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Professor: U.S. Lagging Behind Brazil’s No-Smoking Measures

Brazil  “Brazil’s strong cigarette control policies should be a lesson to us all," says David Levy, Georgetown professor of oncology and lead author of a study on the South American country's successful anti-smoking measures.

November 15, 2012 – High cigarette prices, smoke-free air laws and other measures saved more than 400,000 lives in Brazil between 1989 and 2010, according to a study published this month in PLOS Medicine by a Georgetown researcher and the Brazilian National Cancer Institute.

David Levy, a professor of oncology at Georgetown Lombardi Comprehensive Cancer Center, was part of the team that found the measures led to a 50 percent reduction in smoking prevalence in Brazil during that time period.

He says the United States could learn a lot from the Brazilians based on the findings in journal's Nov. 6 issue.

Devastating Toll

“Everyone knows smoking exacts a devastating toll leading to premature death and suffering, but getting people to give up the habit or prevent it has proved challenging,” says Levy, the study's lead author. “Brazil’s strong cigarette control policies should be a lesson to us all. If we are to implement policies here in the U.S. that will make a lasting impact we’ll need the political will and the courts’ support.”

Tobacco kills up to half its users, and more than 5 million smokers worldwide die every year from tobacco-related causes, Levy says.

Brazil has played a pioneering role among low- and middle-income countries in providing support for tobacco control measures, he says.

Using modeling to determine projections, the researchers say the Latin American country’s policies could eventually result in as many as 7 million lives saved by 2050.

Graphic Health Warnings

The country introduced its first cigarette-specific tax in 1990, and in 1996 placed its first warnings on cigarette packages and introduced smoke-free air laws.

Many of these measures have subsequently been strengthened, including stronger advertising restrictions, higher taxes and more bold and graphic warnings.

Levy says a distinguishing factor in Brazil’s tobacco policies is its use of graphic health warnings on cigarette packages.

U.S. vs. Brazil

“While our model credits only 8 percent of the reduction in smoking to health warnings, this is likely greatly underestimated because the value assigned in the model was based on current literature,” the Georgetown researcher says. “We believe that value doesn’t accurately represent the impact health warnings have in Brazil – particularly for youths.”

In contrast, Levy points out that the U.S. Court of Appeals for the District of Columbia rejected a government mandate requiring the use of nine specific graphic health warnings on cigarette packaging.

Levy suggests rigorous testing with graphic warnings in the youth population in the U.S. might also demonstrate a significant impact on smoking behaviors.

Banning Menthol

He also notes that Brazil recently decided to ban menthol cigarettes, and that the U.S. Food and Drug Administration is considering a similar policy in this country.

While the U.S., particularly states such as California, have seen success in reducing smoking rates by implementing strong policies, none have had the kind of success seen in Brazil in such a short period of time.

Levy conducted his research in collaboration with two scientists from the Brazilian National Cancer Institute including Liz Maria de Almeida, and André Szklo.

The work in this study is supported by contracts with the Tobacco Control Research Branch of the National Cancer Institute and by Bloomberg Philanthropies.

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