title: Understanding the relationship between sales of legal cigarettes and deaths: A case-study in Brazil.
abstract: Brazil has experienced a large decline in cigarette consumption in the last 25years. However, the most recent annual reports from the tobacco industry market leader in Brazil did not show a decrease in its gross profits. This is particularly important because tobacco industry donations/sponsorships come directly from the industry's reported gross-profits and are used to subvert health policies. The aim of the present study was to estimate (i) tobacco industry's gross-profit from legal cigarettes sales, and (ii) all-cause smoking-attributable deaths (SADs) among current Brazilian smokers who consumed legal cigarettes in 2013. We collected information on prevalence of legal cigarette use, cigarette consumption, price per cigarette pack among individuals aged ≥35years from the Global Adult Tobacco Survey, legal cigarettes sales (e.g., average costs and total volume of sales) provided by the Federal Secretariat of Revenues, and population mortality from the available vital statistics. With a gross-profit of US$1.378 billion (1.307-1.434) from sales of 54.6 billion sticks of cigarettes (53.4-55.5) to 8,424,510 smokers aged 35years and older in Brazil in 2013, cumulative SADs were estimated at 96,012 (85,647-107,654) (around 34% of cumulative SADs also including current smoking of illegal cigarettes and past smoking), i.e., one SAD was equivalent to a gross-profit of US$14,352 (12,140-16,743). Our results revealed the association between sales of cigarettes, gross-profits, and deaths in Brazil. As tobacco industry donations/sponsorships originate from industry's gross profits, which, in turn, depend on cigarette sales, our findings may be useful for increasing "moral pressure" on individuals and institutions and help countries in stopping tobacco industry interference in health policies.
authors.affiliation: Division of Epidemiology, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil. Electronic address: aszklo@inca.gov.br.
authors.forename: André Salem
authors.initials: AS
authors.lastname: Szklo
authors.affiliation: Center of Studies on Integration and Development (CINDES), Rio de Janeiro, Brazil.
authors.forename: Roberto Magno
authors.initials: RM
authors.lastname: Iglesias
authors.affiliation: Division of Epidemiology, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil.
authors.forename: Mirian Carvalho
authors.initials: MC
authors.lastname: de Souza
authors.affiliation: Division of Epidemiology, The Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Moysés
authors.initials: M
authors.lastname: Szklo
authors.affiliation: National Commission for the Implementation of the Framework Convention on Tobacco Control, Brazilian National Cancer Institute (INCA). Rio de Janeiro, Brazil.
authors.forename: Tânia Maria
authors.initials: TM
authors.lastname: Cavalcante
authors.affiliation: Division of Epidemiology, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil.
authors.forename: Liz Maria
authors.initials: LM
authors.lastname: de Almeida
mesh_terms: D000328:Adult; D001938:Brazil; D003132:Commerce / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology / Q000401:mortality*; D019460:Tobacco Industry / Q000191:economics* / Q000331:legislation & jurisprudence; D062789:Tobacco Products / Q000191:economics*
keywords: Health policy; Smoking; Tobacco industry