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November 11th, 2016:


As we aproach the closing ceremony we all may want to start thinking about how COP7 decisions will improve tobacco control work at national level.

Decisions requesting action on resource mobilisation are likely to be considered among the most important of these.

FCA has prepared two documents to illustrate the type of material that Parties could request to be developed between COP7 and COP8 to support resource mobilisation.

Copies of these documents are available at the FCA booth.


This is a prototype (see below) of a brochure to explain to international development agencies – in language that is relevant to their priorities – why providing assistance for FCTC implementation is such an effective and cost-effective investment.

The sidebar of the document includes explanatory notes on the thinking behind the text and references to key UN processes.

The text explains the FCTC in the context of the Sustainable Development Goals with a particular focus on why raising tobacco tax is both an essential intervention for health and a tool to raise revenue that can be used for domestic development priorities.

It also outlines the results of a (hypothetical) list of parties specific needs for assistance with FCTC implementation.


This document is a mock report that could be produced for future COP sessions to provide an overview of Parties’ expression of needs for assistance with FCTC implementation.

The format of this mock report is similar to reports routinely prepared by the Secretariats for other treaties to help their Parties understand the scale and type of requests for assistance with treaty implementation.

Seven different “categories” of assistance have been identified and these are defined in the mock report.

In order to collect the data presented in the mock report, a short survey will need to be launched for all Parties to complete (the table adjacent). If such a survey were completed within the three months following COP7, the Secretariat would be able to produce a real report ahead of any financing dialogue it holds with international partners in 2017.

If this one-off survey is found to be useful in identifying Parties’ needs in a way that can easily be presented to potential funders, then Parties could consider the questions being incorporated into the main treaty reporting instrument in due course.

To produce materials of this nature will require a real COP decision this week. Parties should request the Secretariat to undertake this exercise of identifying, analysing and
prioritising implementation needs.

A package of materials that both the Secretariate and Parties can use in 2017 in their discussions with potential donors will go a long way.


Illicit trade in tobacco products is an alarming issue which undermines implementation of the FCTC.

Progress on tackling it could be made at COP7, but only if Parties collaborate.

To enter into force, the ITP needs 40 ratifications. At the moment, there are 24 Parties. During the debate on Tuesday, Parties explained their concerns about the Protocol’s implementation, mostly related to technical aspects and related costs.

Parties should be reassured that they will not have an impossible task after ratification. With regards to Parties that have already ratified (or are about to ratify), the concerns are that they are setting up and implementing measures of the ITP without talking to one another.

A forum for exchange of best practices where Parties can discuss problems and solutions should be set up.

The Meeting of the Parties (MOP1), which has to take place around the regular COP session and therefore not before the end 2018, will unfortunately come too late to address immediate concerns.

To facilitate discussions among Parties, a working group on preparations for the entry into force of the ITP could be set up.

Yesterday, the Convention Secretariat tabled three options to prepare for MOP1. Because of its costs, the option to set up an inter-governmental working group was not supported.

In light of those constraints, the option to establish a pre-MOP working group open only to Parties to the Protocol may be preferable.

The decision on that type of group to set up should be driven by the objectives of that group, particularly that of exchanging experience in implementing the Protocol and ensuring that any tracking and tracing regimes must be compliant with the Protocol requirements of independence from the tobacco industry set out in its article 8.12.

Florence Berteletti
Director Smokefree Partnership
Wael Safwat Abdul Meguid


WHO FCTC Article 12 commits governments to warn citizens about the harms of tobacco, the W in MPOWER. This is to help overcome decades of tobacco industry misinformation that encourages people— especially youth – to start and persist in using tobacco against the interests of their health and wellbeing and to de-normalize the social acceptability of tobacco use.

The most efficient way to quickly achieve the Article 12 objectives is to mount frequent, high impact, effective campaigns on media platforms that reach large populations such as television and radio, and increasingly, mobile and social media.

It’s true that signatories to the WHO FCTC are more likely to have implemented such campaigns than to have implemented sufficiently high tobacco taxes, but only one in five countries currently directs sufficient resources to media campaigns. Fewer countries again run campaigns with the frequency, intensity and duration required to drive rapid progress against tobacco use. This is problematic because low knowledge about tobacco’s harms and insufficient public education are key barriers to overall progress in tobacco control.

Constraints on health funding prevent greater investment in anti-tobacco campaigns, as do a lack of awareness of their efficacy and a perception that these campaigns are costly. In fact, there is convincing evidence that best practice mass media campaigns are highly effective in reaching consumers, helping to deliver behaviour change (for example, by prompting smokers to make a quit attempt) and to build support for policies such as smokefree public places.

Such campaigns are also highly cost-efficient and can be deployed rapidly, particularly when countries take advantage of the wealth of proven, best practice campaigns that can be adapted and broadcasted at relatively low cost.

For example, preliminary analysis of campaigns in three low- and middle income countries indicates that campaign awareness was associated with increased quit attempts among tobacco users, with related per-person costs per quit attempt of US$0.07 in India, US$0.21 in China and US$0.56 in Vietnam.

Countries are more likely to run campaigns at the optimum levels of frequency and duration when sustainable funding mechanisms are in place. Four good models are:

1. Transfer mass media campaign costs to the tobacco industry, as India has done. Warning messages about the harms of tobacco must be shown when tobacco is depicted in a film or TV program.
2. Dedicate tobacco tax revenue to mass media campaigns, as Thailand has done.
3. Require broadcasters to provide free air time, as Turkey has done. All broadcasters air at least 90 minutes of tobacco control content every month, including 30 minutes during prime time.
4. Agree and budget for upfront, multi-year funding commitments, as Australia has done.

Governments are advised to examine and emulate, where appropriate, these innovative funding, legislative and governance mechanisms to deliver an impactful anti-tobacco communication campaign strategy. This strategy should also seek to reinforce the graphic warnings printed on tobacco packs, to deliver maximum impact.

A position paper available at the Vital Strategies website (, goes into more detail on this topic.

Vital Strategies and other allies, including the Secretariat of the WHO FCTC, Framework Convention Alliance, and countrylevel organizations such as national health-promotion foundations, are available to provide advice and assistance to governments wishing to implement more sustainable funding mechanisms for tobacco control and improve their use of strategic communication campaigns.

Sandra Mullin
Senior Vice President, Policy,
Advocacy and Communication Vital Strategies


Behavioural science teaches us that people sometimes make seemingly irrational decisions, such as consuming tobacco despite knowing its deadly harms, because their decisions are manipulated by peripheral factors. Cues in their environment, like the barrage of tobacco depictions in films as glamorous and desirable, can push people towards a habit despite knowing its harms.

In India, as in other countries, product placement of tobacco in films increased when international and national regulations against the direct advertising of tobacco came into force. The tobacco industry now spends billions of dollars globally to carefully cultivate the image of tobacco use as glamorous, desirable and commonplace, through misleading depictions in film and TV.

Scientific studies have shown that exposure to such positive depictions has increased tobacco consumption, particularly among youth.

The problem is particularly acute in India. A study by the World Health Organization and the Health Ministry found that 76 percent of 1,000 movies made in India in one year depicted tobacco use. In terms of audience, around 15 million people see Bollywood films on a daily basis. In terms of influence, 52.2 percent of Indians who initiated tobacco use in childhood said they were influenced by cinematic depictions of tobacco. Indian students who are highly exposed to tobacco imagery in films have more than twice the risk of being a tobacco user as those with low exposure.

Youth are misled into thinking that tobacco use is normal, acceptable, socially beneficial and more common in society than it actually is.

To help counter this problem, in 2011 India implemented the “Film Rule”, under the Cigarettes and Other Tobacco Products Act 2003 (COPTA). TV programmes and films that show tobacco use must include messages – as flashing subtitles for the duration of the scene – that warn of tobacco’s harms, with anti-tobacco public service announcements (PSAs) shown before, during and after the broadcast itself. So the Film Rule, which is currently “under review” after lobbying from the film and tobacco industries, is helping to increase awareness and change attitudes regarding the real harms of tobacco use. Alongside graphic warnings, it is a critical tool in delivering information to populations with lower levels of literacy, who may not be reached by traditional health education campaigns.

Another, little-discussed aspect of the Film Rule is that it is giving a voice to a generation of young tobacco victims, empowering them to share their stories – their truth and the truth of many others in India today.

The tobacco industry effectively cocoons current and prospective tobacco users with soothing images of superstars smoking, which produces the deceptive comfort that the tobacco user, like the fictional characters on screen, is protected from the risk of disease and death.

The raw and real PSAs featuring victims of tobacco, currently broadcast under the Film Rule, pierce that bubble. They replace the glossy veneer that the industry seeks to peddle with the harsh reality of disfiguring disease and death, heartbreak among families and real economic loss in communities. And those PSAs, many developed by Vital Strategies, are produced to deliver the strongest possible impact while remaining respectful of the victim.

As we described in a paper published in the British Medical Journal publication, Tobacco Control , the PSAs are carefully developed in close concert with the victims, their families and their attending physicians. Each PSA is then tested among focus groups of tobacco users to ascertain if the message is clear and understood by those whom it seeks to save. Ultimately, we have found that it is critical to the victims themselves, and to tobacco users in the focus groups, that the true voice of the victim be heard, relating the actual pain of their suffering, and speaking their exhortations against others similarly falling prey to tobacco.

We must trust that the review of India’s Film Rule does not remove this vital tool from the armoury of our battle against the tobacco industry. The realities of tobacco must not be censored or sanitized.

We owe it to simply too costly.

India has the highest rate of oral cancers among young adults in the world. In a single year, tobacco-related illnesses cost our economy US$22.4 billion.

Today, tobacco causes 1.3 million deaths every year. Without urgent action, this toll is expected to rise to 8 million annually.

Rather than taking a backward step in revoking aspects of the Film Rule, India should be moving forward. Socially conscious TV and film industry professionals should be asking themselves whether tobacco needs to be in the picture. health professionals and tobacco victims would say it doesn’t.

And as we move towards a tobacco free world, depictions of tobacco use will look increasingly out of touch.

Dr. Nandita Murukutla, Vital Strategies


The illicit trade in tobacco products is a threat both to government finances and to public health. It robs governments of much needed revenues, and it undermines efforts to reduce tobacco consumption, particularly through the imposition of high levels of tobacco taxation.

Although by definition the global illicit trade in tobacco products is hard to measure with accuracy, it is known to be very substantial. A 2009 study estimated that 11.6 percent of the global cigarette market was illicit. This is equivalent to 657 billion cigarettes a year, and means a loss of tax revenues of about US$40.5 billion.

Overwhelming evidence from the tobacco industry’s own documents shows massive involvement in global cigarette smuggling operations. In 2000, for example, they were accused by the European Union of “an ongoing global scheme to smuggle cigarettes, launder the proceeds of narcotics trafficking, obstruct government oversight of the tobacco industry, fix prices, bribe foreign public officials, and conduct illegal trade with terrorist groups and state sponsors of terrorism.”

While the tobacco companies made some effort to get their house in order after these damning revelations, World Customs Organisation data indicate that, in 2012, still 69% of global cigarette seizures were tobacco company cigarettes. Over the last few years whistleblowers, investigative journalists and even government reports suggest that industry involvement in the illicit tobacco trade has continued and, at best, tobacco companies are failing to control their supply chain in the knowledge their products will end up on the illicit market.

Despite this, the tobacco industry has been aiming to position itself as central to solving the smuggling problem and in this way fundamentally undermine the Illicit Trade Protocol. Its key aim has been to ensure that Codentify, the industry’s track and tracing system, is taken up by governments to meet their obligations under Article 8 of the Protocol to Eliminate Illicit Trade in Tobacco Products.

The system was developed and patented and the trademark registered by Philip Morris International (PMI) in 2006. To promote the system as an “industry standard”, the four major tobacco multinationals, PMI, British American Tobacco (BAT), Japan Tobacco International (JTI) and Imperial Tobacco Group (ITG) in 2011 created a Digital Coding and Tracking Association (DCTA), based in Zurich Switzerland.

The Codentify system uses relatively unsecured commercially available equipment on sites where operators may have a vested interest in misusing it. When enforcement agencies use Codentify codes in their investigations, the enquiries could be transparent to the industry, allowing it to manipulate replies and hide key data.

The system does not appear to prevent valid codes from being used twice. Therefore, counterfeiters and other illicit manufacturers could simply copy codes (sometimes called “code cloning”). Since Codentify codes are visible, it could be easy to collect a large number of such codes. If the same code is scanned twice on different packs it appears to be impossible to tell which is illicit.

Codentify also seems vulnerable to “code recycling”, to print valid codes on illicit products, for example by using codes originally printed on tobacco products that have been rejected and destroyed (which isn’t unusual during the production process).

There may also be a weakness around “code migration”; where codes printed in one country can be reprinted in another, creating apparently legal products that enforcement agencies could not effectively trace. Codes produced using inkjet printers may be easily erased or altered, and would therefore not be “securely affixed”, as required by the Protocol and Directive.

Some information required under the Protocol and Directive will not be known at the time of production, when Codentify codes would be printed. This includes shipment routes from manufacturing to first retailer, the identity of all purchasers from manufacturing to first retail outlet, and the invoices, order numbers and payments of all purchasers from manufacturing to first retailers. It is not clear how this information will be associated with Codentify codes.

The fact that the tobacco industry is controlling and promoting this system raises a serious concern notably because of the industry’s record of involement in illicit trade of
tobacco products.


New Zealand’s Smokefree 2025 goal is rooted in long-standing concerns among Mäori (the indigenous peoples of New Zealand) communities and leaders about the high rate of smoking related harms among Mäori.

In 2006 a leading Mäori Party Member of Parliament (MP), Hone Harawira, introduced a private member’s bill to make it illegal to produce or sell tobacco in Aotearoa (the Mäori name for New Zealand).

The bill was not successful.

However, it contributed to a change in focus of the aims for Mäori in tobacco control, from “auahi kore” (smoke-free), to “tupeka kore” (tobacco-free), led by another Mäori advocate, Shane Bradbrook.

The immediate trigger for New Zealand’s goal was the 2010 Mäori Affairs Select Committee (MASC) inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Mäori. The inquiry drew on input from multiple stakeholders, including Mäori communities, wh nau (extended family), hapü (sub-tribe), and iwi (tribes), researchers and clinicians.

The first of the MASC’s 42 recommendations was endorsed by the government in March 2011 in setting a goal of “reducing smoking prevalence and tobacco availability to minimal levels, thereby making New Zealand essentially a smoke-free nation by 2025.” In doing so it became the first government in the world to set a specific ‘endgame’ goal for the use of smoked tobacco products. This goal goes well beyond the more incremental target of the World Health Organization (WHO): a 30-percent reduction in  smoking prevalence, from 22 percent in 2010 to 15 percent in 2025.

New Zealand’s Smokefree 2025 goal has had a highly positive impact. It has created a clarity of purpose and clear timeline that has galvanised the tobacco control sector, media and the public. It has stimulated local Smokefree coalitions, and facilitated the discussion of radical interventions such as mandated very low nicotine cigarettes or radical reductions in supply of tobacco.

The goal has overwhelming public support and has ensured that tobacco control remains strongly on the political and policy agenda.

Since the adoption of the goal, some key interventions have been introduced, including:

• Annual, above-inflation, tobacco excise tax increases since 2010
• Introduction of smoke-free prisons in 2011
• Removal of point-of-sale tobacco displays in shops in 2012, and
• Substantial reductions in duty-free allowances for tobacco in 2014.

In September 2016 the bill to introduce standardised packaging (also known as plain packaging) was passed by Parliament; implementation will occur in the next 18 months. The Ministry of Health is currently consulting on permitting the sale of nicotine containing e-cigarettes and e-liquids.

There are however growing concerns about whether the Smokefree 2025 goal will be achieved. The goal is often interpreted as reaching a smoking prevalence of less than 5 percent.

Smoking prevalence in 2014-15 in the New Zealand Health Survey was 17 percent. Modelling studies suggest the government’s midpoint target of 10 percent by 2018, and the 5-percent target, are unlikely to be met on current trends. Furthermore, current smoking prevalence of 38 percent for Mäori and 25 percent for Pacific peoples are unacceptably high. Studies suggest that the 5- percent figure for Mäori will not be achieved until beyond 2060.

One of the key MASC recommendations was for the government to establish a tobacco control strategy and action plan with a strong emphasis on Mäorifocused outcomes.

No such plan has been developed. It is unclear how the government intends to achieve the Smokefree 2025 goal, and what measures will be taken to reduce the unacceptably high level of smoking among Mäori and Pacific peoples.

Furthermore, although the government has implemented some positive measures since 2011, many more, including several key recommendations in the MASC Inquiry report, remain unaddressed.

For example, the government Smokefree 2025 goal included the aim of reducing tobacco availability to minimal levels by 2025, and also a commitment to investigate options for measures to reduce tobacco supply. However, the ministry of health in a report to the MASC described these measures as ‘low priority’, and there is no
evidence of any investigation or implementation of supply-side measures, other than the restriction on duty-free sales introduced in 2014.

Adoption of the Smokefree 2025 goal put New Zealand at the forefront of tobacco control internationally. However, the goal will not be reached without bold and determined political leadership.

Interventions cannot be cherrypicked according to what is politically pragmatic.

Achievement of the goal will require the government to develop a strategy and introduce a comprehensive range of effective interventions, developed in partnership with Mäori and Pacific communities and leaders, building on the energy, commitment and innovation to achieve Smokefree 2025 that is being shown by local coalitions across New Zealand.

With such a robust, evidencebased and comprehensive approach, the Smokefree 2025 goal can and should be achieved.

Professor Richard Edwards , Co-Head of Department, Department of Public Health, University of Otago, Wellington,

Shayne Nahu, Health Promotion and Campaigns Manager, Cancer Society of New Zealand,

Boyd Broughton, Programme Manager, Action on Smoking and Health,

Zoe Hawke, General Manager Tobacco Control Advocacy, Häpai

Te Hauora Mäori Public Health,

Louisa Ryan, Pacific Health Manager, Heart Foundation.

Smoking banned in all indoor public sites, workplaces from March as city passes law

SHANGHAI will extend its smoking ban to all indoor public venues, indoor workplaces and public transport sites from March 2017, the city’s top legislative body said today.

That means the ban on smoking would be imposed at all the hotels, restaurants, offices, airports and railway stations and even entertainment venues, according to the city’s new smoking control regulation which was approved by the standing committee of Shanghai People’s Congress today.

Hotels cannot categorize smoking or non-smoking rooms, while restaurants and entertainment venues cannot set up smoking areas. The meeting rooms, canteens and offices of government agencies will also ban smoking. The airports, railway stations, ferry ports and bus stations will shut down all the smoking rooms, according to the regulation.

The new regulation also extend the smoking ban on outdoor areas to public venues for minors, such as primary schools, kindergartens and training institutes, children’s hospitals, historic venues, stadiums and public transport waiting areas. Performance areas like stages and audience areas will also be smoke-free.

“The regulation aims to take a stricter control on smoking and extend the smoking ban areas to protect the public from second-hand smoking,” said Ding Wei, deputy director of the congress’s legislation department.

The current regulation, which was introduced in 2009 ahead of the World Expo 2010 Shanghai, stipulates that star-rated hotels, restaurants, airports, railway stations and ferry terminals could set up smoking areas or smoking rooms. Hotels were allowed to categorize their rooms into smoking or non-smoking.

Considering the feasibility of the new regulation and avoiding the “walking smokers” on streets, the regulation has added that outdoor smoking spots can be set up near the public venues, workplaces and transportation hubs, Ding said.

However, the outdoor smoking areas must be away from the public and major passageways and have signs saying “Smoking is harmful to health.” Facilities to collect cigarette ash and butt must be arranged. They will also have to be approved by the city’s fire prevention authority, the regulation says.

Fines for breaking the new laws are unchanged at 50-200 yuan (US$7.34-US$29.4) for individuals and up to 30,000 yuan for companies.

Dozens quit smoking thanks to HKU service hotline

Dozens of smokers have successfully kicked the habit with the help of a hotline set up by the University of Hong Kong.

Altogether, 1,147 people have used the service in the past five years, of whom 233, or 23.5 percent, have stopped smoking, the Hong Kong Economic Journal reports.

The success rate was achieved within six months.

Project director Dr. William Li said the average age of participants was 19.9 years.

Three in five were students including three in 10 who used to smoke more than 10 cigarettes a day.

Just 10 percent of the help seekers have cut down on their tobacco intake.

Li said the situation is “quite worrying” but some cases are promising.

Ah-Tung, 18, started smoking a year ago because of pressure from school and personal relationship issues.

He used to consume half a pack of cigarettes a day.

An avid runner, he decided to seek help after noticing his health had deteriorated.

“I could only complete two laps on the jogging track when I was a smoker, but soon after I quit, I was capable of doing a lot more laps,” he said.

Li said Ah-Tung’s case is typical.

About 43 percent of the people who called the Youth Quitline said they suffer from emotional stress.

Li said those who are emotionally disturbed are more easily influenced by their peers would usually find it more difficult to quit smoking.

HKU School of Nursing also found that 60 percent of young smokers who tried to quit smoking have switched to electronic cigarettes (e-cigarettes), according to Ming Pao Daily.

The percentage was even higher among younger smokers.

Among e-cigarette smokers aged 25 and below, 43 percent are between 15 and 17 while those aged between 18 to 20 make up 35 percent of the group, followed by those from 21 to 25, which makes up 14 percent.

Lam Tai-hing, chair professor of the School of Public Health of the HKU Li Ka Shing Faculty of Medicine, said the success rate among traditional cigarette and e-cigarette smokers is more or less the same.

The figures suggest that e-cigarettes do not help smokers get rid of nicotine addiction, Lam said.

He said more effort is needed to educate the public about the dangers of smoking.

Lam also called for legislation to ban e-cigarettes.

Youth Quitline (5111 4333) targets smokers aged 25 and below.

WHO commends Shanghai’s move to strengthen smoke-free law; urges strict enforcement as way forward

The World Health Organization (WHO) warmly welcomes the strengthening of Shanghai’s existing tobacco control law with respect to smoke-free public places and work places. The Shanghai Regulations on Control of Smoking in Public Places was amended today after months of intense debate and deliberation.

“We are delighted that with the adoption of this new law, Shanghai will be protecting non-smokers from the deadly harms of second-hand smoke. The amended law clearly prohibits smoking in all indoor public places, work places, and public transport as well as in many outdoor public areas. We look forward to Shanghai’s continuous effort to fully implement and enforce the 100% indoor smoking ban without exceptions,” said Dr Bernhard Schwartländer, WHO Representative in China.

The WHO Framework Convention on Tobacco Control (WHO FCTC) – the global tobacco control treaty which China ratified in 2005 – requires all indoor public places and work places to be 100% smoke-free. This is because exposure to second-hand smoke kills – and there is no safe level of exposure. Governments, including in cities like Shanghai, have an obligation to protect non-smokers from toxic, carcinogenic second-hand smoke. Exposure to second-hand smoke causes around 100,000 deaths in China each year.

“When this new law comes into force from March next year, the people of Shanghai will be able to breathe smoke-free indoor air. This is a huge step forward for the health of Shanghai’s more than 20 million residents: deaths caused by involuntary exposure to second-hand smoke are entirely preventable, and from a public health perspective that is simply unacceptable,” Dr Schwartländer said.

WHO notes with concern the clause in the new law which states that the city government may issue specifications regarding indoor smoking rooms under special circumstances.

“We hope that this clause in the law is never invoked. Allowing indoor smoking rooms – in any circumstances – would be in clear contravention of the WHO FCTC. The emphasis should now be on ensuring that the new law is strictly enforced, without any exceptions. Shanghai can count on WHO’s full support in this regard,” Dr Schwartländer said.

“Cities like Beijing, Moscow and others around the world have clearly shown that a comprehensive law that is fully WHO FCTC compliant coupled with rigorous enforcement, public education, and strong political leadership is a sure-win formula for success. 100% smoke-free public places do work. And they are incredibly popular with the public,” said Dr Schwartländer.

As Shanghai plays host to the 9th Global Conference on Health Promotion in just 10 days’ time, all eyes will be on the city and its best practices in promoting public health.

“By fully implementing and enforcing the comprehensive indoor smoking ban without exceptions, Shanghai will once again be able to position itself as a leader in tobacco control and the Healthy City movement in China.” Dr Schwartländer concluded.

About the World Health Organization (WHO):

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

For more information, please contact:
Ms WU Linlin WHO China Office E-mail: Office Tel: +86 10 6532 7191

Tobacco usage linked to 40% of all cancers in US

Almost everyone knows tobacco can cause cancer— but did you know just how much cancer it can cause?

As it turns out, tobacco is responsible for nearly half of all cancer diagnosis in the nation, according to a new report from the Center for Disease Control. An estimated 40 percent of all cancer cases in the United States can be linked to tobacco usage.

And it’s not just lung cancer.

The CDC reports tobacco can cause cancers of the mouth and throat, the voice box, esophagus, stomach, kidney, pancreas, liver, bladder, cervix, colon and rectum, and a even a type of leukemia.

Around 343,000 people died from cancer each year between 2009 and 2013, the report said. Researchers said smoking is the main cause, and kicking the habit is the key to reducing cancer risk.

There are nearly 36 million smokers in the county, and because smoking changes a person’s DNA, some suffer from permanent brain damage. The research also revealed smoking is just four to five packs of cigarettes in your lifetime can cause permanent cell mutations in your lungs— that look kind of like scars.

However, doctors said there are a lot of thing that can revert back when you quit smoking, so there’s still a good reason to quit.

About 1.3 million lives have been saved as smoking rates have continued to drop since 1990, the CDC reports.

It’s simple. If you want to bring down your chances of getting cancer, then you should stop lighting up!