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BACKGROUND: Despite being the third largest tobacco producer in the world, Brazil has developed a comprehensive tobacco control policy that includes a broad restriction on both advertising and smoking in indoor public places, compulsory pictorial warning labels, and a menthol cigarette ban. However, tax and pricing policies have been developed slowly and only very recently were stronger measures implemented. This study investigated the expected responses of smokers to hypothetical price increases in Brazil. METHODS: We analyzed smokers' responses to hypothetical future price increases according to sociodemographic characteristics and smoking conditions in a multistage sample of Brazilian current cigarette smokers aged≥14 years (n=500). Logistic regression analysis was used to examine the relationship between possible responses and different predictors. RESULTS: In most subgroups investigated, smokers most frequently said they would react to a hypothetical price increase by taking up alternatives that might have a positive impact on health, i.e., they would "try to stop smoking" (52.3%) or "smoke fewer cigarettes" (46.8%). However, a considerable percentage responded that they would use alternatives that would reduce the effect of price increases, such as the same brand with lower cost (48.1%). After controlling for sex age group (14-19, 20-39, 40-59, and ≥60 years), schooling level (≥9 versus ≤9 years), number of cigarettes per day (>20 versus ≤20), and stage of change for smoking cessation (precontemplation, contemplation, and preparation), lower levels of dependence were positively associated with the response "I would try to stop smoking" (odds ratio [OR], 2.19). Young age was associated with "I would decrease the number of cigarettes" (OR, 3.44). A low schooling level was strongly associated with all responses. CONCLUSIONS: Taxes and prices increases have great potential to stimulate cessation or reduction of cigarette consumption further among two important vulnerable populations of smokers in Brazil: young smokers and those of low educational level. The results from the present study also suggest that seeking illegal products may reduce the impact of increased taxes, but does not eliminate it.

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AIMS AND DESIGN: The historical and economic involvement of Brazil with tobacco, as a major producer and exporter, was considered an insurmountable obstacle to controlling the consumption of this product. Nevertheless, the country was able to achieve significant progress in implementing public policies and to take an international leadership position, meeting its constitutional commitment to protect public health. In this paper we provide a brief historical overview of tobacco control (TC) in Brazil, and analyse the factors that contributed to the major decline in tobacco consumption in the country over the last 20 years, as well as identify the challenges that had to be overcome and those still at play. FINDINGS: The Brazilian case demonstrates how cross-sectorial collaborations among health-related groups that capitalize on their respective strengths and capacities can help to influence public policy and overcome industry and population resistance to change. Although Brazil still lags behind some leading TC nations, the country has an extensive collaborative TC network that was built over time and continues to focus upon this issue. CONCLUSIONS: The tobacco experience can serve as an example for other fields, such as alcoholic beverages, of how networks can be formed to influence the legislative process and the development of public policies. Brazilian statistics show that problems related to non-communicable diseases are a pressing public health issue, and advocacy groups, policy-makers and government departments can benefit from tobacco control history to fashion their own strategies.

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The burden of disease due to tobacco for each country will depend on the prevalence of tobacco use and the duration of the epidemic. Given that the tobacco epidemic in West African Francophone countries is relatively recent, the burden of disease due to tobacco use is currently low. However, tobacco related burden of disease in Francophone West African countries is increasing as the number of smokers continues to increase and the population has been smoking for a longer period of time. If the current trends continue, West African countries will be suffering the massive consequences of tobacco use in two or three decades. Apart from the classical health consequences of tobacco consumption such as certain types of cancer and cardiovascular diseases, there are some conditions of special importance in low income African countries such as the increased risk of tuberculosis infection and mortality amongst smokers, low birth weight for babies of smoking mothers, and tobacco consumption associated malnutrition especially amongst women. Furthermore, developing countries, with inadequate resources and other important health issues, cannot afford the costs of the chronic degenerating conditions caused by tobacco use, as these are very expensive to treat. Tobacco control in Francophone African countries is still deficient Human and financial resources which are often scarce in West African countries are dedicated to other health issues since tobacco is normally not amongst the public health priorities. Legislation in Francophone African countries is limited and not adequately enforced. A major reason for governments' inaction on tobacco is their fear of creating unemployment and loss of revenue from tobacco taxes. This fear is derived mainly from the arguments of the tobacco industry. Apart from lobbying governments, the tobacco industry uses all kinds of strategies to market their products in these countries and faces practically no barriers to their business in these countries. It is essential that Francophone African countries take immediate action and develop and implement comprehensive multisectoral tobacco control programmes. These programmes must be integrated into the existing public health programmes and make use of existing infrastructure and resources in order to stop the tobacco epidemic from expanding. In February 2005, the WHO Framework Convention for Tobacco Control (WHO FCTC) entered into force. Most Francophone African countries have signed the treaty thus expressing their intention to become Parties in the future. WHO urges these countries to become Parties as soon as possible and to implement the WHO FCTC provisions in order to control the tobacco epidemic. WHO in turn will provide guidelines and assistance for the process of becoming Parties to the treaty and implementing tobacco control measures outlined therein.

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