Todor Pavlovic was 14 and dancing at a local club in his hometown when a friend stuck a lit cigarette in his mouth, making him dizzy from his first hit of nicotine.

Soon, Todor was smoking two or three Marlboro Touch Blues a night with his middle school friends in Užice, a small industrial city in western Serbia. By high school, he was lighting up not just in the evening but between classes in the alley behind his school, or in the stalls of the school bathroom. Nine of his 10 closest friends were smokers.  

“For some people it was stress, for other people it was the social component,” he said, of how his group got hooked. “For some it was boredom.”

And while Todor’s experience starting smoking would be familiar to American and other Western teens 50 years ago, today’s tobacco epidemic is in some ways quite different than that of the 1970s. For one, the locus of the problem has swung from the wealthiest countries to emerging economies. While the United States, Japan and Western Europe were once the world’s main tobacco consumers, today about 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries such as Serbia, according to the World Health Organization. 

The tobacco industry has also made big bets on newer products such as electronic cigarettes, a market that was worth more than $20 billion last year and is forecast to grow rapidly over the next decade. The health risks of these vaping devices and other products are not yet fully understood, and may not be for decades — in many cases, scientists don’t even know what chemicals are being inhaled. In the meantime, public health officials fear that the new devices will undo years of anti-tobacco work, hook a new generation on nicotine and provide a gateway to smoking.

Even as the nature of the tobacco problem has changed, its consequences have never been worse. Population growth and aging mean a record 8.7 million people died of tobacco-related diseases in 2019, according to the Global Burden of Disease study published by The Lancet medical journal.  Even in the U.S. and Canada, both top performers when it comes to reducing smoking, tobacco remains the leading cause of preventable death.

Filling a coverage gap

The Examination is committed to reporting on the present and future threats posed by tobacco, and directing attention to those whose lives are altered by its consequences. We will also explore the risks of newer nicotine products such as e-cigarettes and nicotine pouches. As with all of our coverage, our reporting starts with questions, not answers, and seeks to reach evidence-based conclusions that inform the public and the public discourse around tobacco and the tobacco industry.

Given the death toll from tobacco compared with the relative amount of news coverage, we’d even argue that tobacco is one of the world’s great under-reported issues. 

Tobacco kills 12 times as many people each year as malaria and more than 1,000 times as many as terrorism.  

In the 20^th century, tobacco killed 100 million people – far more than the estimated military and civilian deaths in World War I and World War II combined. In the 21st century, we’ve already surpassed that figure by far, according to the Global Burden of Disease.

And then there’s the economics. Globally, tobacco costs the world economy $1 trillion per year in health care costs and lost productivity. That burden hits the poor the hardest. Not only are those with lower incomes more likely to use tobacco and face associated medical costs, studies show that tobacco purchases in places like Bangladesh, Mexico and Pakistan cut into household spending on education, clothing and housing. 

Kicking the habit

The health risks of smoking have been well-known for a half century, but nicotine’s addictiveness makes quitting a tall order. In the U.S., where smoking cessation products are widely available, research from the Centers for Disease Control and Prevention showed that while more than half of smokers try to quit in a given year, fewer than one in 12 succeed.  

Furthermore, since tobacco kills people relatively slowly — it is usually decades from first puff to a diagnosis of lung cancer or heart disease. The issue of tobacco control lacks the dramatic punch of issues like terrorism, drug overdoses or homicides, which quicken the pulse of politicians and journalists. 

Anti-smoking and other tobacco awareness campaigns also face cultural resistance. Throughout its long history of use by humans, tobacco has become associated with eating a good meal, coping with stress, having a drink at a bar, taking a break from work and even as a coda to sex. 

Tobacco’s continuing appeal is evident in parts of the Middle East, Asia and Africa, where the number of smokers is rising fast, propelled by population growth. 

Big Tobacco’s enduring might

Yet far and away the biggest obstacle to curtailing tobacco use is the tobacco industry itself. In many sectors, the promise of profits spurs beneficial innovations. In the tobacco industry, the word “innovation” has often meant finding new ways to curb regulation and sell deadly products. 

For decades, tobacco companies hid what they knew about the well-documented health risks and addictiveness of smoking. They targeted advertising appeals to teenagers, and burnished their reputations through high-profile donations to charities and universities. 

They profited from selling “light” and “low-tar” cigarettes on the premise that they were lower risk, despite studies showing such products were just as harmful as regular cigarettes. The industry purchased political support by funneling tobacco earnings to campaigns and lobbyists, and flouted tobacco taxes and import restrictions by facilitating the smuggling of its own products. 

Tobacco companies created front groups to fight smoking restrictions, conducted covert surveillance of tobacco control advocacy groups and operated intimidation campaigns against whistleblowers and scientists. 

In a landmark 1998 settlement with U.S. state attorneys general, major tobacco companies agreed to pay more than $200 billion for the costs of treating smoking-related disease, and publicly disavowed some of its most aggressive strategies. Even so, the substantial profits to be had from selling an easily produced and highly addictive product continue to create powerful incentives for them to repackage their old methods and find new ways to market addictive products. 

In the market for e-cigarettes, companies have targeted young people with flavors like tangerine-raspberry and cotton candy  as well as with sophisticated TikTok campaigns and other marketing tools such as sponsoring college scholarships and music festivals.

And the legal battles aren’t over. Now, a quarter century after the settlement with U.S. states, the tobacco industry is fighting similar lawsuits in countries like Canada, Brazil and Nigeria. It has launched hundreds of legal challenges to prevent, delay or weaken tobacco control laws since the international Framework Convention on Tobacco Control (FCTC) came into force in 2005.

In-depth reporting, from Serbia to China and beyond

It’s no coincidence that many of the tobacco industry’s most rapidly growing markets are in countries whose institutions — from health ministries, to the judiciary to the media — are least-equipped to push back on industry interference. 

Instead of staying in Serbia, Todor decided to move to Spain for university. The first thing he noticed was that Spain, unlike Serbia, had graphic warning labels on cigarette packs showing large pictures of diseased lungs and dying people. “That,” says Todor, “brings a bad vibe.”

Still, he puffed his way through his first year in Spain. But when he went out at night in Madrid, he found he could no longer smoke in bars and nightclubs like he did in Užice. When he wanted to smoke, instead of being in the midst of friends listening to a band, he was standing outside alone with his Marlboros. 

Prices were also higher, and his new friends thought differently about the habit. “As soon as I transitioned to Spain, a lot of my friends are American and they have a bad image of cigarettes,” he says. “I felt like they were looking at me weird.” 

Eventually he quit. Now 23, Todor’s move to Madrid may have kept him from becoming a lifelong smoker, and eventually a smoking statistic.

The tobacco industry’s fight today is to make sure that countries like Serbia don’t adopt laws like those in Spain — and that people like Todor keep lighting up, or at least reaching for a vape.

At The Examination, our goal is to deliver deep reporting on the tobacco industry’s ongoing efforts to keep the world hooked on nicotine. That will include coverage of  tobacco operations worldwide, with a particular emphasis on low- and middle-income countries; the emergence of addictive new nicotine products on which Big Tobacco has staked its future growth; and reporting the myriad and often hidden ways in which tobacco companies have sought to undermine public health policies.

We are committed to telling the most important stories — even those that are the most challenging to tell. That’s why for our debut tobacco feature, we report from China, home to the world’s largest smoking population and a state-controlled tobacco giant that has led an incredibly successful fight to limit smoking declines and derail the country’s commitments under a global tobacco control treaty.  

Want to help? You can reach us with tips, documents and story ideas here.

Jason McLure and María Pérez contributed reporting.