How effective are tobacco industry bar and club marketing efforts in reaching young adults?

OBJECTIVE: Recently, the tobacco industry has focused marketing efforts on young adults through bar and club promotions, such as advertising and distribution of free cigarettes in these settings. This study estimates the fraction of the California young adult population that might be exposed and potentially influenced by these efforts. DESIGN AND PARTICIPANTS: Data were from 9364 young adult (18-29 years) respondents to the cross sectional population based 2002 California Tobacco Survey. As background, we analysed social smoking (only smoke with other smokers), and enjoyment of smoking while drinking. Our main focus was on bar and club attendance, what was observed in bars and clubs, and how this might differ according to respondents' risk for future smoking. RESULTS: Social smokers comprised 30.0 (2.2)% of all current smokers, including experimenters. Nearly three quarters (74.5 (2.3)%) of current smokers/experimenters said they enjoyed smoking while drinking. About one third (33.8 (1.2)%) of all young adults said they attended bars and clubs at least sometimes; attendance was significantly higher among smokers and those at risk for future smoking. Close to 60% (57.9 (2.2)%) of bar and club attenders reported seeing cigarette advertising and promotions in these settings. Again, smokers and those at risk were more likely to report seeing such advertising and promotions in these settings. CONCLUSIONS: About 20% of all young adults and about 30% of those at risk for future smoking (including current smokers) were exposed to tobacco advertising and promotions in bars and clubs. These California results may be conservative, but nonetheless indicate that the group potentially influenced is sizable.

Adolescent smoking decline during California's tobacco control programme.

OBJECTIVE: California's comprehensive tobacco control programme was 13 years old in 2002; by then, children entering adolescence at the start of the programme were young adults. This study examines whether adolescent smoking declined over this period, whether any decline carried through to young adulthood, and whether it was specific to California. SETTING AND PARTICIPANTS: Most data were from the 1990-2002 California Tobacco Surveys (CTS) (adolescents 12-17 years, > 5000/survey, young adults 18-24 years, > 1000/survey). Additional data were from the national 1992/93-2001/02 Current Population Survey (CPS) (young adults 18-24 years, > 15,000/survey). RESULTS: Over the 13 year period in California, ever puffing declined by 70% in 12-13 year olds, by 53% in 14-15 year olds from 1992-2002, and by 34% in 16-17 year olds from 1996-2002 (CTS). As noted, the decline commenced progressively later in each older group. Smoking experimentation (1+ cigarettes) and established smoking (> 100 cigarettes in lifetime) showed similar patterns. Compared to 1990, the percentage of California young adults (CTS data) who ever experimented declined by 14%, with half of the decline from 1999-2002. CPS young adult smoking prevalence (established and now smoke everyday or some days) was constant in the rest of the USA over the entire period, but California showed a recent 18% decline from 1998/99 to 2001/02. CONCLUSIONS: California's comprehensive programme may have kept new adolescent cohorts from experimenting with cigarettes. Low young adolescent experimentation rates at programme start appeared to carry through to young adulthood, resulting in a recent drop in young adult smoking prevalence in California not observed in the rest of the USA.

Compliance and support for smoke-free school policies.

Our objective was to examine factors associated with compliance and support for a smoke-free campus before and after a 1995 campus-wide smoking ban for everyone, including teachers and visitors, in California. Adolescent (12-17 years) data from the 1993, 1996, 1999 and 2002 (N approximately 6000 each year) California Tobacco Surveys (population-based telephone surveys) were analyzed. Trends in compliance with smoke-free school policies and support for smoke-free campuses were examined among students in public and private schools. Perceived compliance with the no-smoking rule by most or all student smokers increased from 43.7 +/- 1.6% in 1993 to 71.5 +/- 1.4% in 2002. While non-smokers have overwhelmingly favored smoke-free school grounds since 1993 (more than 85% each survey year), support among current smokers increased from 55.8 +/- 4.7% in 1996 to 69.1 +/- 6.8% in 2002. Student smokers who saw teachers smoking in school were less likely to favor school smoking bans (odds ratio = 0.25, 95% confidence interval 0.12-0.49). The percentage of private school students seeing teachers smoke on school grounds has been at least twice that of public school students since 1996. Compliance with and support for smoke-free schools increased since smoking was banned on campus for everyone. Perceived compliance by teachers, much lower in private schools, appears to undermine student smokers' support of this policy. Increased efforts are necessary to communicate to teachers the importance of their modeling of policy compliance to students.

Changes in population attitudes about where smoking should not be allowed: California versus the rest of the USA.

BACKGROUND: The decade long California Tobacco Control Program is unique to the nation in its duration, emphasis, and level of funding. Programme emphasis is on changing social norms about smoking as a means to discourage smoking and thus reduce the harmful health effects of tobacco to the population. METHODS: Data from the 1992-93, 1995-96, and 1998-99 Tobacco Use Supplements to the national Current Population Survey (n > 175 000 each period) were used to examine changes in norms regarding where smoking should "not be allowed at all" in both California and in the rest of the USA. Venues queried were restaurants, hospitals, work areas, bars, indoor sports venues, and indoor shopping malls. RESULTS: There were substantial increases in the percentages of the adult population (18+ years) stating that smoking should not be allowed in the venues queried in California by 1998-99 compared to 1992-93; only modest increases were observed in the rest of the USA. In fact, for most venues, the percentages for the rest of the USA were lower in 1998-99 than in California in 1992-93. Further, the percentage increase over this period in respondents stating that smoking should not be allowed in four or more of the six venues was 30% in California and 23% in the rest of the USA. The most dramatic percentage increase in California occurred among current smokers (93%). CONCLUSIONS: A strong, comprehensive tobacco control programme such as California's can influence population norms, including those of smokers, with respect to where smoking should not be allowed.

Tolerance and immunity following in utero transplantation of allogeneic fetal liver cells: the cytokine shift.

Although in utero transplantation (IUT) has resulted in donor-specific tolerance to posnatal solid organ transplantation, the mechanisms of this tolerance remain poorly understood. Our recent findings demonstrate that under specific conditions prenatal injection of allogeneic cells may lead to allosensitization instead of tolerance. These laboratory observations were supported by clinical findings as well, and therefore suggested that, depending on the conditions of prenatal transplantation, tolerance or immunity may develop. The present study explored the role of CD4 cells, cytokines, and I-E superantigen in developing tolerance vs. immunity after in utero transplantation. Sixteen animals survived IUT (40-60% survival rate) and were free from any signs of graft-versus-host disease (GVHD). Mice were considered tolerant when their antidonor and antihost CTL responses were similar, sensitized when antidonor responses were significantly higher than antihost and anti-third-party responses, and nontolerant when antidonor responses in transplanted and control mice were similar. The TH1 --> TH2 shift was associated with tolerance and TH2 --> TH1 shift with allosensitization. Our results showed that tolerant BALB/c (H-2d, I-E+) --> CS7BL/6 (H-2b, I-E-) (2/7) mice showed higher IL-4 (p < 0.05) in antidonor MLR, and partial deletion of recipient I-E-reactive T cells (CD3Vbeta11) (p < 0.045). On the other hand, nontolerant animals (5/7) demonstrated high production of IFN-gamma (p < 0.05) without deletion of CD3Vbeta11 T cells. In C57CBL/6 (H-2b, I-E-) --> C3H (H-2k, I-E+) mice CD3Vbeta11 T cells do not play any role in tolerance induction because they are deleted in the C3H background. Tolerant mice (4/9) showed an overproduction of IL-4 (p < 0.05) in antidonor MLR whereas allosensitized animals (5/9) demonstrated high level of IFN-gamma (p < 0.05). Suppressor cells seem to play no role in tolerant C57BL/6 --> C3H as demonstrated by suppressor assay. Hence, a shift from TH1 --> TH2 or TH2 --> TH1 cytokines may determine whether tolerance or immunity develops.

Was there significant tax evasion after the 1999 50 cent per pack cigarette tax increase in California?

OBJECTIVES: Several states, including California, have implemented large cigarette excise tax increases, which may encourage smokers to purchase their cigarettes in other lower taxed states, or from other lower or non-taxed sources. Such tax evasion thwarts tobacco control objectives and may cost the state substantial tax revenues. Thus, this study investigates the extent of tax evasion in the 6-12 months after the implementation of California's 0.50 dollars/pack excise tax increase. DESIGN AND SETTING: Retrospective data analysis from the 1999 California Tobacco Surveys (CTS), a random digit dialled telephone survey of California households. MAIN OUTCOME MEASURES: Sources of cigarettes, average daily cigarette consumption, and reported price paid. RESULTS: Very few (5.1 (0.7)% (+/-95% confidence limits)) of California smokers avoided the excise tax by usually purchasing cigarettes from non- or lower taxed sources, such as out-of-state outlets, military commissaries, or the internet. The vast majority of smokers purchased their cigarettes from the most convenient and expensive sources: convenience stores/gas (petrol) stations (45.0 (1.9)%), liquor/drug stores (16.4 (1.6)%), and supermarkets (8.8 (1.2)%). CONCLUSIONS: Despite the potential savings, tax evasion by individual smokers does not appear to pose a serious threat to California's excise tax revenues or its tobacco control objectives.

Patterns of cigar use in California in 1999.

BACKGROUND: Adult cigar use in California increased substantially between 1990 and 1996. METHODS: Cigar smoking prevalence is from the 1990, 1996, and 1999 California Tobacco Surveys (CTS), large cross-sectional random-digit-dialed surveys designed to identify trends in tobacco use in the California population. Questions added to the 1999 CTS allowed a more detailed assessment of cigar smoking patterns. RESULTS: Adult cigar use prevalence increased from 2.5% (95% confidence interval [CI], 2.2-2.8) in 1990 to 4.9% (95% CI=4.5-5.3) in 1996, and declined to 4.4% (95% CI=4.1-4.7) in 1999. Nearly the entire decrease was accounted for by less use in adults who had never been cigarette smokers. Among current cigar smokers in 1999, 43.3% (95% CI=37.8-48.8) had not smoked a cigar in the last month, just 16.2% (95% CI=7.9-24.5) of never cigarette smokers smoked three or more cigars in the past month, but 10.4% (95% CI=5.0-15.8) of former cigarette smokers-the group with the highest level of cigar consumption-reported daily use. CONCLUSIONS: Cigar use may have peaked in California around 1996; in 1999, the intensity of use was generally at modest levels. California's bans on smoking in bars and restaurants may limit cigar smoking while drinking, so that the observed patterns may or may not reflect those in the rest of the United States.

News media coverage of smoking and health is associated with changes in population rates of smoking cessation but not initiation.

OBJECTIVE: To determine whether changes in news media coverage of smoking and health issues are associated with changes in smoking behaviour in the USA. DESIGN AND MAIN OUTCOME MEASURES: Issue importance in the US news media is assessed by the number of articles published annually in major magazines indexed in The Reader's Guide to Periodical Literature. Annual incidence rates for cessation and initiation in the USA were computed from the large, representative National Health Interview Surveys (1965-1992). Patterns in cessation incidence were considered for ages 20-34 years and 35-50 years. Initiation incidence was examined for adolescents (14-17 years) and young adults (18-21 years) of both sexes. RESULTS: From 1950 to the early 1980s, the annual incidence of cessation in the USA mirrored the pattern of news media coverage of smoking and health, particularly for middle aged smokers. Cessation rates in younger adults increased considerably when second hand smoke concerns started to increase in the US population. Incidence of initiation in young adults did not start to decline until the beginning of the public health campaign against smoking in the 1960s. Among adolescents, incidence rates did not start to decline until the 1970s, after the broadcast ban on cigarette advertising. CONCLUSIONS: The level of coverage of smoking and health in the news media may play an important role in determining the rate of population smoking cessation, but not initiation. In countries where cessation has lagged, advocates should work to increase the newsworthiness of smoking and health issues.

Determining the probability of future smoking among adolescents.

AIMS: To determine whether the probability of future current established smoking among adolescents is related to both previous smoking experience and cognitions regarding future smoking. DESIGN, SETTING AND PARTICIPANTS: The analyses used two principal datasets: (1) a US longitudinal sample of 7960 adolescents 12-18 years old in 1989 reinterviewed at 15-22 years in 1993, (2) a California longitudinal sample of 3376 adolescents 12-17 years old in 1993 reinterviewed at 15-20 years in 1996. MEASURES: Previous smoking experience was categorized as never smoked, puffed, non-recent or recent experimenting, and non-recent or current established smoking (> or = 100 cigarettes in life-time). Smoking intentions and efficacy expectations were used to classify adolescents as having low- or high-risk cognitions. FINDINGS: High-risk cognitions (HRCs) increased the probability of future current established smoking (FCES) within each level of previous smoking experience over low-risk cognitions (LRCs); the probability of FCES for those with LRCs was about the same as those in the previous experience group with HRCs. In the US sample, the 4-year probability of FCES ranged from 5.6% for committed never smokers (with LRCs) to 83.0% for current established smokers with HRCs. Development of HRCs among middle-school never smokers occurred rapidly through age 14 years. However, current established smoking did not increase until age 14 years and stabilized by age 19 years. Where sample size was sufficient, these findings were validated in the California sample. CONCLUSIONS: Effective prevention programs should aim to convert HRCs to LRCs regardless of past behavior, particularly among middle-school never smokers and high-school experimenters.

Index for US state tobacco control initial outcomes.

Public health tobacco control efforts have increasingly targeted communities in addition to individuals. Before population smoking decreases, effectiveness might be detected from initial outcomes reflecting these efforts, such as higher cigarette prices or more workplace and home smoking restrictions. Presumably, these initial outcomes will eventually influence smoking behavior. State-specific estimates of percentages of the population working or living under smoking bans are available from the 1992-1993 tobacco use supplement to the Current Population Survey, conducted annually by the US Bureau of the Census. In addition, the tobacco industry reports the average state cigarette price yearly. The authors constructed a tobacco control initial outcomes index (IOI) by using values of these variables for each state and correlated it with state-specific adult (aged > or =25 years) and youth (aged 15-24 years) smoking prevalence computed from the Current Population Survey and per capita cigarette consumption data computed from sales and Census Bureau data. Both adult smoking prevalence (r = -0.70) and per capita consumption (r = -0.73) were significantly correlated with the IOI; youth smoking prevalence correlated less well (r = -0.34). Although the analysis is not definitive, deseasonalized 1983-1997 consumption trends for IOI-based tertile groups were divergent beginning in 1993, with the high IOI group showing the greatest decrease. A high relative IOI index may be predictive of future smoking decreases and should be considered when tobacco control efforts are evaluated.

Factors influencing survival after resection for periampullary neoplasms.

BACKGROUND: The purpose of this study was to determine predictors of survival after resection for periampullary neoplasms. METHODS: Over a 15-year period, 208 patients underwent laparotomy for periampullary neoplasms. Data were analyzed to assess predictors of survival. RESULTS: Pathologic examination showed pancreatic cancer (n = 136; 65%), ampullary cancer (n = 28; 13%), distal common bile duct cancer (n = 10; 5%), duodenal cancer (n = 4; 2%), neuroendocrine tumor (n = 11; 5%), cystadenocarcinoma (n = 4; 2%), cystadenoma (n = 5; 2%), and other (n = 10; 5%). A total of 129 patients underwent pancreatic resection (71 Whipples, 35 total pancreatectomies, 21 distal pancreatectomies, and 2 partial pancreatectomies) whereas 79 patients were found to be unresectable and underwent palliative bypass and/or biopsy. Median survival was 20.4 months for resectable patients versus 4.5 months for unresectable patients (P<0.001). Of the 129 resected patients, factors significantly (P<0.05) favoring long-term survival on univariate analysis included well-differentiated histology, common bile duct or ampullary adenocarcinoma, early stage, tumor diameter <2 cm, negative margins, and absence of lymph node metastases, perineural, or vascular invasion. Age, sex, race, and type of procedure had no influence on survival. On multivariate analysis, only tumor differentiation appeared independently related to survival. Using Kendall's tau analysis, tumor type and grade correlated significantly with all other predictors. CONCLUSIONS: Of all variables studied, tumor type and poor tumor differentiation in periampullary neoplasms appear to be markers that predict a constellation of other adverse findings.

Association between household and workplace smoking restrictions and adolescent smoking.

CONTEXT: Recent marked increases in adolescent smoking indicate a need for new prevention approaches. Whether workplace and home smoking restrictions play a role in such prevention is unknown. OBJECTIVE: To assess the association between workplace and home smoking restrictions and adolescent smoking. DESIGN, SETTING, AND SUBJECTS: Data were analyzed from 2 large national population-based surveys, the Current Population Surveys of 1992-1993 and 1995-1996, which included 17,185 adolescents aged 15 to 17 years. MAIN OUTCOME MEASURES: Smoking status of the adolescents surveyed, compared by presence of home and workplace smoking restrictions. RESULTS: After adjusting for demographics and other smokers in the household, adolescents who lived in smoke-free households were 74% (95% confidence interval [CI], 62%-88%) as likely to be smokers as adolescents who lived in households with no smoking restrictions. Similarly, adolescents who worked in smoke-free workplaces were 68% (95% CI, 51%-90%) as likely to be smokers as adolescents who worked in a workplace with no smoking restrictions. Adolescent smokers were 1.80 (95% CI, 1.23-2.65) times more likely to be former smokers if they lived in smoke-free homes. The most marked relationship of home smoking restrictions to current adolescent smoking occurred in households where all other members were never-smokers. Current smoking prevalence among adolescents in homes without smoking restrictions approached that among adolescents in homes with a current smoker but with smoking restrictions. CONCLUSIONS: Parents with minor children should be encouraged to adopt smoke-free homes. Smoke-free workplaces can also augment smoking prevention. These findings emphasize the importance of tobacco control strategies aimed at the entire population rather than at youth alone. JAMA. 2000;284:717-722

Characterizing and identifying "hard-core" smokers: implications for further reducing smoking prevalence.

OBJECTIVES: Some smokers may never quit. Depending on how many of these "hard-core" smokers exist, tobacco control efforts could reach the limits of a minimum achievable smoking prevalence. We defined the hard core as heavy smokers with weak quitting histories who expect never to quit smoking. We compared them with other smokers and analyzed whether they represent a meaningful barrier to further reducing smoking prevalence. METHODS: We used data from the 1996 California Tobacco Surveys (18616 adults; response rate = 72.9%). RESULTS: In 1996, 5.2% of California smokers 26 years and older (1.3% of the California population) were hard-core smokers. Compared with other smokers, hard-core smokers were more likely to be retired non-Hispanic White males, with 12 years or less of education and incomes below $30,000 a year, who live alone. They began smoking at younger ages and attributed fewer negative health consequences to smoking than other smokers. CONCLUSIONS: Current tobacco control efforts have a long way to go before they "hit the wall." Nonetheless, the group of hard-core smokers represents a challenge because they appear to be largely unaffected by the messages of tobacco control.

A phase II study of two cycles of high-dose chemotherapy with autologous stem cell support in patients with metastatic breast cancer who meet eligibility criteria for a single cycle.

Multi-cycle high-dose chemotherapy with autologous stem cell support (HDC-ASCS) may improve the results obtained with single-cycle HDC-ASCS in metastatic breast cancer (MBC). However, the tolerability and efficacy of additional cycles of HDC-ASCS in patients selected using standard eligibility criteria for single cycle HDC-ASCS is uncertain. Twenty-nine patients with MBC and a CR or PR to induction chemotherapy were selected by standard institutional eligibility criteria for single-cycle HDC-ASCS. Cycle 1 HDC-ASCS (cyclophosphamide 6 g/m2; mitoxantrone 70 mg/m2; carboplatin 800 mg/m2) was followed by a planned second cycle (etoposide 1.6 g/m2; thiotepa 800 mg/m2; carboplatin 800 mg/m2 modulated by tamoxifen 120 mg/m2/day x 5 days) with a median interval of 3.2 months. CR rate was 20% after induction chemotherapy and 33% and 54% after HDC cycles I and II, respectively. Sixteen patients (55%) failed to complete HDC cycle II within 200 days because of disease progression, toxicity, inadequate stem cell collection, insurance denials or patient choice. Median progression-free survival (PFS) for all 29 patients entered is 301 days from date of HDC cycle I and actuarial PFS at 2 years is 35%. For the 13 patients who received the two cycles of HDC-ASCS, actuarial PFS at 2 years was 54% (P = NS compared to those receiving only one cycle). These data show that a second cycle of full-dose intensity HDC-ASCS may increase the proportion of patients with MBC that achieve CR and may increase PFS. However, a large proportion of patients that complete HDC-ASCS cycle I may fail to proceed to cycle II in a timely fashion. Bone Marrow Transplantation (2000) 25, 519-524.

The effects of household and workplace smoking restrictions on quitting behaviours.

OBJECTIVE: To assess the association of household and workplace smoking restrictions with quit attempts, six month cessation, and light smoking. DESIGN: Logistic regressions identified the association of household and workplace smoking restrictions with attempts to quit, six month cessation, and light smoking. SETTING: Large population surveys, United States. SUBJECTS: Respondents (n = 48,584) smoked during the year before interview in 1992-1993, lived with at least one other person, and were either current daily smokers or were former smokers when interviewed. MAIN OUTCOME MEASURES: The outcome measures were an attempt to quit during the last 12 months, cessation for at least six months among those who made an attempt to quit, and light smoking (< 15 cigarettes a day). RESULTS: Smokers who lived (odds ratio (OR) = 3.86; 95% confidence interval (CI) = 3.57 to 4.18) or worked (OR = 1.14; 95% CI = 1.05 to 1.24) under a total smoking ban were more likely to report a quit attempt in the previous year. Among those who made an attempt, those who lived (OR = 1.65, 95% CI = 1.43 to 1.91) or worked (OR = 1.21, 95% CI = 1.003 to 1.45) under a total smoking ban were more likely to be in cessation for at least six months. Current daily smokers who lived (OR = 2.73, 95% CI = 2.46 to 3.04) or worked (OR = 1.53, 95% CI = 1.38 to 1.70) under a total smoking ban were more likely to be light smokers. CONCLUSIONS: Both workplace and household smoking restrictions were associated with higher rates of cessation attempts, lower rates of relapse in smokers who attempt to quit, and higher rates of light smoking among current daily smokers.

How many adolescents start smoking each day in the United States?

PURPOSE: To provide daily estimates of first experimentation and attainment of established smoking in adolescents 11-17 years of age. METHODS: The 1989 and 1993 Teenage Attitudes and Practices Surveys (TAPS) (16,954 observations) was used to estimate rates in 1991 for: (a) first experimentation (even a few puffs), and (b) established smoking (reaching a lifetime level of at least 100 cigarettes). The 1992 and 1993 Current Population Surveys (CPS) (82,279 adults) allowed calculation of year-specific initiation rates (1980-1989) from the age respondents reported as having started smoking "fairly regularly." Rates were applied to Census data for the appropriate years to yield numbers accruing each day. Estimates were calculated for adolescents (11- to 17-year-olds) and youth (11- to 20-year-olds). RESULTS: For TAPS, in 1991, 4824 adolescents first tried cigarettes and 1975 became established smokers each day. Considering all youth, these estimates increase to 5497/day for first experimentation and to 2933/day for established smokers. For CPS, from 1980 to 1989, around 2300 adolescents initiated fairly regular smoking each day. For all youth, the estimate has increased to about 3400/day. CONCLUSIONS: Because approximately 4800 adolescents and 5500 youth appear to be experimenting with cigarettes for the first time each day, and close to 3000 youth become established smokers daily, increased prevention efforts are clearly justified.

Sharing the blame: smoking experimentation and future smoking-attributable mortality due to Joe Camel and Marlboro advertising and promotions.

BACKGROUND: Despite public denials, internal tobacco company documents indicate that adolescents have long been the target of cigarette advertising and promotional activities. Recent longitudinal evidence suggests that 34% of new experimentation occurs because of advertising and promotions. OBJECTIVE: To apportion responsibility for smoking experimentation and future smoking-attributable mortality among major cigarette brands attractive to young people (Camel and Marlboro). DATA SOURCES, SETTING, AND PARTICIPANTS: Data were from confirmed never-smoking adolescents (12-17 years old) responding to the 1993 (n = 2659) and 1996 (n = 2779) population-based California Tobacco Surveys. MAIN OUTCOMES: Adolescents named the brand of their favourite cigarette advertisements and tobacco promotional items. Using these "market shares" and the relative importance of advertising and promotions in encouraging smoking, we estimated how many new experimenters from 1988 to 1998 in the United States can be attributed to Camel and Marlboro. From other data on the natural history of smoking, we projected how many future deaths in the United States can be attributed to each brand. RESULTS: Although Camel advertisements were favoured more than Marlboro and other brands in 1993 and 1996, the "market share" for promotional items shifted markedly during this period from Camel and other brands towards Marlboro. We estimated that between 1988 and 1998, there will be 7.9 million new experimenters because of tobacco advertising and promotions. This will result in 4.7 million new established smokers: 2.1, 1.2, and 1.4 million due to Camel, Marlboro, and other brands' advertising and promotions, respectively. Of these, 1.2 million will eventually die from smoking-attributable diseases: 520,000 from Camel, 300,000 from Marlboro, and the remainder from other brands. CONCLUSIONS: Our analysis provides a reasonable first estimate at sharing the blame for the long-term health consequences of smoking among the major brands that encourage adolescents to start smoking.