摘要：The future of the tobacco-produced disease epidemic rests in low- and middle-income countries, where cigarette sales are growing—the result of rising incomes, trade liberalization, liberalization of the treatment of women, and the introduction of Western-style advertising. Research on disease causation, epidemiology, and educational and policy interventions has contributed significantly to reducing smoking rates in developed countries. A similar contribution is needed in less affluent nations, but severe challenges are involved in implementing a robust research program in such countries. In an attempt to understand these challenges and begin to conceptualize an approach to overcoming them, I examine the need for and methods to achieve a program of meaningful research on tobacco and health, as well as health policy, in the developing world. Tobacco has entered the era of globalization. The business of selling cigarettes and, hence, the business of tobacco control, inevitably has joined Big Macs, MTV, Toyotas, and even terrorism in playing to an international audience. The major multinational tobacco companies function in scores of countries around the world. The economic future of the industry rests in low- and middle-income countries, where rising incomes, trade liberalization, liberalization in terms of the treatment of women, and the widespread introduction of sophisticated Western-style advertising ensure a thriving future for cigarette sales. The tobacco disease epidemic will thrive there as well. Consequently, the future of tobacco control must also reside in the developing world. The existence and prominence of the Framework Convention on Tobacco Control (FCTC)—the World Health Organization’s (WHO’s) first-ever use of its international treaty-making authority—demonstrate that the world’s health leaders clearly envision that future today. 1 Although not entirely oblivious of the need, researchers have been less adept at shifting from a nearly exclusive focus on developed countries toward one that encompasses issues pertinent to the spread of tobacco in developing nations as well. Creation of a robust developing country research program confronts a number of severe challenges. Here I strive to convey an understanding of these challenges and begin to conceptualize an approach to overcoming them. I address the need for and methods to achieve a program of meaningful research on tobacco and health and health policy in the developing world. After an overview of the magnitude and nature of the global tobacco epidemic, I discuss a framework for thinking about the stages of research in a global tobacco control context. I then briefly contemplate the historical role of nicotine and tobacco research and identify the domains of research that seem to be particularly critical for the future of international tobacco control. Next, I consider how research findings might make important contributions to global tobacco control and discuss obstacles that temper this potential. A number of existing international database resources facilitate development and application of useful research. I identify these resources and then turn to the need to expand research capacity in the world’s poorest countries. In addition, I address the challenge of generating interest in and use of research. I close with some comments on the role of research in the formulation, development, and eventual implementation of the FCTC.
