Global tobacco-related mortality will rise from the current 2.5 million to over 10 million annually by 2050. Most of this increase will occur in developing countries, where legislative controls and other measures that succeed in limiting the use of tobacco in industrialized countries do not exist or are at best inadequate. Of particular concern is the penetration of developing countries by the transnational tobacco companies, with aggressive promotional campaigns that include specific targeting of women, few of whom currently smoke in developing countries. The transnational tobacco companies advertise and market in ways long banned in the United States, for example, selling cigarettes without health warnings, advertising on television, and selling cigarettes with higher tar content than the same cigarettes sold in the United States. Also, tobacco advertising revenue prevents the media from reporting on the hazards of tobacco, a particularly serious problem in developing countries, where awareness of the harmfulness of tobacco is low. The transnational tobacco companies interfere with the national public health laws of developing countries via political and commercial pressures to open markets and to promote foreign cigarettes. This has led to an increase in market share by foreign cigarettes, but evidence also points to market expansion, especially among young people. The entry of the transnationals leads to a collapse of national tobacco monopolies or to their changing from unsophisticated government departments that may still cooperate with health initiatives on tobacco to copying the aggressive marketing and promotional behavior of the transnationals.(ABSTRACT TRUNCATED AT 250 WORDS)