Harvard Public Health Review Winter 2007
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Making Smoking History Worldwide

Those figures can raise eyebrows, especially once they reach politicians’ ears through the media. For instance, in Armenia in 2002, Connolly says, $24 million entered the country in International Monetary Fund aid. That same year, $26 million left in the form of profits for British American Tobacco, one of the world’s largest tobacco companies.

Flush with data, Connolly delivers attention-getting press conferences. “I can go on the air in Greece, a nation with one of the highest smoking rates and say, ‘400,000 children here are going to die prematurely of smoking.’ To motivate society, you need to make people feel a bit of pain.”

Making a Move in Cyprus
HSPH’s global efforts on tobacco have recently gained traction in the Mediterranean island country of Cyprus, where 38 percent of men and 10 percent of women smoke. At the behest of the Cypriot government, Connolly and Philip Demokritou, an assistant professor of Aerosol Physics in the Department of Environmental Health at HSPH who directs the Cyprus International Institute for the Environment and Public Health (CII), have created a national tobacco research program that could have far-reaching influence.

Established within the CII, a HSPH-Cyprus research and training initiative launched in 2004 to help Eastern Mediterranean countries tackle public health and environmental problems, the program sponsors training, research, and outreach in tobacco control. To advance that agenda, Connolly, Demokritou, and colleagues in Cyprus and Boston have crafted a 95-page strategic plan emphasizing local research, a tobacco education mass media campaign, limits on youth access to tobacco, clean indoor-air policies, and treatment programs for nicotine dependence. Backed by Cypriot leaders, the plan will be implemented by a high-level task force led by the CII’s Adamos Adamou, chair of the European Parliament’s Committee on the Environment, Public Health, and Food Safety. Demokritou expects modest declines in smoking rates within three years, dramatic declines within a decade.

Pursuing tobacco control in Cyprus makes regional sense, he adds. Cyprus is neutral ground in a tense neighborhood; countries from throughout the Middle East and North Africa meet there to hash out their differences. “We’re optimistic that Cyprus can be a model for the whole Eastern Mediterranean,” Demokritou stresses. In the past two years, he, Connolly, and Koh have organized annual scientific conferences on tobacco and health in Cyprus for 14 Eastern Mediterranean nations.

Demokritou’s optimism rests on hard evidence that tobacco controls produce tangible results. In Massachusetts, cigarette consumption fell by 48 percent in 10 years; in Ireland, compliance with the national smoke-free policy approaches 90 percent, reports Luke Clancy, director of the Research Institute for a Tobacco-Free Society, in Dublin. Connolly and Clancy worked for 12 years to make Ireland’s smoke-free policy a reality.

Irish researchers have found that since the policy was enacted, indoor levels of benzene, particulates, and other tobacco pollutants have fallen dramatically. Respiratory function among workers has improved. And the policy has become popular among smokers and non-smokers alike.

“We’ve had officials from throughout Europe come here to see what we’ve done with their own eyes,” Clancy says. “What seemed to be important was that we had a consistent, coherent strategy—with a small group of influential people repeating the same facts and message again and again.”

Last year, the HSPH team measured small respirable particles in Irish-style pubs in 15 countries. The levels in Ireland’s own pubs were 93 percent lower than in pubs in countries that allowed smoking. Strategically, the study was released on St. Patrick’s Day to multinational media fanfare.

Koh says he, Connolly, and other colleagues are working to amplify a “real-world practice component” at their HSPH division to complement the School’s past efforts in tobacco epidemiology and community-based interventions. While at the Massachusetts Department of Public Health, they oversaw production of more than a hundred 30-second ads and countless billboards and other materials that helped Massachusetts go smoke-free; they are now exporting these globally. And the Massachusetts success story over which they presided has been widely praised as a global model. “Our approach turned out to be an extraordinarily effective cancer vaccine,” says Koh. Board-certified in oncology, hematology, dermatology, and internal medicine, he has seen many patients die of tobacco-related illnesses.

Having seen smoking decline in the United States, Koh and Connolly now have planes to catch. At the Maria Sklodowska-Curie Memorial Cancer Center in Warsaw, for example, which just won funding from the Bloomberg Foundation, they plan to do training in research and policy development in tobacco control for Poland and, potentially, Eastern Europe.

“This international work is the fun part,” Connolly says. “It’s getting hard to study smoking in Massachusetts; fewer and fewer people now smoke. But in Cyprus, or Greece, that’s a different story. We’re going after Big Tobacco wherever we can. If they want a fight, we’ll give it to them.”

Charlie Schmidt writes about public health and environmental health for Environmental Health Perspectives, Science, National Geographic Online, the Washington Post, and other journals and media outlets.

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