History of Tobacco Control in the United States

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History of Tobacco Controlin the United States

• Kristie L. Foley, Ph.D.
• Associate Professor of Medical Humanities
• Davidson College
• Szeged, Hungary
• 18 June 2011

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History

• Huron Indian myth has it that in ancient times,
  when the land was barren and the people were
  starving, the Great Spirit sent forth a woman to
  save humanity. As she traveled over the world,
  everywhere her right hand touched the soil, there
  grew potatoes. And everywhere her left hand
  touched the soil, there grew corn. And when the
  world was rich and fertile, she sat down and
  rested. When she arose, there grew tobacco...

Tobacco Huron Goddess
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From ceremonial to commercial

• From 1617 to 1793 tobacco was the most valuable
  staple export from the English American mainland.
• Until the 1960s, the U.S. not only grew but also
  manufactured and exported more tobacco than any
  other country.

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79 of tobacco grown in 3 states 94 in 6 states
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James Albert Bonsack of Roanoke, Va invented the
first cigarette rolling machine in 1880.

• Bonsack's cigarette rolling machine, as shown on
  U.S. patent 238,640.
• Tobacco companies
• American Tobacco
• Philip Morris
• RJ Reynolds
• Lorrilard
• Brown Williamson
• American Brands

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Adult per capital cigarette consumption in
US1900-1964
US Tobacco Program
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Call to action in 1961

• A letter was sent to the President
• American Cancer Society
• American Public Health Association
• American Heart Association
• National Tuberculosis Association
• Urging a commission to study the widespread
  implications of the tobacco problem
• Surgeon General Luther L. Terry

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1964 Surgeon Generals Report
"cigarette smoking is a health hazard of
sufficient importance in the United States to
warrant appropriate remedial action"
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Adult per capital cigarette consumption in
US1900-1984
1965 Congress required all cigarette
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Adult per capital cigarette consumption in US
from 1900-2006
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National Tobacco Control Program (NTCP) 1999 to
present

• CDCs Office on Smoking and Health created the
  National Program to encourage coordinated,
  national efforts to reduce tobacco-related
  diseases and deaths.
• All 50 states
• The District of Columbia
• Eight U.S. territories/jurisdictions
• Six national networks
• Eight tribal support centers

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Federalism Impacts Strategy
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State-Level Tobacco Control
Strategies

• Targets
• Prevention
• Cessation
• Secondhand Smoke

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Educational

• School-based and Mass Media

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Clinical

• Pharmacotherapy and behavioral counseling

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Regulatory

• Advertising Promotion Restrictions
• Youth access restrictions
• Product regulation
• Package warnings
• Clean-indoor air regulation

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Regulatory

• Advertising Promotion Restrictions
• Youth access restrictions
• Product regulation
• Package warnings
• Clean-indoor air regulation

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Regulatory

• Advertising Promotion Restrictions
• Youth access restrictions
• Product regulation
• Package warnings
• Clean-indoor air regulation

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1998 Smoke-free restaurants, bars, workplaces
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2004
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2008
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2011
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2011 Any Smoke-Free Indoor Space
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Economic

• Taxation
• Tariffs and trade

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Adult smoking rates vary across the US, but the
states with the most smokers are in the Midwest
and Southeast regions.
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Price ConsumptionU.S.
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FDA Tobacco Control Act 2009
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Key Elements of TCA

• Prohibits reduced harm claims (e.g., light
  cigarettes)
• Requires industry to
• submit marketing research
• disclose research on health effects and
  ingredients
• Requires bigger, bolder warnings
• FDA authority over registration inspection of
  tobacco companies
• FDA oversees the implementation of TCA

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Current Issues in US

• The decline in smoking has stalled in the past
  five years.
• Decreased spending on tobacco control at the
  state level
• Price
• Secondhand Smoke
• Product interests
• Potential impact of the Tobacco Control Act

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Final Thoughts

• To de-normalize tobacco
• Shift emphasis from individual to society
• Create a culture of unacceptability without
  blaming the tobacco user
• Hold government accountable demonstrate their
  economic interest

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Acknowledgements

• Funding by the National Institutes of Health
  Fogarty International Center, National Cancer
  Institute, and National Institute on Drug Abuse
• 1R01TW007927-01