more frequent targets of the tobacco companies. The WHO estimates that worldwide 1.3 billion individuals smoke or use other tobacco products,1 and it is predicted that by 2020 the global burden will exceed nine million deaths annually3 with seven million of these occurring in economically developing countries.4 Even without an increase in the number of smokers in less developed countries, the current impact of cigarettes is extensive, accounting for an estimated 4.83 million deaths per year worldwide.5 In the United States alone, recent estimates blame approximately 440000 annual deaths on tobacco,6 while a staggering 800000 tobaccoattributable deaths per year are estimated in Europe7,8 and 800000 more in China.9
