U.S.
Tobacco
Exports
Fact
Sheet
MINIMAL
CLINICAL
INTERVENTIONS
Tobacco
use
remains
the
leading
cause
of
preventable
illness
and
death
in
the
United
States,
and
a
growing
number
of
other
countries
are
experiencing
the
health
burdens
of
tobacco
use.
Globally,
smoking-related
deaths
will
rise
to
10
million
per
year
by
2030,
with
7
million
of
these
deaths
occurring
in
developing
countries.
For
the
first
time,
the
United
States
and
other
countries
are
collaborating
to
create
an
international
framework
designed
to
stem
the
global
epidemic
of
tobacco-related
death
and
disease.
On
February
17,
1998,
President
Clinton
issued
a
directive
on
the
U.S.
foreign
tobacco
policy
to
all
diplomatic
posts.
The
directive
states
that
the
U.S.
Government
will
not
promote
the
sale
or
export
of
tobacco
and
tobacco
products
abroad.
The
directive
also
states
that
the
U.S.
Government
supports
tobacco
control
efforts
of
foreign
governments
and
their
people
and
specifically
directs
diplomatic
personnel
to
facilitate
those
efforts.
In
general,
U.S.
tobacco
exports
are
specifically
exempted
from
federal
laws
and
regulations
concerning
the
export
of
potentially
harmful
products.
The
Federal
Government
has
no
regulations
or
laws
governing
the
packaging
or
advertising
of
cigarettes
produced
domestically
for
export.
The
threat
of
retaliatory
trade
sanctions
has
successfully
opened
some
foreign
markets
to
U.S.
cigarette
manufacturers,
thereby
significantly
expanding
trade
in
tobacco
products
between
the
United
States
and
other
countries.
In
1991
the
market
share
of
U.S.
cigarette
companies
increased
by
an
average
of
600
percent
in
countries
affected
by
the
threat
of
trade
sanctions.
In
1998
the
United
States
exported
539
million
pounds
of
tobacco
leaves.
The
largest
export
markets
for
U.S.-grown
tobacco
in
recent
years
have
been
Japan,
Germany,
the
Netherlands,
and
Turkey.
Although
acreage
devoted
to
tobacco
farming
has
fallen
worldwide,
technological
improvements
have
led
to
overall
increases
in
tobacco
production.
In
1999
growers
around
the
world
produced
more
than
six
million
metric
tons
of
tobacco.
Four
countries
accounted
for
more
than
60%
of
this
production:
China
(34.9%),
India
(9.7%),
the
United
States
(9.4%),
and
Brazil
(8.2%).
In
some
producing
countries,
such
as
Zimbabwe,
nearly
all
tobacco
production
is
exported.
An
estimated
85%
of
the
worlds
tobacco
crop
is
used
for
cigarettes.
In
1996,
cigarette
manufacturers
around
the
world
produced
nearly
6
trillion
cigarettes.
These
areas
accounted
for
more
than
half
of
this
production:
China,
Europe,
and
the
United
States.
Although
cigarette
consumption
is
falling
in
industrialized
countries,
global
consumption
is
rising
because
of
significant
increases
in
developing
countries.
World
trade
in
cigarettes
has
grown
steadily
for
at
least
the
past
30
years.
U.S.
cigarette
firms
capitalized
on
this
growth,
expanding
cigarette
exports
from
an
average
of
24.3
billion
per
year
in
the
late
1960s
to
a
peak
of
almost
250
billion
in
1996;
as
a
result,
domestic
cigarette
production
rose
even
as
domestic
sales
were
declining.
Through
the
1990s,
nearly
30
percent
of
all
cigarettes
produced
in
the
United
States
were
exported.
The
implementation
of
multinational
agreements
liberalizing
trade,
including
trade
in
tobacco
and
tobacco
products,
is
likely
to
further
increase
U.S.
exports
of
tobacco
and
tobacco
products
to
countries
around
the
world.
A
probable
consequence
of
this
increase
is
that
the
prices
of
cigarettes
and
other
tobacco
products
will
fall
due
to
enhanced
competition.
Lower
prices
could
stimulate
the
use
of
cigarettes,
particularly
among
adolescents
and
young
adults.
Nicotine
gum
is
approved
as
an
over-the-counter
nicotine
replacement
product.
Chewing
the
gum
releases
nicotine,
which
is
absorbed
through
the
mouth
and
mucous
membranes.
Nicotine
gum
is
available
in
a
2-mg
dose
introduced
in
1984
and
a
4-mg
dose
introduced
in
1994.
The
higher
dose
of
nicotine
gum
may
be
a
better
aid
for
heavier
smokers
or
for
those
highly
dependent
on
nicotine.4
Nicotine
patches
contain
a
reservoir
of
nicotine
that
diffuses
through
the
skin
and
into
the
smokers
bloodstream
at
a
constant
rate.
Patches
are
available
both
as
over-the-counter
and
prescription
medications.4
Nicotine
nasal
spray
was
approved
for
prescription
use
in
March
1996.
The
spray
consists
of
a
pocket-sized
bottle
and
pump
assembly,
with
a
nozzle
that
is
inserted
into
the
nose.
Each
metered
spray
delivers
0.5
mg
of
nicotine
to
the
nasal
mucosa.3,4
In
May
1997
the
nicotine
inhaler
was
approved
as
a
prescription
medication
to
treat
tobacco
dependence.
The
inhaler
consists
of
a
plastic
tube
about
the
size
of
a
cigarette
and
contains
a
plug
filled
with
nicotine.
Menthol
is
added
to
the
plug
to
reduce
throat
irritation.
Smokers
puff
on
the
inhaler
as
they
would
a
cigarette.
Each
inhaler
contains
enough
nicotine
for
300
puffs.3,4
Clonidine
is
used
primarily
to
treat
high
blood
pressure
and
has
not
been
approved
by
the
FDA
as
a
smoking-cessation
medication.
Abrupt
discontinuation
of
clonidine
can
result
in
nervousness,
agitation,
headache,
and
tremor
accompanied
or
followed
by
a
rapid
rise
in
blood
pressure.
Therefore,
clinicians
need
to
be
aware
of
potential
side
effects
when
prescribing
this
medication
to
smokers.4
Nortriptyline
is
used
primarily
as
an
antidepressant
and
has
not
been
evaluated
or
approved
by
the
FDA
as
a
smoking-cessation
medication.
The
antidepressant
produces
a
number
of
side
effects,
including
sedation
and
dry
mouth.
It
is
recommended
that
nortriptyline
be
used
only
under
the
direction
of
a
physician.4
TREATING
OTHER
TOBACCO
USE
Smokeless
tobacco
users
should
be
strongly
urged
to
quit
and
treated
with
the
same
cessation
counseling
interventions
recommended
to
smokers.
Clinicians
delivering
dental
health
services
should
conduct
brief
interventions
with
all
smokeless
tobacco
users.4
Users
of
cigars,
pipes,
and
emerging
novel
tobacco
products
such
as
bidis
and
kreteks
(clove
cigarettes)
should
be
urged
to
quit
and
offered
the
same
counseling
interventions
recommended
for
smokers.4
ECONOMIC
BENEFITS
Cost-effectiveness
analyses
have
shown
that
smoking
cessation
treatment
compares
favorably
with
hypertension
treatment
and
other
preventive
interventions
such
as
annual
mammography,
pap
tests,
colon
cancer
screening,
and
treatment
of
high
levels
of
serum
cholesterol.3
Treating
tobacco
dependence
is
particularly
important
economically
because
smoking
cessation
can
help
prevent
a
variety
of
costly
chronic
diseases,
including
heart
disease,
cancer,
and
lung
disease.
In
fact,
smoking
cessation
treatment
has
been
referred
to
as
the
"gold
standard"
of
preventive
interventions.3
Progress
has
been
made
in
recent
years
in
disseminating
clinical
practice
guidelines
on
smoking
cessation.
Healthy
People
2010
calls
for
universal
insurance
coverage,
both
public
and
private,
of
evidence-based
treatment
for
nicotine
dependency
for
all
patients
who
smoke.3
The
Centers
for
Disease
Control
and
Prevention
recommends
that
treatment
for
tobacco
addiction
should
include
(1)
population
based
counseling
and
treatment
programs,
such
as
cessation
helplines;
(2)
adoption
recommendations
from
the
PHS
clinical
practice
guideline;
(3)
coverage
of
treatment
for
tobacco
dependence
under
both
public
and
private
insurance;
and
(4)
elimination
of
cost
barriers
to
treatment
for
underserved
populations,
particularly
the
uninsured.5
REFERENCES
1.
Centers
for
Disease
Control
and
Prevention.
Cigarette
smoking
among
adultsUnited
States,
1993.
MMWR
1994
43:925-29.
2.
Centers
for
Disease
Control
and
Prevention.
Smoking
cessation
during
previous
year
among
adultsUnited
States,
1990
and
1991.
MMWR
1993
42:504-7.
3.
U.S.
Department
of
Health
and
Human
Services.
Reducing
Tobacco
Use:
A
Report
of
the
Surgeon
General.
Atlanta:
U.S.
Department
of
Health
and
Human
Services,
Centers
for
Disease
Control
and
Prevention,
2000.
4.
U.S.
Department
of
Health
and
Human
Services.
Public
Health
Service.
Treating
Tobacco
Use
and
Dependence.
Clinical
Practice
Guideline.
Rockville,
MD,
2000.
5.
Centers
for
Disease
Control
and
Prevention.
Best
Practices
for
Comprehensive
Tobacco
Control
Programs,
1999.
Atlanta:
U.S.
Department
of
Health
and
Human
Services,
Centers
for
Disease
Control
and
Prevention,
1999.
|
