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Call To Action

Tobacco control policies need to explicitly protect the most vulnerable people, particularly children.

The tobacco epidemic’s impact is fundamentally unequal. To find more customers, the tobacco industry markets its products aggressively to women and children. Furthermore, in most countries, individuals with lower incomes and less education are far more likely to be tobacco users, and to pay a steep personal price for their addictions through poor health and the misallocation of precious resources to addictive tobacco products. In 24 countries, more girls than boys are now smoking tobacco, which foreshadows a major and ominous shift in who is using these deadly products.

Disparity in tobacco deaths

Percentage of smoking-related deaths in mixed-race (mixed black and white ancestry, generally with lower socioeconomic status) and white men (ages 35-74 years) in South Africa: 1999–2007

Tobacco-related deaths are more common in people with lower socioeconomic status. In South Africa, mixed race men tend to be of lower socioeconomic status than white men.

Smoking During Pregnancy

Health risks to mothers and children associated with maternal smoking

Exposure by Socioeconomic Status

Voluntary smoking ban at home by education level: Guangdong, China, 2010

Families with low socioeconomic status may be more likely to be exposed to secondhand smoke at home.

In 2007, South Australia became the first Australian state to ban smoking in cars in which children were travelling. “While it is an adult’s right to choose to smoke and expose themselves to all the associated and well-known health risks, this ban aims to protect children who could not otherwise protect themselves.” –Katy Gallagher, Chief Minister of the Australian Capital Territory, 2012

Underestimated Exposure

Exposure to secondhand smoke in children brought to a hospital for asthma or breathing problems: Cincinnati, USA, 2010–2011

While only one third of parents reported that their children were exposed to secondhand smoke, laboratory tests confirmed that, in reality, 80% of children brought to a hospital (Cincinnati Children’s Hospital Medical Center) in the United States for asthma or breathing problems were exposed to secondhand smoke. These findings indicate that many respiratory diseases that might not be linked to secondhand smoke based on self-reports may in fact be related to the exposure.

Child Labor

Working in tobacco fields affects school attendance and retention rates

Suza in Kasungu district and Katalima in Dowa district of Malawi: 2008

63% of children of tobacco-growing families were involved in child labor.

10–14% of children from tobacco-growing families are out of school because of working in tobacco fields.

16% of parents said their children were out of school because of an inability to pay educational fees and buy uniforms and shoes.

Lack of education drives individuals further into poverty.

“…when child and maternal mortality are falling universally around the world, the threat of a rise in tobacco is heading in the wrong direction…The developing world is about to enter a phase of rapid growth in tobacco at a time when it can least afford it” –Keith Hansen, The World Bank Group, 2012



Hansen K. Remarks by Mr. Keith Hansen, Director of Human Development for Latin America and Caribbean – The World Bank Group: The Tobacco Atlas DC Launch. D.C., USA: The National Press Club; 2012.

“The yawning poverty gap in smoking exacerbates existing, and unconscionable, health disparities. Endgame strategies, therefore, must pay particular attention to the least advantaged, focusing on the equitable distribution of benefits. What justice requires is that the poor do not feel the blowback of the last blasts in the war against Big Tobacco” –Keith Hansen, The World Bank Group, 2012

“One [hypothesis] is the greater concern women have that if they stop smoking they will gain weight. THIS FEAR UNDOUBTEDLY PREVENTS MANY WOMEN from desiring to stop smoking.” –Lorillard 1973

In the United Kingdom in 2011, EVERY DAY AROUND 600 BOYS AND GIRLS ages 11–15 (over 200,000 a year) took up smoking.

Women and Water Pipe

Proportion of all tobacco users who used water pipes: by sex, 2011

Water pipe use is especially difficult to confront because it often happens in homes, away from where traditional social pressures and policy interventions like smoking bans can have an impact.



We calculated the proportion of all tobacco users who engaged in water pipe use. We want to emphasize that women in Middle Eastern countries who are frowned upon for using cigarettes, as they are a form of tobacco typically consumed in public, are more likely to pick up water pipe use. I’m showing that when women choose to smoke tobacco they often use water pipe at a higher rate than their male counterparts. This does not mean that women smoke more water pipe than men, but simply that among those women who smoke, water pipe is disproportionately popular.


Baheiraei A, Mirghafourvand M, Nedjat S, Mohammadi E, Mohammad-Alizadeh Charandabi S. Prevalence of Water Pipe Use and Its Correlates in Iranian Women of Reproductive Age in Tehran: A Population-Based Study. Med Princ Pract. 2012;21(4):340–4.

Khattab A, Javaid A, Iraqi G, Alzaabi A, Ben Kheder A, Koniski M-L, et al. Smoking habits in the Middle East and North Africa: Results of the BREATHE study. Respir Med. 2012 Dec 1;106:S16–24.

A U.S. study found that nearly three quarters of children aged 7-17 who were laboring in tobacco fields in the USA experienced symptoms of green tobacco sickness.

This is ironic as it is illegal for children under 18 to purchase cigarettes, yet they can be employed in tobacco fields and experience illness from their labors.

In 2013, Cancer Research UK (CR UK), the UK’s country’s largest health charity, produced shocking video clips of young schoolchildren examining various packets of cigarettes. Tellingly, a red pack reminded one boy of Ferrari (whose Formula One racing cars are sponsored by Marlboro); two boys likened a bright yellow pack to the sun, one adding, ‘it makes you almost happy just by looking at it.’ And a girl clearly loved a pink pack so much that she cuddled it, enthusing to her neighbour, ‘Pink, pink, pink!’

Funding Charities

2013 US charitable contributions from the Altria Companies, in millions, USD


(E.G. SUCCESS 360°)
78 different educational institutions and programs received funding

The Smithsonian Institution received funding

Two donations were to healthcare organizations

88 different organizations received
funding through employee programs

Six charities in Virginia,
a top tobacco-growing state, received funding

The American Red Cross and its
Virginia chapter received funding

The Texas Conservative Coalition
Research Institute received funding

485 charitable events received wine
donated by Ste. Michelle Wine Estates, of which Altria is the parent company

6 chapters of the Boys & Girls Club received funding


Tobacco company charitable giving is small compared to profits and creates a conflict of interest when donated to youth or healthcare organizations.

“Charitable Giving”

Donations from Philip Morris International (PMI); 2009 – 2013

0 - 49999
50000 - 99999
100000 - 199999
200000 - 499999
500000 - 999999
1000000 - 1000000000
No Data

Donations from Philip Morris International (PMI); 2009 – 2013

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