As smoking rates fall in North America and western Europe, transnational tobacco companies (TTCs) from the United States and Great Britain turn to cigarette markets of the developing world to replace those smokers who have quit or died from smoking. The majority of these markets are dominated by state tobacco monopolies that advertise and promote smoking minimally. Few women or adolescents smoke in those nations. The majority of men do, but they smoke far fewer cigarettes per year than their counterparts in developed nations. Trade barriers in the developing world prevent foreign cigarette companies from entering. TTCs employ various techniques to force open those markets, including trade pressure from the US government. Once the market is open, Western cigarette advertising and promotions target nonsmoking women and children. Retail tobacco outlets increase, smoking rates rise, and more death and disease result. Latin America was the TTC target in the 1960s, the newly developed nations of Asia during the 1980s, and, today, the tobacco giants are pushing into eastern Europe, China, and Africa. If nothing is done, emerging national smoking-control programs will be overwhelmed, and state-owned cigarette monopolies will be taken over by the TTCs. Policies and programs to curb smoking exist, but for various reasons many lesser developed countries have not adopted them. The threat of TTC entry into a closed market offers an opportunity to form national coalitions against smoking, educate the public about the dangers of tobacco use, and implement public health policies and programs to restrict marketing and use of cigarettes.(ABSTRACT TRUNCATED AT 250 WORDS)