cancer specialists in the late 1940s. While these efforts continued to be widespread through the 1950s, it was not until the first Surgeon General's report (U.S. Department of Health and Human Services, 1964) that there was a clear indication of the acceptance of the gravity of the issue by the profession. The length of this process was determined by the continual need to bolster the evidence linking smoking with disease. In most countries, there is a need to document the link between smoking and disease, both locally and internationally, in order to build broad-based support for tobacco control.

There is some evidence from Australia that the government health department's early use of strong television commercials on the health consequences of smoking had the effect of galvanizing the medical community toward tobacco control. Given that Eastern European government authorities have shown a willingness to try to ban cigarette advertising (although not to enforce such a ban), they may be willing to allow public service announcements presenting the health side of the issue. The most effective counteradvertising focusing on health impacts includes testimonials from famous actors dying of lung cancer (from the United States) and a commercial that has proved extremely successful in crossing cultural boundaries (the "Sponge" commercial, developed in Australia in 1977) (Pierce et al., 1986).

Another mass media theme that might be effective would be to challenge the apparent perception among Eastern European youth that most young Americans smoke. One way to do this might be to use current anti-smoking advertising from the United States, with voice-overs addressing the misperception.

A key approach, given the current state of the economies in the region, would be to focus on the price of cigarettes. There does appear to be a price inflation level that is acceptable to consumers. The pricing strategy that has worked best for the industry has been to increase the price of cigarettes by small increments at regular intervals. Whenever there is an excise tax, the industry appears to reduce the amount of its own price increase. However, as discussed earlier, pricing can be an effective component of a tobacco control strategy. At the same time, it is important to note that if the increase is too large, it runs the risk of fostering a black market in the area, as it has appeared to do in Canada in recent years.

The advantages of a taxation policy can be maximized if, say, 10 percent of the revenues can be earmarked for use in tobacco control, with the rest being used to assist in other needy areas of the health system or even placed in the general revenues. Both Victoria, Australia, and California are examples of how a creative tax policy has supported the development of an aggressive tobacco control movement (The Catalonia Declaration, 1995).



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