various policies will emerge only when the NIS countries start experimenting; small pilot projects will shed light on the complex interaction among policies, sociocultural preferences, commercial interests, and adult behavior.

Controlling Tobacco Consumption

The chapters by Lopez, Prokhorov, and Pierce address the problem of tobacco consumption. In the Soviet Union in the 1980s, approximately half the adult men smoked, compared with less than 15 percent of the women. By comparison, in the United States in 1987, around 31 percent of men and 26 percent of women smoked. According to Prokhorov and Pierce, survey data indicate that smoking appears to be increasing among adult males in Russia—from 53 percent in 1985 to 67 percent in 1992—and also among adolescents. Lopez points out that in the other NIS countries, rough estimates indicate the highest per adult yearly consumption of cigarettes to be in Armenia, Turkmenistan, Moldova, Georgia, and Ukraine.

Prokhorov and Pierce also note that in recent years, transnational tobacco companies have expanded their role in the NIS. At the same time, tobacco promotion and advertising have increased, a development Prokhorov suggests is particularly noticeable in promotions and is directed to youth. Pierce documents the powerful impact of advertising on the smoking habits of the American public over time, with specific targeting measures quickly showing up in smoking prevalence among the targeted groups. He notes that susceptibility to advertising is a strong determinant of starting behavior. His observations echo the perception of Prokhorov regarding the acute susceptibility of the NIS market, which has not previously been exposed to these powerful marketing tools, combined with the tendency in the NIS to imitate the poor health habits of the West.

Applying a new methodology (Peto et al., 1994) that examines impact across a range of causes of death, Lopez presents calculations of smoking-attributable mortality that suggest smoking claims many lives through lung cancer, but claims up to two to three times more lives from other diseases, such as coronary heart disease and stroke. According to the estimates presented, in one group of NIS countries—Armenia, Belarus, Estonia, Kazakstan, Latvia, Lithuania, the Russian Federation, and Ukraine—about 25 to 30 percent of all male deaths are currently due to smoking, and roughly 40 percent of deaths among men of middle age. The remaining countries can be considered as being at an intermediate or earlier stage of their tobacco epidemics, with proportionate mortality of 6 to 20 percent attributable to smoking.

According to Pierce, regulations that control smoking among confirmed smokers have been shown to be effective in the United States and other developed countries. Quitting smoking is a time-dependent process, with success increasing with repeated attempts. Public control of tobacco use decreases levels



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