Smoking. A brief history of the victorious epidemic

In Russia, recently more attention has been paid to the issues of protecting public health. Government officials, speaking in the media, are increasingly expressing concerns related to the unfavorable demographic trends observed in our country. Actions aimed at urgently changing the current situation are classified as measures to ensure state security [1] . As a response, it is proposed to increase funding for the health care system and ensure the implementation of a number of national projects in the field of public health [2] .

In this situation, it is puzzling that smoking, as the main preventable cause of morbidity and mortality in the Russian population, is not given due attention.

Tobacco kills! Tobacco is a unique consumer product. The uniqueness of tobacco lies in the fact that it is the only legally distributed product that causes harm when used for its intended purpose. Given the existing standards regulating the consumer market, there is no way tobacco could be introduced into it. Tobacco continues to function in the market only because smoking is already widespread among various groups of the population that are highly dependent on it. These provisions, which do not raise doubts among Russian anti-tobacco activists (not yet numerous), have not yet been realized by the entire Russian society. It is unfortunate to note that in Russia they underestimate the harmful effects of tobacco on the health of the population and are loyal to smoking. In Russia people smoke at home and on the street, at work and in public places, in schools and universities, in hospitals and sports facilities. This situation is taken for granted and, surprisingly, does not cause active opposition from the non-smoking part of society. But this was not always the case, and therefore it seems useful to look back at the history of the global tobacco epidemic.

History of the epidemic

Tobacco is a plant of the nightshade family that grew wild in America and Australia. Smoking has been known to mankind for thousands of years [3] . The American Indians, who were the first to use tobacco, used it in small doses as a stimulant, to suppress hunger and thirst, and as a pain reliever. Smoking a small amount of tobacco was carried out during military negotiations to confirm friendship and strengthen the morale of soldiers. In addition, the Indians knew that large doses of tobacco affected consciousness, and this property was used for religious purposes - inducing trance, communicating with spirits. Such features of the effects of tobacco gave it a sacred status. It is worth noting that smoking was not the main method of tobacco consumption. More often, the Indians added tobacco to their food, chewed the leaves, and drank tobacco juice or syrup [4] .

The first Europeans to become acquainted with tobacco were Spanish sailors who arrived in 1492 with the expedition of Christopher Columbus to the shores of the continent, later called America. Local residents called the curled leaves of the plant used for ritual smoking with the word "tobaco". The leaves and seeds of this plant were brought by the Indians as a gift to the newcomers who tried to smoke, imitating the natives. The first Spanish and Dutch expeditions brought tobacco and its seeds to Europe [5] . Tobacco quickly gained popularity among Europeans. But unlike the Indians, who used it mainly during various ceremonies, Europeans used tobacco for pleasure [6] . The rapid spread of tobacco was facilitated by misconceptions about the medicinal properties of this plant. Thus, snuff came into fashion in France after in 1560, Jean Nicot de Villemain, from whose name the word “nicotine” was derived, the French ambassador to Portugal, sent tobacco seeds to Queen Catherine de Medici of France, in the belief that that it is a panacea for migraine headaches [7] .

Gradually, smoking the leaves became the main way of consuming tobacco in the Old World. But the spread of smoking for a long time was limited by the relative labor intensity of the preparatory actions and the duration of the pipe smoking procedure itself. Tobacco smoking began to spread rapidly, widely covering various segments of the population, only in the 19th century. English and French officers returning from the Crimean War of 1854-1856 brought cigarettes rolled by hand by the Turks to Europe. The most powerful impetus for the mass appearance of cigarettes was the beginning of their industrial production. The machine, patented in 1881 by James A. Bonsack, produced 12,000 cigarettes per hour [8] . And in 1892, safety matches were invented [9] . Smokers were able to consume tobacco quickly and without much effort. The beginning of the work of Bonsack's machine can be considered the beginning of the global tobacco smoking epidemic.

Current global trends in smoking prevalence

Currently, every third adult on Earth smokes. The total number of smokers in the world is estimated at 1.3 billion people: approximately 1.1 billion men and 230 million women. At the same time, the number of people who smoke continues to grow [10] . If the growth trends in the prevalence of tobacco smoking remain unchanged, then by 2025 the number of smokers will reach 1.9 billion people [11] . This increase is driven by increased tobacco consumption in low-income countries. Of the total number of smokers, 84% live in developing countries and countries with economies in transition [12] . In developed countries, on the contrary, the number of smokers is decreasing [13] .

Assessing global tobacco consumption, experts from the United States Department of Agriculture came to the conclusion that it is gradually decreasing [14] . In 2001, 6,411,165 tons of tobacco were used worldwide, in 2004 - 5,704,216 tons. This decrease is ensured, first of all, by a noticeable decrease in the prevalence of smoking in developed countries. But global figures remain stable due to persistently high and even rising levels of tobacco consumption in developing countries.

World Bank experts note the rapid growth of global production and consumption of cigarettes. Thus, over the course of 30 years, from 1970 to 2000, cigarette consumption in the world increased by 2.5 trillion (Fig. 1) [15] . In developed countries, there is a decline in cigarette consumption, in countries with economies in transition, cigarette consumption is gradually increasing, and in developing countries, consumption growth is very rapid.

An analysis of global trends shows that in economically developed countries the number of consumers of transnational tobacco companies' products is decreasing, while in countries with low incomes the population is growing. And in all countries, regardless of their level of economic development, smoking is concentrated among the poorest segments of the population [16] .

Global burden of tobacco smoking

The global burden of tobacco smoking is enormous. More than 5 million people die each year from smoking-related causes. This means that every six seconds a human life is sacrificed to tobacco companies. The World Bank estimates, based on data from a document called the Surgeon General's Report (USA), that the added consumption of 1,000 tons of tobacco leads to 200 annual added deaths from cancer, 330 annual added deaths from cardiovascular diseases, 50 from cerebrovascular diseases, 70 - from chronic obstructive pulmonary disease. The total annual excess mortality is 650 cases [17] . If the observed trends in the spread of tobacco smoking continue, by 2010 about 10 million people will die annually due to smoking - this is more than from HIV/AIDS, tuberculosis and pregnancy complications combined [18] .

Representatives of tobacco companies, recognizing the “possible negative consequences” of smoking on health, justify their existence by benefits for economic development, job creation, and filling budgets through taxes.

But according to Howard Barnum, an economist at the World Bank, tobacco use is a global economic disaster [19] . It is true that tobacco provides benefits to consumers in the form of immediate gratification and some economic benefits associated with production, but these are dwarfed by the cost of disease and mortality caused by tobacco.

The burden of tobacco use includes direct and indirect costs. Direct costs are the cost of medical care for diseases caused by smoking - cancer, cardiovascular diseases, cerebrovascular diseases and chronic obstructive pulmonary disease. Indirect costs are the economic value of years of life lost due to premature mortality. All the economic benefits and costs of the added consumption of 1,000 tons of tobacco result in a loss of US$27 million. Using the presented calculations and taking into account the data of annual world tobacco production, World Bank experts conclude that the global annual economic losses caused by the world tobacco market amount to 200 billion US dollars [20] .

It should be noted that recently these problems have not been as significant for many countries in the developing world. But as international tobacco companies' sales decline in Western Europe and North America, their focus is shifting to developing countries and countries with economies in transition. Currently, the economic losses from tobacco smoking place an unbearable burden on countries with low incomes and account for half of global losses [21] .

Tobacco consumption in Russia

The lack of transparency of the Russian economy and the high percentage of smuggled tobacco products make it very difficult to assess the real scale of tobacco consumption in Russia.

During the Soviet Union, there was an increase in tobacco consumption. From year to year, the import of tobacco leaves for the needs of the state tobacco industry increased, and purchases of ready-made cigarettes increased. In the USSR, over the course of 10 years, from 1970 to 1980, cigarette consumption increased by 50,000 million units per year (from 375,256 million to 424,624 million units) [22] .

During the period of rapid economic reforms in the countries of the former Soviet Union, including Russia, there was extremely aggressive activity by large international tobacco companies. Taking advantage of the naivety of the young governments of the newly independent states, the lack of information about the economic consequences and damage to public health, tobacco corporations convinced the governments of these countries to pass laws favorable to corporations on privatization and excise taxes, which had adverse consequences for the states themselves [23] .

After the collapse of the Soviet Union, liberalization of investment in the tobacco industry led to an increase in cigarette production. Cigarette consumption increased by 40% between 1991 and 2000, and this will have a lasting negative impact on the health of the populations in these countries [24] . By the end of 2000, investments of multinational tobacco companies in the countries of the former Soviet Union reached 2.7 billion US dollars. The largest investments were made in Russia - $1.7 billion. Thus, in Russia these funds amounted to more than 4% of all foreign direct investment. As a result, according to various researchers, from 60% to 90% of tobacco factories are owned by foreign investors. In the Soviet Union there was a state monopoly on the production of tobacco products; there was no need for tobacco advertising and it was completely prohibited. During the transition period, multinational tobacco companies took advantage of the shortcomings of the legislation and actively promoted their brands. In the mid-1990s, up to 50% of all billboards in Moscow and 75% of plastic bags in Russia carried tobacco advertising [25] .

In addition, taking advantage of the chaos that reigned in post-Soviet government legislation, tobacco corporations used barter trade to smuggle cigarettes. Companies flooded markets with cheap cigarettes and encouraged tobacco consumption. The target groups for the tobacco industry were adolescents and women. Tobacco corporations conducted aggressive, well-organized advertising campaigns to promote their products in new markets and to prevent possible marketing restrictions [26] .

Currently, more than 205 billion cigarettes are smoked annually in Russia. This allows Russia to be included in the list of five countries that occupy leading positions in the world in tobacco consumption [27] .

According to State Duma deputy and deputy chairman of the Budget and Tax Committee Ivan Savvidi, annual tobacco consumption per person in the Russian Federation has doubled over the past 10 years, and now this figure is twice as high as the world average. According to his estimates, in Russia in 2003, 382 billion cigarettes were produced and 300 billion were consumed [28] .

Experts from the regional European office of the World Health Organization also believe that Russia has one of the highest per capita cigarette consumption rates in Europe. So, in 2000, this figure in Russia was 2,411 cigarettes per person per year, in Germany - 1,553, in Israel 1,366, in France - 1,303, in Finland - 92 0 [29] . This high consumption of cigarettes by smokers is likely due to the low price. The retail price of the most popular international brand of cigarettes in Russia in 2001 was only three US dollars (taking into account the purchasing power parity of currencies). This is a fairly low price for Europe. For comparison, in Germany this figure is $4.2, in Israel - $4.5, in France - $4.6, in Finland - $4.8, in the UK - $7.6.

According to experts from the US Department of Agriculture, in 2004 tobacco consumption in Russia amounted to 280,917 tons [30] . This puts Russia fourth in the world in terms of tobacco consumption after China, India and the United States. Very small quantities of tobacco are produced in Russia, so our country occupies a leading position in the world in importing tobacco.

Prevalence of smoking among various groups of the Russian population

Before we begin to assess the prevalence of smoking among the population, it should be noted that in Russia there is no national program to control behavioral factors (low physical activity, poor nutrition, etc.) of the risk of chronic non-communicable diseases. There is no official information resource on this issue. Despite the magnitude of the negative impact of smoking on public health indicators, information on the prevalence of smoking and changes in tobacco consumption in Russia is insufficient [31] . Freely available sources of information - the results of original research and analytical materials - provide data, the representativeness of which is often questionable. But all of them indicate an increase in the prevalence of smoking among the Russian population.

The World Health Organization database allows comparison of trends in smoking prevalence observed in recent years in Russia and other European countries [32] . While smoking prevalence is declining in many European countries, Russia is experiencing rapid growth. According to this information source, the prevalence of smoking among men in Russia increased from 47% in 1991 to 63.2% in 1998 and was 60.4% in 2001 (Fig. 2).

The prevalence of smoking among women in Russia has traditionally been lower than in other countries in the European region. But in most European countries there is a stabilization of smoking prevalence or a downward trend, while in Russia the prevalence of smoking among women is rapidly increasing (Fig. 3).

The results of studying the problem of smoking at the national level were presented by S. A. Shalnova and co-authors in a study conducted in Russia in 1998. A representative national sample of the Russian population was surveyed, including 6,498 households (14,799 people aged 15 years and older). The age-standardized smoking prevalence rate is 63.2% among men, 9.7% among women [33] .

A study carried out in 2000-2001 in three Russian cities - Moscow, Arkhangelsk and Murmansk - found data indicating a rapid increase in the proportion of women smokers [34] . It was found that the prevalence of smoking among women in Moscow is 28.7%, in Arkhangelsk - 23.2%, and in Murmansk - 29.6%.

The results of studying the prevalence of smoking among adolescents cannot but cause concern. According to research, 19.4% of boys and 9.7% of girls aged 15 years smoke at least once a week [35] . According to WHO estimates, in 2002–2005, the prevalence of smoking among adolescents in Russia reached 22.5% [36] . Children in our country start smoking at an early age. As part of an international project called the Global Youth Smoking Study, it was found that among Moscow schoolchildren, 66.8% had ever smoked, 33.5% smoked occasionally at the time of the study, and 15.9% smoked frequently [37] . Of these, 22.4% indicated that they started smoking before the age of 11 years [38] . At the same time, children's smoking does not meet with active opposition from adults - 48.1% of schoolchildren reported that they smoke in public places. It was found that teenagers do not face serious obstacles in purchasing tobacco products - 63% of them bought cigarettes in a store or from street vendors. Schoolchildren reported that they often encountered tobacco advertising in the press, on television, and especially on billboards. At the same time, only 25% of students received information about the dangers of smoking within the last 30 days.

Data from the World Health Organization indicate an even higher prevalence of smoking among children and adolescents in Russia: 12.2% of eleven-year-old girls and 24.9% of boys have ever smoked; at thirteen years of age, 42.3% and 54.6 %, among fifteen-year-olds - 58.9% and 67.8%, respectively [39] . Interviewing 15-year-old teenagers who smoke showed that their first experiments with tobacco began at the age of 12-13 years.

The impact of smoking on the health of the Russian population

The number of studies devoted to this important topic is extremely small. While the medical and demographic consequences of smoking in Russia have yet to be studied, an assessment of the economic consequences cannot be found in the available sources.

The life expectancy of men in Russia is 18 years, and among women it is 9-11 years shorter than in developed European countries [40] . Among the Russian population, there is excess mortality from cardiovascular diseases [41] . There are many explanations for this tragic situation, but the negative impact of smoking is beyond doubt.

According to Academician R. G. Oganov, 40% of cases of coronary heart disease and malignant tumors could have been avoided if men had not smoked [42] .

According to specialists from the State Research Center for Preventive Medicine, in Russia approximately 270,000 people die annually from causes related to smoking. Smoking is the cause of 30% of all deaths among Russian men and 4% among women.

The WHO Regional Office for Europe's tobacco control database provides data for 2000 on the impact of smoking on the health of the Russian population [43] . Experts estimate that smoking is responsible for 301,000 deaths among men and 29,000 among women. The total number of smoking-related deaths is 330,000.

Tobacco control activities. Story

Tobacco control efforts have as long a history as Europeans' introduction to tobacco. The first to be repressed for smoking tobacco was one of Columbus's companions, Rodrigo de Jerez. During the voyage, he became heavily addicted to tobacco and, returning to Spain, horrified his neighbors by releasing choking smoke from his mouth and nose. The court of the Holy Inquisition decided that the soul of Jerez was possessed by the devil, and sentenced the sailor to seven years in prison. The measure was not successful. By the time Jerez was released from prison, smoking had become widespread in Spain.

It should be noted that the negative effects of smoking were not known to Europeans for a long time. However, already in the 16th and 17th centuries, in the early stages of the spread of tobacco, attempts were made in many countries to impede its promotion, mainly for religious reasons [44] .

In 1604, King James I of England published a pamphlet “A Counterblast to Tobacco”, in which he wrote that smoking is “...a custom disgusting to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs. .." In 1606, King Philip III of Spain issued a decree restricting the cultivation of tobacco. In 1610, the Emperor of Japan issued acts against smokers and tobacco manufacturers. In 1634, Tsar Mikhail Fedorovich issued a decree according to which smokers and tobacco sellers were required to have their nostrils pulled out. “Repeat offenders” had their heads cut off.

In the 17th century, Turkish Sultan Murad IV banned the sale of tobacco. The violators had their heads cut off and their bodies thrown into the street.

In 1624 and 1642, the Pope issued decrees restricting tobacco consumption. He ordered the excommunication of Catholics who used snuff or smoking tobacco in church, because the smoke polluted the aroma of incense, and coughing monks disrupted the harmony of the chants.

Despite the severity of the penalties imposed on tobacco producers and consumers, these measures have failed to stop the spread of smoking throughout the world [45] .

The lack of scientific evidence of the impact of tobacco on health and the underestimation of the consequences of smoking have long been reasons that hinder the development of measures for effective tobacco control. The intensification of global anti-tobacco activities began shortly after the publication in the mid-60s of the 20th century of research results in which a connection was found between smoking and certain diseases [46] . To date, more than 70,000 scientific articles have been published, which leave no doubt that smoking is the most important cause of premature disability and mortality worldwide [47] .

Humanity has accumulated extensive experience in tobacco control. Current knowledge may still be limited and imperfect, but existing evidence of the effectiveness of various approaches and methods is sufficient to warrant action now [48] .

A reflection of the world experience of effective anti-tobacco activities is an international document - the Framework Convention on Tobacco Control (FCTC).

Framework Convention on Tobacco Control

Tobacco control is a very complex process. Discussions on the text of the framework convention lasted almost four years. The FCTC was approved by all 192 WHO Member States at the World Assembly on 21 May 2003 [49] . The document was open for signature from June 16, 2003 to June 29, 2004. 168 countries took advantage of this opportunity.

The purpose of the Framework Convention “is to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke” [50] . The Framework Convention offers truly effective measures to combat the tobacco epidemic. Unlike many other international documents, the FCTC does not simply call on countries that have signed this document to declare commitment to certain ideas, but imposes legal obligations to implement a number of measures. All countries that ratify this Convention will be obliged to:

• increase taxes on tobacco products, since the Convention emphasizes that tax measures are very important and are an effective means of reducing tobacco consumption, and, first of all, by young people;
• within three years, change national legislation so that, in accordance with it, health warnings cover 50% of the surface of the packaging (at least 30%);
• ban the use of misleading names for tobacco products, such as “light”, “very light” and “mild”;
• Completely ban tobacco advertising and sponsorship within five years;
• take legislative, administrative and other measures to ensure the protection of non-smokers from tobacco smoke in the workplace, in transport and in public places;
• conduct a study of the composition of tobacco products in accordance with the recommendations of competent international bodies and strictly regulate the substances contained in tobacco products;
• develop and implement effective smoking cessation and tobacco dependence treatment programs;
• combat all forms of illicit trade in tobacco products, including smuggling, illicit production and counterfeiting;
• take measures to prevent the distribution of tobacco products among minors;
• promote and develop national tobacco control research [51] .

Tobacco control measures in Russia

It is with regret that we have to admit that there is no clear state policy to combat tobacco in Russia. The main legislative acts designed to regulate the production, distribution, advertising and consumption of tobacco are the federal laws “On Advertising” from 1995 and “On Restricting Tobacco Smoking” from 2001. Numerous amendments to these laws adopted in subsequent years did not change their essence. Russian legislation remains extremely loyal to tobacco producers, distributors and consumers. Our country has not introduced a complete ban on tobacco advertising; partial restrictions, as world experience shows, are not effective. The sensational federal law of the Russian Federation of December 1, 2004 “On Amendments to Articles 3 and 6 of the Federal Law “On Restricting Tobacco Smoking”” does not at all prohibit “.“tobacco smoking in workplaces, in urban and suburban transport, in air transport during flight duration of less than three hours, in indoor sports facilities, healthcare organizations, cultural organizations, on the territories and premises of educational organizations, in premises occupied by government bodies,” as reported by the media. In all these numerous places, in accordance with the adopted law, you can smoke (!), but only “... in specially designated places for smoking tobacco”! Thus, you should organize smoking rooms in medical universities, hospitals, schools and no longer worry about breaking the law. The complexity of Russian anti-tobacco legislation, the ambiguity of interpretations, the unclear mechanisms for implementation and prosecution in case of violation allow international experts to argue that these laws were not adopted in the interests of protecting public health, but defend the interests of tobacco companies [52] .

Tobacco companies are allowed to continue deceiving Russian smokers and placing “light” and “ultralight” labels on cigarette packs. Research shows that this labeling creates the illusion among some smokers that smoking these cigarettes causes less harm to health. However, consumption of cigarettes with lower tar and mechanically measured nicotine content is known to provide no health benefits [53] .

Russia does not have such a powerful means of limiting the spread of smoking as high taxes on tobacco products. In Russia, cigarette prices are extremely low for Europe, and the reason for this is very low excise taxes. Tobacco companies operating in our country are divided into two groups, lobbying for different methods of calculating taxes on tobacco, and by discussing these technical problems they successfully distract society from the key issue - the need for a significant increase in the excise tax.

Until 2003, Russia had a so-called specific excise tax rate on tobacco products, when manufacturers paid a fixed amount for every thousand cigarettes produced. But on January 1, 2003, a mixed excise tax rate was introduced. In addition to the specific component, the so-called ad valorem part of the tax has been added - a percentage of the selling price. In accordance with the Federal Law of the Russian Federation dated July 21, 2005 No. 107-FZ “On introducing amendments to part two of the Tax Code of the Russian Federation and on invalidating certain provisions of legislative acts of the Russian Federation,” from January 1, 2006, the specific component is equal to 78 rubles per 1 000 cigarettes with a filter and 35 rubles for 1,000 cigarettes without a filter, plus the ad valorem part - 8% of the selling price. Thus, Russia maintains one of the lowest tobacco taxes in Europe. This can be seen by comparing the Russian tax with the tax levels adopted in a number of European countries presented in the table.

Table 1

Structure of tobacco taxation in European countries (2003, in%)
Country Fixed Percentage excise tax on sales price			Full excise tax	VAT	Full tax
Austria	14,25	42	56,25	16,67	72,92
Belgium	11,16	45,84	57	17,36	74,36
Bulgaria	3,33	40	43,33	16,67	60
Cyprus	60,95	0	60,95	13.04	73,99
Czech Republic	18	22	40	18.03	58,03
Denmark	32,61	21,22	53,83	20	73,83
Estonia	25,45	24	49,45	15,25	64,7
Finland	7,56	50	57,56	18.03	75,59
France	3,35	58,05	61,4	16,39	77,79
Germany	36,63	24,23	60,86	13,79	74,65
Greece	3,64	53,86	57,5	15,25	72,75
Ireland	43,59	18,32	61,91	17,36	79,27
Italy	3,73	54,26	57,99	16,67	74,66
Latvia	37,42	0	37,42	15,25	52,67
Lithuania	32,15	10	42,15	15,25	57,4
Luxembourg	10,25	46,84	57,09	10,71	67,8
Malta	6,16	53,1	59,26	13,04	72,3
The Netherlands	36,49	20,51	57	15,97	72,97
Poland	31,67	25	56,67	18,03	74,7
Portugal	38,75	23	61,75	15,97	77,72
Romania	16,05	32	48,05	19	67.05
Slovakia	42,22	0	42,22	16,7	58,92
Slovenia	13,94	39,07	53,01	16,67	69,68
Spain	4,01	54	58,01	13,79	71,8
Sweden	10,67	39,2	49,87	20	69,87
Great Britain	42,96	22	64,96	14,89	79,85
Source: WHO, Tobacco Control Database, 2003.

It should be noted that in countries that have achieved certain successes in the fight against tobacco, non-governmental organizations are actively operating, uniting anti-tobacco activists in their ranks [54] .

The influence of public organizations in Russia is small, and the leaders of anti-tobacco activities are unknown to the population. The country's government is not bombarded with public appeals demanding stricter control over tobacco [55] .

Russian doctors are not ready to lead the national anti-tobacco social movement, as happens in all other countries [56] . They are focused on treating diseases caused by tobacco. The prevalence of smoking among male physicians is no different and is even higher among female physicians than among the general population [57] .

One can only guess about the strength of influence of the tobacco lobby on government authorities in our country. One indicator is the extremely low level of taxes. Another litmus test may be the situation with Russia's signing of the Framework Convention on Tobacco Control. At the stage of preparation of this international document, Russian delegations took an active part in the discussion of the Convention. Leading experts and specialists in anti-tobacco activities from different countries were invited to the sessions of the Intergovernmental Working Group to develop the most effective approaches that can actually limit the tobacco smoking epidemic in different countries. Russia's participation in this process was marked by scandal. The official Russian delegation participating in the fifth session (October 14-25, 2002) and the sixth session (February 17-28, 2003) of the Intergovernmental Working Group included a certain L. Yu. Sinelnikov, presented as an expert from the Ministry of Agriculture [58 ] . But on the BAT-Java website there is information that Leonid Sinelnikov is the chairman of the board of directors of this tobacco company [59] . One might assume that this is just a strange coincidence of surname and initials, and the expert from the Ministry of Agriculture, representing Russia, actively worked in Geneva for the benefit of the global tobacco control movement. But on the website of the Association of Tobacco Distributors “Grandtabak” there is a message that Mr. Sinelnikov spoke at a press conference held in this organization on June 24, 2003, where he warned his colleagues about the adverse consequences for the tobacco industry that would occur if Russia signed Framework Convention [60] . After all, then Russia will have to greatly tighten anti-tobacco legislation within a short time, completely ban tobacco advertising, and sharply increase taxes on tobacco products. There is no doubt that tobacco companies have taken proactive steps to protect their financial interests from potential risks. Is it any wonder that Russia remained among the few countries that have not signed the Convention. The possibility of joining this international document remains, but our country, under various far-fetched pretexts, refuses this procedure, and there is no public discussion of this problem.

Instead of truly effective tobacco control measures in Russia, anti-tobacco activity is feigned from time to time. Thus, tobacco corporations, in an effort to make their activities socially acceptable, themselves finance school anti-smoking programs, apparently taking into account the long-known fact that school programs are not effective [61] . The degree of cynicism of manufacturers of poisonous products cannot but cause amazement. On the already mentioned website www.batrussia.ru you can find information about the active involvement of Russian schoolchildren in the activities of the Public Council on the Problems of Teenage Smoking “Your Choice” and the Educational Program “My Choice”. These organizations do not hide the fact that they exist with money from the tobacco industry. Their representatives are making incredible efforts to whitewash their activities and covertly involve young people in the number of consumers of tobacco companies' products. Consider just one of the insidious messages with which these organizations address teenagers: “...the choice - to smoke or not to smoke - should only be faced by adults...” High school students, poorly assessing all the consequences of smoking, but considering themselves adults , make the choice offered to them. And often in favor of smoking.

* * *

Smoking is the most important public health problem in Russia, requiring urgent measures to change the current tragic situation. Even if the necessary measures are taken in the near future, then, in accordance with existing predictive models of the development of the tobacco epidemic, for several decades we will see an increase in the negative impact of smoking on the health indicators of the country's population. A broad discussion of this problem in society seems extremely useful. Only a national anti-tobacco coalition can initiate an active discussion, uniting in its ranks active anti-tobacco activists, representatives of various professions - doctors, teachers, economists, lawyers, scientists, journalists, etc. The activities of this public organization should be aimed at lobbying the interests of supporters of tightening tobacco control in government bodies and contribute to the formation of a clear national anti-tobacco policy that takes into account existing global experience in effectively controlling the tobacco epidemic.

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[1] Mironov S. People’s health is the “calling card” of the state // Home Doctor. 2003. P. 3. No. 8.

[2] Nevinnaya I. Why do we need “Health” // Russian newspaper. 8.12.2005.

[3] Borio G. Tobacco Timeline [ http://www.tobacco.org/resources/history/Tobacco_History.html ].

[4] US Department of Health and Human Services, Smoking and Health in the Americas. A Report of the Surgeon General in Collaboration with the Pan American Health Organization. Washington, DC: US Government Printing Office, 1992.

[5] Borio G. Op. cit.

[6] US Department of Health and Human Services...

[7] Borio G. Op. cit.

[8] Ibid.

[9] Hirschfelder A. B. Encyclopedia of Smoking and Tobacco, 1999; p. 34. Phoenix, Arizona: The Oryx Press.

[10] Guindon G. E. and Boisclair D. Past, current and future trends in tobacco use. Health, Nutrition and Population (HNP) Discussion Paper. Economics of Tobacco Control Paper No. 6. Washington, DC, World Bank, 2003.

[11] The World Bank, Curbing the epidemic: governments and the economics of tobacco control. Series: Development in practice. Washington DC: The World Bank. 1999.

[12] World Health Organization. Regional Office for the Western Pacific. Tobacco is impoverishing people and nations, WHO warns. Press Release. 31 May 2004.

[13] The World Bank, Curbing...

[14] United States Department of Agriculture. Tobacco: World Markets and Trade. April 2005.

[15] Guindon GE and Boisclair D. Op. cited

[16] European Opinion Research Group EEIG. Smoking and the environment: Action and Attitudes. Eurobarometer. Bruxelles. November, 2003; World Health Organization. Regional Office for Europe. Poverty and health - Evidence and action in WHO's European region. Copenhagen, WHO Regional Office for Europe, 2002 (document EUR/RC51/8); Bobak M., et al. "Poverty and Smoking" in Tobacco Control in Developing Countries, eds. Prabhat Jha and Frank Chaloupka, (Oxford: Oxford University Press, 2000), p. 42-61.

[17] Barnum H. The Economic Burden of the Global Trade in Tobacco. Tobacco Control, 1994; 3:358—361.

[18] Ezzati M. and Lopez A. D, Estimates of global mortality attributable to smoking in 2000. Lancet, 2003. 362: p. 847-852.

[19] Barnum H. Op. cit.

[20] The World Bank, World Development Report 1993: Investing in Health 1993. University Press Book.

[21] Ibid.

[22] Guindon GE and Boisclair D. Op. cited

[23] Gilmore A. B. and McKee M., Moving East: how the transnational tobacco industry gained entry to the emerging markets of the former Soviet Union—part II: an overview ofpriorities and tactics used to establish a manufacturing presence. Tobacco Control, 2004. 13: p. 151—160.

[24] Gilmore A. B. and McKee M., Exploring the impact of foreign direct investment on tobacco consumption in the former Soviet Union. Tobacco Control 2005. 14: p. 13—21.

[25] Ibid. p. 136—142.

[26] Ibid. 14: p. 13—21.

[27] The World Bank Group. Economics of Tobacco Control. Country data. [ http://www1.worldbank.org/tobacco/brieflist_db.asp ].

[28] RBK News. In the Russian Federation use in 2 times of more tobacco, than all over the world. 3 March 2004 [ http://top.rbc.ru/index.shtml7/news/incidents/2004/03/02/02203729_bod.shtml ].

[29] World Health Organization. Regional Office for Europe. Tobacco control database. 2003.

[30] United States Department of Agriculture. Tobacco...

[31] McKee, M., et al., Patterns of smoking in Russia. Tobacco Control, 1998. 7(1): p. 22-6.

[32] World Health Organization Regional Office for Europe. European health for all database (HFA-DB). Updated: June 2005.

[33] Shalnova S. A., Deev A. D., Oganov R. /. Prevalence of smoking in Russia: Results of a survey of a representative sample // Disease prevention and health promotion. 1998. No. 3. P. 15-20.

[34] Kamardina V. et al. Prevalence of smoking among women in Russia // Disease prevention and health promotion. 2002. No. 1. P. 7-12.

[35] World Health Organization Regional Office for Europe, Smoking, drinking and drug taking in European Region. Alcohol, Drugs and Tobacco Program WHO Regional Office for Europe, Copenhagen, Denmark. 1997.

[36] World Health Organization. Tobacco Control Country Profiles 2003. 2003.

[37] Demine A. K. Report on the Results of the Global Youth Tobacco Survey in Russsia. 2001 [ http://www.cdc.gov/tobacco/global/GYTS/reports/pdf/russia.pdf ].

[38] CDC. Russian Federation — Moscow. Global Youth Tobacco Survey (GYTS). FACT SHEET. 1999.

[39] World Health Organization. Young people's health in context. Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002 survey. 2004.

[40] World Health Organization Regional Office for Europe. European health for all database (HFA-DB). Updated: June 2005.

[41] Ibid.

[42] Oganov R. G. et al. The influence of smoking on mortality from chronic non-infectious diseases according to the results of a prospective study // Disease prevention and health promotion. 1998. No. 3. P. 13-15.

[43] World Health Organization. Regional Office for Europe. Tobacco control database. 2003 [ http://data.euro.who.int/tobacco/?TabID=2402 ].

[44] Borio G. Op. cit.

[45] Rob Cunningham. Smoke screen. The Canadian Tobacco War. 2001, Moscow. 496.

[46] World Health Organization, Tobacco or Health: A global status report. 1997, Geneva: World Health Organization.

[47] The World Bank, Curbing.

[48] US Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. US DHHS/PHS Atlanta, USA. 2000.

[49] The Framework Convention for Tobacco Control Alliance [ http://www.fctc.org ].

[50] www.un.org/russian/documen/convents/tobacco.pdf

[51] World Health Organization. Framework Convention on Tobacco Control. Open-ended Intergovernmental Working Group. [ http://www.who.int/gb/fctc/E/E_Index.htm ].

[52] Gilmore Anna and Balabanova Dina, Russia: the lobbyist's art is alive and well. Tobacco Control, 2002. 11: p. 293.

[53] US Department of Health and Human Services. The Health Consequences of Smoking: Surgeon General's Report. 2004.

[54] American Cancer Society/International Union Against Cancer (UICC), Strategy Planning for Tobacco Control Movement Building, in Tobacco Control Strategy Planning, American Cancer Society, Editor. 2003.

[55] Gilmore A. B. and McKee M. Tobacco and transition: an overview of industry investments, impact and influence in the former Soviet Union. Tobacco Control 2004. 13: p. 136—142.

[56] American Cancer Society. Getting Doctors to Quit and Lead. Practical Strategies for Engaging Doctors in the Full Range of Tobacco Control Activities. 2002.

[57] Aleksandrov AA et al. Prevalence of smoking among doctors of various specialties in Moscow. M., 2001.

[58] World Health Organization. Framework Convention on Tobacco Control. Open-ended Intergovernmental Working Group. [ http://www.who.int/gb/fctc/E/E_Index.htm ].

[59] British American Tobacco Russia Annual Shareholders Meeting at OJSC "BAT-Yava". 2005 [ http://www.batrussia.ru/oneweb/sites/BAT_5FZF3V.nsf/vwlivelookupHomePage/HOME ? opendocument].

[60] Association of tobacco distributors «Grandtabak» Tobacco Business Hot News. June 2003.

[61] The World Bank, Curbing...