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History of Tobacco Controlin the United StatesKristie L. Foley, Ph.D.
Associate Professor of Medical HumanitiesDavidson College
Szeged, Hungary 18 June 2011
HistoryHuron 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
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.
79% of tobacco grown
in 3 states
94% in 6 states
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
Adult per capital cigarette consumption in US:1900-1964
6
US Tobacco Program
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
1964 Surgeon General’s Report"cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action"Launched the first “wave” of the tobacco control science, policy, and advocacy
Adult per capital cigarette consumption in US:1900-1984
1965: Congress required all cigarette
Adult per capital cigarette consumption in US from 1900-2006
11
National Tobacco Control Program (NTCP)
1999 to present•CDC’s 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
Federalism Impacts Strategy
State-Level Tobacco Control
Targets:•Prevention•Cessation•Secondhand Smoke
Strategies
Educational•School-based and Mass Media
Clinical•Pharmacotherapy and behavioral
counseling
Regulatory•Advertising &
Promotion Restrictions•Youth access
restrictions•Product regulation•Package warnings•Clean-indoor air
regulation
Regulatory•Advertising &
Promotion Restrictions•Youth access
restrictions•Product regulation•Package warnings•Clean-indoor air
regulation
Regulatory•Advertising & Promotion
Restrictions•Youth access restrictions•Product regulation•Package warnings•Clean-indoor air
regulation
1998: Smoke-free restaurants, bars, & workplaces
2004
2008
2011
2011: Any Smoke-Free Indoor Space
Economic•Taxation•Tariffs and trade
The most direct and effective method for reducing tobacco consumption is to increase the price of tobacco products through tax increases.
Adult smoking rates vary across the US, but the states with the most smokers are in the Midwest and Southeast regions.
Price & Consumption—U.S.
FDA: Tobacco Control Act 2009
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
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
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
Acknowledgements•Funding by the National Institutes of Health: Fogarty International Center, National Cancer Institute, and National Institute on Drug Abuse ▫1R01TW007927-01