AUG/SEPT 2005
Volume 11 - No. 3

SRNT Newsletter

Advancing Science & Health

Aug/Sept 2005, Volume 11, Number 3

Smoking and Smoking Cessation in Argentina

by Luis Wehbe and Peter Hajek

Argentina has a population of 36 million (INDEC, 2001). Smoking rates there are higher than in the USA and Europe, with 46% of men and 35% of women smoking (Pitarque, Perel, & Sanchez, 2003a). The rates of smoking among young people, and overall tobacco consumption per capita are the highest in the continent (Pitarque, Perel, & Sanchez, 2003a). An estimated 16% of annual deaths in Argentina are caused by smoking, with lung cancer being the leading cause of smoking related death in men under 65 years of age and stroke playing the same role in the statistics for women in this age group. In people over 65, the leading smoking-related cause of death is cardiovascular disease (Perel, Pitarque, & Sanchez, 2003a).

The prevalence of smoking is currently on the rise, with overall smoking rates moving from 32% in 1992 to 40% in 2000. By the end of secondary school, 42% of students smoke regularly (Zanalda, 2002). The rate of smoking among medical doctors is now below that of the general population but still high at 33% (Zabert, 1998).

Argentina is a tobacco producing country, and this has influence on taxation, general attitude to smoking, and tobacco control policies. The relative importance of tobacco crops is limited to only 65.000 hectares (i.e. 0.4% of agricultural land growing tobacco; Corradini et al., 2002). Interestingly, there are 21,000 tobacco growers, with the majority owning relatively small plots of land. These family farms are mostly in the northern provinces of Catamarca, Chaco, Corrientes, Misiones y Tścuman, Salta and Jujuy (Corradini et al., 2002). However, the volume of tobacco produced is not negligible. Argentina is the 12th largest tobacco producer in the world (Food and Agriculture Department, 2002). Some 70,000 farm laborers work permanently on tobacco crops, and the annual income from tobacco exportation is estimated at $160,000,000 (Corradini et al., 2002).

About 9%-16% of domestic sales come from the illegal market. There is a strong smuggling network between Argentina and Brazil (mainly through Paraguay), and there are few effective control measures. These two countries share second place for volume of illegally sold cigarettes in South America, with Colombia at the top of the list (Aguinaga, Bialous, Shatenstein, & Peruga, 2002; Campaign for Tobacco Free Kids, 2002; Jha & Chaloupka, 2000).

Tobacco control legislation in Argentina is lenient and often ignored. Federal Law (23.344/86) restricts tobacco promotion to certain times of day and puts restrictions on TV and radio advertisements. It also prohibits distribution of tobacco samples at schools and controls the extent of smoking in TV programs. However, none of these rules are strictly enforced. Indirect advertisement is allowed, and this often targets vulnerable groups such as teenagers.

Health warnings on cigarette packs are compulsory and take 10% of the space on the side of the pack. The warnings are thus smaller than recommended by the Framework Convention, signed by Argentina. The lenience of the federal law is often compensated for by local government legislation on smoking in public places, schools, health centers, and public transportation (Molinari & Muller, 2004).

Cigarettes are very inexpensive in Argentina. A pack costs on average 2.6 pesos, which equates to about 0.9 US dollars, with 70% of this cost representing tax. Therefore, cigarettes are reasonably affordable even to low income groups.

At present the Ministry of Health is leading tobacco control activities in the country. It sponsors or runs a range of programs which aim to reduce tobacco consumption and exposure to second hand smoke, and it compiles smoking statistics. The Argentina Union Against Tobacco also makes a substantial contribution, together with other organizations such as national associations for cardiology and respiratory medicine. The national newspapers are devoting an increasing amount of space to tobacco control issues.

There is a growing awareness of health risks of smoking, as well as growing interest in smoking cessation. One example of this can be seen in the clinical work of the lead author, who runs one of the largest smoking cessation clinics in the country at Hospital de Comunidad in Mar del Plata (population 600, 000). Dr. Wehbe has witnessed steadily increasing interest in smoking cessation treatment over the past few years. Regarding smoking cessation medications, only bupropion and nicotine patches are available. The Clinic uses withdrawal oriented treatment combining medication, behavioral support (Hajek, 1989) and a telephone helpline. There are about 20 smoking cessation clinics in Argentina, mostly in Buenos Aires.

Argentinian tobacco control activities are increasing. Further progress in tobacco control, greater availability of treatments, and more training of health care providers in smoking cessation appear likely. There is also growing interest in tobacco research (Corradini et al., 2002, Perel, Pitarque, & Sanchez, 2003; Pitarque, Perel, & Sanchez, 2003a, Pitarque, Perel, & Sanchez, 2003b, Wehbe, 2003, Zabert, 1998; Zabert G., 1999). Several groups are studying the epidemiology and health risks of smoking. New projects concerning research in smoking cessation and collaboration with some of the world leading research centers are in the planning stages. It is hoped that links with SRNT will support and strengthen such developments.

Luis Wehbe, M.D., is Head of Respiratory Medicine, Hospital Privado de Comunidad, Buenos Aires, Argentina. Peter Hajek, Ph.D., is Professor of Clinical Psychology, Head of Psychology and Director of the Tobacco Dependence Research Center at Barts and The London, Queen Mary's School of Medicine, University of London.

References:
Aguinaga, I., Bialous S., Shatenstein S., & Peruga A. (2002). La rentabilidad a costa de la gente: Actividades de la industria tabacalera para comercializar cigarrillos en América Latina y el Caribe. OPS, 85-95 href www.paho.org.

Campaign for Tobacco Free Kids (2002). Illegal pathways to illegal profits. The big cigarette companies and international smuggling. tobaccofreekids.org.

Corradini, E., Cuesta, R., Merello, P. et al. (2002). Caracterización del sector productor tabacalero en la Argentina. Centro de Altos Estudios "Jorge Gándara", Facultad de Ciencias Agrarias; Serie "documentos de Investigación" 2002; Universidad Católica Argentina Santa Mar’a de los Buenos Aires.

Food and Agriculture Department. (2002). Tobacco Leaves, Area Harvested, 2001. FAO database, 2002. apps.fao.org.

Hajek, P. (1989). Withdrawal-oriented therapy for smokers. British Journal of Addiction, 84, 591-598.

Jha, P. & Chaloupka, F.J. (2000). Tobacco control in developing countries. Oxford, UK: Oxford University Press.

Molinari, M. & Muller, F. (2004). Un análisis de la legislación nacional e internacional en el control del tabaco. Polemos.

National Institute for Statistics (INDEC). 2001. www.indec.mecon.ar.

Perel, M., Pitarque, R., & Sanchez, G. (2003). Estimación del costo económico de la mortalidad atribuible al tabaco en Argentina. Codes of the Journal of Economic Literature I1. CEMA working papers 2003; Universidad del CEMA, www.cema.edu.ar.

Pitarque, R., Perel, P., & Sanchez, G. (2003a). Smoking attribuitable mortality in Argentina. World Conference on Tobacco or Health (WCTOH), S497.

Pitarque, R., Perel, P., & Sanchez, G. (2003b) Estimated tobacco related premature death and disability: Adjusted life years lost over the next 20 years in Argentina. WCTOH, S496.

Wehbe, L. (2003). Non significant weight gain in 20 patients who had stopped smoking using SR Bupropion. WCTOH, S672.

Zabert, G. (1998). Smoking prevalence among Argentinean Physicians. American Thoracic Society, 157, A504.

Zabert, G. (1999). Physicians' knowledge and attitude towards tobacco. AJRCCM, 159, A486.

Zanalda, B. (2002). Secretary of Public Health, Buenos Aires City Government, Advice Bulletin, 2^nd Semester.