Concern about the harm that tobacco use causes usually focuses on the risks of serious illness and premature death that smokers and their families face. The statistics are probably well known to readers of this journal—an estimated 4 million deaths are caused by tobacco each year, with the figure expected to reach 10 million per year by 2030 given current trends in tobacco use.1 The proportion of that burden borne by people living in low and middle income countries is rapidly increasing from 50% to 70%. Countries still grappling with infectious diseases traditionally associated with low incomes, increasingly also face a rising epidemic of cancers, and respiratory and circulatory diseases caused by tobacco.

Many (but not all) of the risks to health and life caused by tobacco consumption develop over a long period, and take decades to become fully evident. But tobacco use can also inflict immediate harm on users and their families, damage that is wreaked little by little each day, and is usually overlooked. This is the damage that is done when scarce family resources are spent on tobacco products instead of on food, or other essential needs. Even a small diversion of resources of poor families who live at or below the edge of poverty can have a significant impact on their health and nutrition. The article by Efroymson and her colleagues in this journal makes an important and …