I first visited the United States as Fulbright scholar in 1996. Then and subsequently I obtained a number of impressions with this country - polite and smiling people, modern research equipment and an excellent science library at the University of Georgia, a perfect ecological situation - flowers, squirrels, chipmunks and singing birds, fresh and clean air, green and clean surroundings. One thing that very much impressed me, and even now, during my third visit to the USA, I remain astonished, relatively few people smoke!

My current visit to the USA (2008) involves research in the area of phytoremediation of indoor air. Professor Stanley Kays, my supervisor, who organized my visit to the University of Georgia, introduced me to this interesting ecological problem, explaining that over 300 volatile organic compounds have been identified as indoor pollutants and many cause a diverse cross-section of illnesses - such as allergies, asthma, frequent fatigue, sick building syndrome. One major source of indoor pollution is smoking. This lead me to search the literature using the library's data bases and Internet sources to try and understand why there is much less smoking in the USA in contrast to the Ukraine where it is widespread and a serious health problem?

Mankind has been smoking since ancient times and the habit undergoes periodic increases during times of war or stress. In the United States as soon as cigarettes became popular, the incidence of lung cancer reached epidemic levels; in 1930, the lung-cancer death rate for men was 4.9 per 100,000 and by 1990, the rate had increased to 75.6 per 100,000 (Silent Victories, 2007). In 1964 the U.S. Surgeon General concluded that cigarette smoking is a cause of lung and laryngeal cancer in men, a probable cause of lung cancer in women, and that smoking harms nearly every organ of the body. The 2004 surgeon general's report reviewed more recent data showing that smoking causes many additional diseases including stomach cancer, acute myeloid leukemia, pancreatic cancer, and pneumonia. At the end of the twentieth century, smokers died more frequently from lung cancer - an average of 124,813 deaths annually between 1995 and 1999. By 2000, about 27,000 more women were dying annually from lung cancer than from breast cancer. On average, smoking shortens the lives of men by 13.2 years and women by 14.5 years when compared with individuals that have never smoked. Along with the human misery caused by smoking, the cost of smoking to the healthcare system and in reduced productivity of workers is astronomical.

Interestingly, one does not actually have to smoke to suffer the consequences of smoking. In 1986 the U.S. Surgeon General concluded that exposure to secondhand smoke can cause similar health problems, including cancer, in otherwise healthy adults. In 1992 the U.S. Environmental Protection Agency documented the effects of secondhand smoke on respiratory outcomes, especially among children.

Significant measures were subsequently taken to protect against smoke mediated health problems. Informational, educational, clinical, legislative, regulatory and other strategies were developed reduce smoking in the U.S. For example, smoking is now- banned in public places and all forms of public transport (e.g., airlines, trains, buses). Smoking was also been reduced via the Nonsmokers' Right Movement, and increase in the federal cigarette tax (effectively doubling it), TV and radio programs on the health hazards of smoking, conferences on smoking and health and so on. The results of these actions were significant. Cigarette smoking had begun increasing rapidly among high school students in the early 1990s, peaking in the 1996-97, and then began a decline by the end of decade. By the year 2000, smoking among high school seniors was 31% of the level in 1980, and since 2000 teenage smoking rates have fallen further.

What about Ukraine? What is current situation with smoking among the Ukrainian population and in particularly, Ukrainian youth?

Cigarette smoking is a major cause of morbidity and mortality in the former Soviet countries. The prevalence of individuals that regularly smoked throughout their lifetime was 80.5% in men and 18.7% in women, with the median ages for starting to smoke 17 and 18, respectively. The youngest female cohorts (born 1965-1984) were 26 times more likely to start smoking than the oldest (Webb et al., 2007)

It was shown that 57 % of men and 10% of women were current smokers and an additional 21 and 7%, respectively, were ex-smokers (Gilmore et al., 2001). Smoking behavior has changed considerably over successive generations, with an increase in the proportion of women smoking and a reduction in the mean age at which smoking is taken up. Factors associated with smoking include young age, urban residence (among women), and material hardship, in particular unemployment.

Recent data (Andreeva et al., 2007) indicate that the risk of starting to smoke at a young age was related to the age of the individual, exposure to tobacco advertising and related information, exposure to second-hand smoke and having no household smoking restrictions. The prevalence of current smoking among Ukrainian men (standardized for age) was 54.8% in 2001 but had increased to 66.8% in 2005. Among Ukrainian women, the incidence increased from 11.5% in 2001 to 20.0% in 2005. In the Ukraine, smoking prevalence is increasing in most population groups. Men with limited education had the highest smoking prevalence. Among women, the most educated, youngest and those living in larger cities are the most frequent tobacco users; other groups are also increasing their tobacco use. The decline in real cigarette prices in Ukraine in 2001-5 could be the main factor explaining the recent increasing prevalence of smoking (Andreeva and Krasovsky, 2007).

One impediment to changing this disastrous increasing frequency of smoking in the Ukraine is that many Ukrainian physicians, who should be implementing an anti-tobacco policy among their patients, actively use tobacco themselves. In all, 13.9% of physicians were current smokers and 21.6% reported being past smokers, with significantly more men than women in either category (Squier et al., 2006).

Data from a survey of 536 current smokers who completed a stages-of-change questionnaire in a public square in the centre of Kiev's business district, in 2000 indicated that the majority (56.1%) had not thought about stopping smoking. Less than 20% of the subjects intended to change their smoking behavior. A progressively later age for the beginning to smoke was associated with fewer cigarettes smoked per day. Females were more likely than males to seriously consider cutting down the number of cigarettes they smoked. However, males were more likely to have intentionally quit smoking for at least one day within the past year (McAllister Jenna et al., 2002).

What is the current smoking situation in Ukraine? Some of the best and brightest representatives of our youth population - students and scholars, are smoking and either do not understand or chose to ignore the future consequences of their actions. Based on this evidence, I readily concur with the conclusions of the scientists at National University of Kyiv-Mohyla Academy (Andreeva et al., 2007) that tobacco promotion efforts appear to have been significantly more effective in the Ukraine than those for smoking control.

• Silent Victories. The History and Practice of Public Health in Twentieth-Century America. J.W. Ward, C. Warren. Eds. Oxford Univ. Press, 2007.
• Webb Charles P M; Bromet Evelyn J; Tintle Nathan L; Schwartz Joseph E; Gluzman Semyon F; Kostyuchenko Stanislav; Havenaar Johan M Smoking initiation and nicotine dependence symptoms in Ukraine: findings from the Ukraine World Mental Health survey. Public health (2007), 121(9), 663-72.
• Gilmore A B; McKee M; Telishevska M; Rose R Epidemiology of smoking in Ukraine, 2000. Preventive medicine (2001), 33(5), 453-61.
• Andreeva Tatiana I; Krasovsky Konstantin S; Semenova Daria S Correlates of smoking initiation among young adults in Ukraine: a cross-sectional study. BMC public health (2007), 7(147), 106.
• Andreeva T.I and Krasovsky K.S. Changes in smoking prevalence in Ukraine in 2001-5. Tobacco control (2007), 16(3), 202-6.
• Squier C., Hesli V., Lowe J., Ponamorenko V., Medvedovskaya N. Tobacco use, cessation advice to patients and attitudes to tobacco control among physicians in Ukraine. European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP) (2006), 15(5), 458-63.
• McAllister J. M., Lindsay G. B, Merrill R. M, Perego U. A. Cigarette smoking and stages of change among men and women in Kiev, Ukraine. European journal of public health (2002), 12(4), 302-7.

Athens, 2008.