Centers for Disease Control and Prevention

During the 20th century, use of tobacco products contributed to the deaths of 100 million persons worldwide (1). In 2011, approximately 6 million additional deaths were linked to tobacco use, the world’s leading underlying cause of death, responsible for more deaths each year than human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS), tuberculo-sis, and malaria combined (1). One third to one half of lifetime users die from tobacco products, and smokers die an average of 14 years earlier than nonsmokers (2,3). Manufactured cigarettes account for 96 % of all tobacco sales worldwide. From 1880 to 2009, annual global consumption of cigarettes increased from an estimated 10 billion cigarettes to approximately 5.9 trillion cigarettes (Figure 1), with five countries accounting for 58 % of the total consumption: China (38%), Russia (7%), the United States (5%), Indonesia (4%), and Japan (4%). Among the esti-mated 1 billion smokers worldwide, men outnumber women by four to one. In 14 countries, at least 50 % of men smoke, whereas in more than half of these same countries, fewer than 10 % of women smoke (4). If current trends persist, an estimated 500 million persons alive today will die from use of tobacco products. By 2030, tobacco use will result in the deaths of approximately 8 million persons worldwide each year (4). Yet, every death from tobacco products is preventable. The Tobacco Industry Tobacco plants are grown in 124 countries. China, which pro-duces 43 % of the world’s tobacco, has seen a 200 % increase in production over the past 30 years. Other leading producers includ