PIP: This discussion describes the development of tobacco smoking in Africa, the increase in consumption, and how tobacco use is promoted. It also presents evidence to show that smoking-related diseases similar to those seen in Western nations may be emerging. Tobacco was first introduced into Africa in the 16th century by the Turks who brought it into Egypt. The smoking habits of today's Africans are governed by local custom and economic status. Cigarette smoking is replacing the traditional pipe (hookah), although the latter is still used, particularly in rural areas. The prevalence of smoking is higher in urban than rural areas. Traditionally, only men smoked, but the proportion of women smokers is now rising. Smoking is also increasing among African children and adolescents. Cigarette consumption was examined in the 6 African countries from which statistics were available. In all of them, it rose steeply between 1967-76 and actually doubled in Libya and Ethiopia. In Egypt domestic cigarette sales increased by 23% between 1976-78, but sales of imported cigarettes rose by 25% in 1 year alone. Consumption of imported cigarettes is rising in many African countries. Between 1965-76 the volume of tobacco imports almost doubled. Cigarette smuggling is common in some African countries and may account for about 1/3 of total cigarette consumption in the Sudan. Some African countries are expanding tobacco agriculture so that they can supply their own needs. Nigeria has increased tobacco cultivation by about 10% a year to meet local dmeands. Zaire's imports of tobacco increased by about 30% between 1969-73 but now expects to become self sufficient in tobacco production. Tanzania's tobacco output incrased 7-fold between 1962-74 and will continue to grow through the help of the International Development Association. Cigarettes are heavily promoted in Africa. The advertisements present smoking as socially desirable by showing young, happy people and by relating it to manliness and success. Smoking-related diseases have already made their appearance in Africa. The 2 most common types of cancer in the Natal Bantu are lung and esophageal tumors. Lung cancer in Natal men has increased 6-fold and in women about 5-fold over the past 11 years. Other studies from southern Africa show much higher smoking rates in patients with lung cancer than in controls. The incidence of esophageal cancer in blacks in Durban, South Africa, and Zimbabwe is among the highest in the world. Other suggestive associations with cigarette smoking in African subjects are bladder cancer, myocardial infarction, and chronic bronchitis. Many Western governments and health authorities now try to persuade people not to smoke, and in some developed countries consumption has already begun to fall. As a result, tobacco companies have started to diversify and intensify promotion of cigarettes and the growth of tobacco in the 3rd world.