Newly hooked teenage smokers in China, Southeast Asia, and Eastern Europe pocket fresh packs of free cigarettes offered by sleekly dressed "Marlboro Girls" stationed on street corners.

In Africa, cigarette billboards praise the manhood of young boys not "afraid to take a chance" that tobacco may kill them.

In Bangladesh, ads equate smoking with wealth. Aid workers find that once hooked, many poor choose tobacco over better food.

Around the world, multinational tobacco companies are reaching out for replacement smokers to protect profits as smoking rates drop in America.

Their tactics are working, and health officials in the new target nations are asking themselves where the money will come from for new medical facilities to treat the flood of disease that is expected as smoking rates mushroom.

Now the targeted nations are fighting back, with the world's first international tobacco control treaty, the Framework Convention on Tobacco Control (FCTC), proposed by the World Health Organization (WHO).

The treaty is backed by the Framework Convention Alliance (FCA), a group representing over 60 countries and comprised of more than 200 non-governmental organizations — including the ACS and the International Union Against Cancer (UICC). The organizations represented by the FCA are united in their goal of preventing cancer and other tobacco-related disease through a strong, clear, and effective treaty.

For adequate funding for the treaty to be enforced John Seffrin, PhD, chief executive officer of the American Cancer Society (ACS), and president of the UICC, says final details of the treaty will be hammered out this coming May in Geneva, but at a minimum it should:

• Stop advertising for tobacco products in countries where it is constitutionally possible

• Curb deceptive marketing, and require adequate warning labels
• Reduce youth smoking
• Reduce exposure to second-hand smoke
• Raise tobacco taxes, discouraging smoking
• Effectively fight smuggling

"Tobacco is already the leading cause of preventable death in the US, and if current trends continue, it will be the leading cause of premature death worldwide within 30 years," said Seffrin.

World Health Organization charts show a growing wave of tobacco-caused disease that will fill cancer wards and hospitals not yet built, eventually killing 500 million people before greater awareness of tobacco dangers among the tobacco-targeted populations brings relief.

Half of the 500 million who will die are children now, according to WHO experts.

Of the 10 million people expected to die yearly by 2025 of cancer, emphysema, heart disease, and other tobacco-caused diseases, about 70% are in countries targeted partly because they have limited resources to fight tobacco use, Seffrin noted.

Nations hoping to use tobacco taxes to pay for treating tobacco-caused disease find that their income is actually dwarfed by tobacco's costs to society, said Thomas Glynn, PhD, director of science and trends in the government relations office of the ACS.

And cigarette smuggling cheats governments of tax money while driving up demand by providing cigarettes cheaper than taxed ones, noted Glynn.

Currently, the European Union (EU) is suing the RJ Reynolds (RJR) tobacco company for helping cocaine traffickers use smuggled, untaxed cigarettes to launder their profits, costing the EU hundreds of millions of tax dollars while increasing RJR profits.

Canada pursued a similar suit for smuggling there, but it was dismissed in the courts Glynn said. Cigarette smuggling is increasingly a worldwide problem, he said.

Provisions similar to those laid out in the treaty have worked well in countries where they've been tried.

"South Africa has banned tobacco advertising, made public places smoke-free, has prominent health warnings on cigarette packs, and has taken other measures to reduce tobacco's damages here," said Yussuf Saloojee, PhD, executive director of that nation's National Council Against Smoking.

South African smoking has dropped every year since those measures began in the early 1990s, when the nation first became a democracy, noted Saloojee.

Yet tobacco ads from cross-border TV and magazines ads, as well as smuggling, are expected to become bigger problems in coming years. The FCTC can help in stopping that, said Saloojee.

Once finalized, the treaty will go to lawmakers in the participating nations for approval.

There is opposition to the treaty's most effective provisions in nations that are home to multinational tobacco companies, including the US, Germany, and Japan.

The US should drop its opposition to such measures, in spite of the $1 million a day the tobacco industry spends lobbying Congress every day it meets, said Seffrin.

"The American people want the US to be a major health exporter, not a major disease exporter," said Seffrin.

The ACS will continue helping nations develop tobacco control leaders who will work tirelessly for appropriate tobacco control policies and programs, and aid development of broad-based coalitions of other cancer organizations, according to Seffrin.

And the UICC will continue to help its member nations to push for support and passage of the Framework Convention for Tobacco Control, Seffrin said, because their joint physical and economic health depends on freedom from tobacco's damages.

"The scope of the disease, death, and loss of revenue caused by tobacco is such that the FCTC should be considered a minimum starting point for all nations to use in addressing the epidemic of tobacco use," said Seffrin.