Low cost of smokes works against program touting abstinence

By TRACEY EATON / The Dallas Morning News

HAVANA – Cuban health officials are trying to persuade at least 200,000 people to quit smoking in May as part of a stepped-up campaign against cigarettes. But it's a daunting task in a nation that has had a steamy love affair with tobacco for more than five centuries.

Tobacco companies in Cuba sell cigarettes for as little as 8 cents a pack, cheaper than anywhere in the world. And as cigarettes have become more affordable over the last decade, the number of young smokers has climbed, surveys show.

Alarmed, health officials are promoting new no-smoking zones and increasing tobacco education in the schools.

"We are carrying out a campaign against smoking. We are against smoking," said Dr. José Miguel Miyar, secretary of the Council of State, Cuba's top governing body.

A habit for millions

This month, health officials have been encouraging Cubans to sign up for the global Quit & Win competition, which runs through May 29, in which adults who have smoked for at least one year will try to abstain from smoking. The National Public Health Institute in Finland has coordinated the biennial event since 1994. Nearly 700,000 people took part in 2002. This year, as many as a million participants are expected from more than 100 nations.

Some critics question whether Cuba's anti-smoking crusade can be successful. Telling people not to smoke and then selling them dirt-cheap cigarettes is irrational, they argue. "It's schizophrenic," said Pedro de la Hoz, a Cuban journalist who writes about culture and music. What's more, he said, many people ignore the government's anti-smoking messages.

"Technically, you're not allowed to smoke on buses, for example. But a lot of the bus drivers smoke. That makes it hard for them to tell passengers they can't."

An estimated 3.25 million Cubans – nearly a third of the population – smoke cigarettes. About 6,000 of them die from smoking every year, health officials say.

And Cubans continue to light up, smoking a staggering 11 billion cigarettes per year, according to CubaNews, a Maryland-based newsletter.

Havana vendor Isabel Miranda, 50, prefers a Cuban brand called Aromas Rubios, or Blonde Aromas. Under a government rationing program that began in the 1960s, she is allowed to buy one pack per month at a subsidized price – 2.5 Cuban pesos or about 10 cents. Any additional cigarettes cost 7.6 pesos or about 29 cents per pack.

"I've smoked since age 13," she said.

Another brand, Titanes, or Titans, fetches about 8 cents a pack at the subsidized price. Otherwise, it's 27 cents – still about as cheap as cigarettes get.

The lowest price per pack found in a 2002 study of 87 countries, provinces and territories was 28 cents. Cigarette makers in Yugoslavia and Senegal shared that dubious honor. Trailing them were tobacco companies in Azerbaijan at 33 cents; Iran, 46 cents; Philippines, 51 cents; Pakistan, 53 cents; Syria, 56 cents; Vietnam, 57 cents; and Indonesia, 62 cents.

Lighting up early

Researchers from the World Health Organization and the Organization for Economic Cooperation and Development in Paris conducted the study. They concluded that the best way for governments to reduce smoking is to increase cigarette taxes.

Even a 10 percent rise in cigarette prices would cause about 42 million smokers to quit and prevent at least 10 million tobacco-related deaths worldwide, they contend.

Cuba wasn't included in the report. But Cuban health officials do take part in the Global Youth Tobacco Survey, which was developed by the Centers for Disease Control and Prevention in Atlanta and the World Health Organization.

In 2001, that survey showed that nearly 30 percent of Cuban students in grades seven through nine had tried smoking. And 88 percent said they brought cigarettes freely despite their age.

By law, Cubans aren't allowed to buy cigarettes unless they are at least 16. But many store clerks overlook that, and enforcement is light, teenage smokers say.

"I buy cigarettes all the time. I've never had a problem," said Yodel, 15, a Havana boy who declined to give his last name.

More and more young people – especially females – are drawn to smoking, health officials say. In 1990, 6.6 percent of students were regular smokers, a Cuban government study said. By 2001, that number had nearly doubled to 13 percent.

Attitudes toward cigarettes have changed, especially among youth, said Mr. de la Hoz, a longtime smoker. Many teenagers hid their habit in the 1960s and '70s. But now many flaunt it, he said.

"Today you see kids smoking right out in the open outside their schools," he said. "In my day, I didn't dare smoke at school."

Cuba's romance with tobacco began long ago. The Taíno Indians, who had inhabited Cuba for about 300 years before Christopher Columbus's arrival in 1492, cherished tobacco.

"They not only smoked the finest cigars in the world, they inhaled an assortment of cigarettes wrapped in cornhusk, banana leaf, and fine tree barks," according to Cigarnexus.com, an informational Web site.

Today, Cuba's Cohiba cigars and other famous smokes get most of the attention. Lesser-known are its domestic cigarettes, going by such names as Popular, Monterrey and Vegas. They sell for as little as 50 cents a pack. Imports are pricier, ranging from Camels at $1.30 to Marlboros at $1.60.

By Cuban law, all must carry warning labels saying smoking is a health hazard.

Flouting the laws

Cuba also bans cigarette ads in the media and outdoors. But many restaurants and bars display signs, ashtrays, plastic tables and trash cans emblazoned with cigarette brand names.

Smoking in offices, meeting halls, theaters, taxis and other public places has been officially banned for years, although many people flout the law.

Undeterred, health officials are trying to expand the no-smoking zones, asking Cubans not to puff cigarettes at factories, schools or even at home if nonsmokers are around.

Key to Cuba's anti-cigarette drive is the network of family doctors working in cities, towns and villages throughout the country. Their clinics are often next to their homes, and their patients are their neighbors.

In 2000 and 2002, Cuban health officials claimed the highest number of successful quitters per capita in the Americas with 33,808 and 155,188, respectively. Their goal this year is 200,000.

Nieves Nodarse, a Havana retiree, won't be among them, saying she sees no sense in quitting now after having smoked for 44 years.

"I know it's harmful," the 58-year-old said. "But I like it. And it's the only vice I have."

Abraham Cabrera, 43, a Havana refrigerator technician who has smoked for 23 years, said he accepts the risks.

"Smoking hurts you, but it also gives you moments of pleasure. After breakfast and before going to bed is when I like to smoke the most."

Twenty-something Mayuris Batallé is another die-hard smoker. Her brand is Hollywood, which sells for $1 a pack – about what most Cubans earn in two days.

"Buying them is a strain," she said, but anything's better than the 7-cent-a-pack cigarettes.

"They taste terrible. Even worse than that ugly thing," she said, pointing to a dead gray mouse next to her table at a Havana cafeteria. "They also give you terrible breath."

Despite it all, giving up smoking can be agonizing because cigarettes are so addictive – "just like heroin, cocaine and crack," said Roger Aveyard, a Nebraska psychologist who wrote a guide to quitting the habit.

"It kind of takes over the brain," said the counselor, who decided to quit after going into the shower with a cigarette one morning and puzzling over ways to keep it dry.

Alain Brooks, 26, a Havana electrician, said he's managed to quit only once – and that was after a throat operation.

"I picked up the habit again within a month," he said.