More than 13 months ago, the United States signed an international tobacco treaty designed to tighten control of cigarette advertising and consumption worldwide, and President Bush said he wanted the Senate to ratify it.

But the treaty -- already in effect in 70 nations from Britain to India to Mexico -- today remains unratified and little discussed in the United States.

It was May 2004 when then-Health and Human Services Secretary Tommy G. Thompson signed the treaty for the United States and said, "I'm hopeful we can get this treaty to pass on a bipartisan basis -- this year." It then disappeared into the State Department and so far has not reappeared.

"The treaty is still under interagency review," State Department spokesman Edgar Vasquez said, adding that it is unclear when the review will be completed. "No decision has been made."

The treaty, negotiated in Geneva over three years, calls for reducing tobacco consumption through various measures, including substantially increasing the size of safety warnings on packaging, strictly limiting cigarette advertising, and moving toward smoke-free workplaces and public areas. It also works to reduce cigarette smuggling -- a priority for tobacco companies.

The Bush administration has been slow to act on six other treaties that it has signed but not sent to the Senate for ratification, but inaction on the tobacco treaty poses unique problems.

Long the world leader in tobacco control, the United States now runs the risk of being a spectator when ratified treaty members meet early next year to establish a permanent operating structure and to set priorities for action. If the United States is not a voting treaty member, public health officials say, American views on issues including cigarette advertising, smuggling and secondhand smoke will inevitably be less persuasive.

The organizational meeting will be convened by the World Health Organization and will begin to implement the principles and directives of the Framework Convention on Tobacco Control. All 168 signatories will be able to attend, but only nations that have ratified the treaty will be able to vote. To qualify as a voting member, the United States would have to ratify the treaty by late October or early November, WHO officials said.

"Those who have not ratified can participate as observers, but they'll have no vote and it's unclear how much of a voice," said Heather Selin, tobacco control adviser for WHO's Americas office in Washington. "This will be an important meeting and will get the treaty machinery to start rolling."

Public health advocates report that even without the United States, the invigorated tobacco-control movement has been surprisingly effective in motivating governments to implement potentially lifesaving initiatives.

The use of tobacco by smoking or chewing is the second-leading cause of preventable death worldwide -- after high blood pressure -- and kills almost 5 million people a year, WHO estimates.

The Bush administration has not publicly voiced concerns about the treaty, but neither has it shown any enthusiasm since it was signed.

Some congressional officials say the administration doubts the treaty can win the two-thirds Senate majority needed for ratification, in large part because the two largest U.S. tobacco companies have objected to some of its provisions. Others say the administration is unwilling to displease the tobacco industry, which has long been a generous source of campaign funding.

Seth Moskowitz, a spokesman for R.J. Reynolds Tobacco Co., said his company has not taken a formal position on ratification, but it objects to treaty provisions that, it says, would restrict cigarette advertising and centralize and expand government authority over other aspects of the industry. "Some of the restrictions are things that could prevent us from competing effectively for the business of adult smokers," Moskowitz said.

Dawn Schneider, a spokeswoman for Altria Group, the parent of Philip Morris USA, said her company also has some concerns about the treaty -- especially possible restrictions on the sale of cigarettes in duty-free stores and an advertising ban in nations with constitutions that allow it.

But Schneider said Altria, unlike R.J. Reynolds, favors having the Food and Drug Administration regulate tobacco products and is using its influence in Congress to get a bill passed. "We believe the best and most effective way to implement [the goals of the treaty] is through FDA legislation," Schneider said.

It remains unclear how much support the treaty has in the Senate. Some senators, such as Richard Burr (R-N.C.), have been outspoken opponents. "Tobacco is an important agricultural product in our state, and anything that threatens the viability of tobacco farmers, he's opposed to it," said spokesman Douglas Heye.

But others have begun lobbying the administration to move the treaty forward.

"This long delay has been very discouraging to many senators," said Allison Dobson, spokeswoman for Sen. Tom Harkin (D-Iowa), who is drafting a letter to Bush calling for a prompt ratification vote. "Harkin believes the votes are there to ratify, but we're very concerned that the administration will end up siding with big tobacco again and not with public health," Dobson said.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said the administration is forfeiting the United States' long-standing leadership on tobacco-control issues and faces the prospect of having other nations make decisions that will have a significant impact on U.S. consumers and companies.

"Unlike some of the environmental treaties, nobody can point to any provision of this treaty that would infringe on American autonomy or otherwise adversely affect other American rights. The question then is 'Why haven't we even sent the treaty up for ratification?' " he asked. "The only answer I can come up with is this: that the administration is listening to our least progressive tobacco companies who oppose the treaty. At one point, the administration considered the treaty worth signing. What happened?"

Tamara Smith helps Joan Haskell with a cigarette purchase at a store in Selma, N.C. The treaty calls for reducing tobacco consumption.