Slide 8
Evolution of Tobacco
Control
Tobacco use has evolved ever since its discovery, which is believed to have occurred around
6000 BC.
First we will talk about how tobacco was used for religious, medical, and social reasons in the
United States and throughout the world. And we will take a close look at how tobacco use
evolved during the last century in the United States. We will also look at how the tobacco control
movement was born and how well it succeeded during the last half century.
Slide 9
Evolution of Tobacco Control
Although the origin of the tobacco plant is unknown, it is speculated to have started growing in
the Americas around 6000 BC. According to research, the tobacco plant is native to Central and
South America and was brought to North America – to Virginia- in the 16th and 17th centuries to
be grown for commercial tobacco products, including cigarettes, pipe tobacco, and cigars.
Native Americans viewed tobacco as sacred. Traditionally tobacco was offered as a gift to the
spirits in ceremonies and prayers.
Tobacco was also used for medical purposes. The Mayans smoked tobacco for such varied
conditions as asthma, bites and stings, bowel complaints, chills, fever, convulsions, nervous
ailments, sore eyes, skin diseases and urinary ailments.1
Reference:
1.
National Indian & Inuit Community Health Representatives Organization (NIICHRO). Historical
Background on Tobacco. Available at: www.niichro.com/Tobacco/Tobac1.html.
Slide 10
Evolution of Tobacco Control
Source: Centers for Disease Control and Prevention Public Health Images Library
Today, the tobacco plant is one of the most profitable commercial products of all time, and it’s
used in all regions of the world.
Tobacco control is a combination of individual and environmental interventions to reduce the use
of tobacco and the number of lives lost because of tobacco use.
Your packet of materials has a detailed graph showing pivotal events that influenced tobacco use
in the United States. But today, we will focus on just some of the highlights that shaped the
history of tobacco use.
Slide 11
Evolution of Tobacco Control
Adult Per Capita Cigarette Consumption
Number of Cigarettes
5,000
4,000
3,000
2,000
1,000
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Sources: Centers for Disease Control and Prevention and United States Department of Agriculture
Look at this graph showing the number cigarettes adults smoked per year from 1900 through
2009. Now, think of events during the last several decades that might relate to the shape of this
graph.
Give trainees 5- 10 minutes, if time permits, for them to discuss this in small groups.
Clearly, adult smoking has gone up and down during the past century. However, there is an
obvious overall increase from 1910 until 1970, and then a decline ever since. And, if you look
closely, you can see that in some years smoking dropped dramatically.1 In 2008, CDC reported
that the 2007 smoking prevalence had dropped below 20%, the lowest level since the early
1940s.2
References:
1.
Centers for Disease Control and Prevention. Tobacco Use Among Adults — United States, 2005. MMWR
2006:55(42);1145-1148. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5542a1.htm
2.
Centers for Disease Control and Prevention. Cigarette Smoking Among Adults—United States, 2007.
MMWR 2008:57(45):1221-1246. Available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a2.htm
Slide 12
Evolution of Tobacco Control
Adult Per Capita Cigarette Consumption
Number of Cigarettes
5,000
Broadcast
Ad Ban Surgeon General’s
Report on
Environmental
Tobacco Smoke
1st Surgeon
General’s Report
4,000
Master
Settlement
Agreement
End of WW II
3,000
First Fairness Doctrine
Modern Messages on TV
and Radio
Reports
2,000
1st SmokingCancer Concern
1,000
0
Great Depression
Family Smoking
Prevention and
Tobacco
Control Act
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Sources: Centers for Disease Control and Prevention and United States Department of Agriculture
Let’s take a look at some of these events . . .
Click the mouse for the events to appear on the screen.
By inserting historical events, such as [mention one or two], we now see how these events caused
fluctuations in tobacco use.
You can find a handout of this image in your packet of materials (Evolution of Tobacco
Control).
Slide 13
Evolution of Tobacco Control
1910 -- 1970
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U.S. enters World War I (1917)
The Great Depression (1929-early 1940s)
U.S. enters World War II (1941)
First modern reports link smoking & cancer (1950)
Surgeon General’s report on smoking and cancer (1964)
Fairness Doctrine messages on broadcast media (1967)
U.S. bans broadcast advertisements (1970)
Let’s look at some of these events in some detail. We won’t discuss every one of them because it
would take too long. We’ll just pick the major events: World War I, the first modern reports
linking smoking with cancer, and the 1964 Surgeon General’s report.
Slides 13 through 16 list the major tobacco-related events from World War 1 to the present. We
provide information (with sources) on all events in case trainees ask questions about them, and
we recommend that presenters become familiar with the information about every event. However,
we definitely do not suggest that presenters simply read what is written here. Present the
information in your own words and style.
United States enters World War I (1917)
War usually causes a sharp upsurge in tobacco use, and World War I was no exception. However,
part of the remarkable growth in cigarette smoking from 1910 to 1930, which includes the war
years, was because women began smoking.1
Great Depression (1929–early 1940s)
The tobacco industry was one of the only industries to make a profit during the Great
Depression. Tobacco was cheap to produce, and the demand for tobacco products increased as
people lost work or came back from war.2
United States enters World War II (1941)
As part of the World War II war effort, President Roosevelt made tobacco a protected crop.
Cigarettes were included in GIs C-rations, and tobacco companies sent millions of free cigarettes
to GIs. Tobacco use was so fierce that a shortage developed and, by the end of the war, cigarette
sales were at an all time high.2
First Reports Linking Smoking and Cancer (1950)
Science history was made. Three important epidemiologic studies showed the first powerful
links between smoking and lung cancer. In the May 27, 1950 issue of JAMA, Morton Levin
publishes first major study definitively linking smoking to lung cancer. In the same issue,
"Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of 684
Proved Cases," by Ernst L. Wynder and Evarts A. Graham of the United States, found that
96.5% of lung cancer patients interviewed were moderate heavy-to-chain-smokers. Later that
year, Richard Doll and A Bradford Hill publish first report on Smoking and Carcinoma of the
Lung in the British Medical Journal, finding that heavy smokers were fifty times as likely as
nonsmokers to contract lung cancer.3
Surgeon General’s Report (1964)
The 1964 Surgeon General’s report linking smoking and lung cancer is a significant event in
tobacco control. It had conclusive data on the health risks of smoking, and it cleared the way to
raise the public’s awareness of the dangers of tobacco use. However, behavior change takes
time, and we did not see a significant decline in tobacco use until 1973.4, 5
Fairness Doctrine messages on broadcast media (1967)
In 1967, the Federal Communications Commission (FCC) ruled that the Fairness Doctrine
applied to cigarette commercials, and that radio and television stations must devote hundreds of
millions of dollars worth of broadcast time to free antismoking messages. The doctrine required
equal time for antismoking commercials as for paid pro-tobacco commercials, which caused a
boom in compelling, free, public service antismoking commercials.6
United States bans broadcast advertisements for cigarettes (1970)
In April 1970, the U.S. Congress passed the Public Health Cigarette Smoking Act, which banned
all radio and television advertising of cigarettes. As a result, the free public service anti-smoking
advertisements required by the Fairness Doctrine disappeared. The ban on advertising is believed
to have contributed to the decline in tobacco use during the early 1970s.7
References:
1.
Hamilton JL. The Demand for Cigarettes: Advertising, the Health Scare, and the Cigarette Advertising Ban. The
Review of Economics and Statistics. 1972;54(4):401-411.
2.
Bernstein, MA. The Great Depression: Delayed Recovery and Economic Change in America, 1929-1939. New
York: Cambridge University Press, 1988.
3.
Borio, Gene. Tobacco Timeline Chapter 7: The Twentieth Century 1950-1999 – The Battle is Joined. 2007.
Available at: http://www.tobacco.org/resources/history/Tobacco_History20-2.html
4.
Centers for Disease Control and Prevention. History of the Surgeon General's Reports on Smoking and Health.
Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/history/index.htm
5.
U.S. Department of Health, Education, and Welfare. Smoking and Health: Report of the Advisory Committee to
the Surgeon General of the Public Health Service. Available at:
http://profiles.nlm.nih.gov/NN/B/B/M/Q/_/nnbbmq.pdf
6.
Seldon, BJ, Doroodian, K. A simultaneous model of cigarette advertising: Effects on demand and industry
response to public policy. The Review of Economics and Statistics. 1989;71(4):673-677.
7. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General.
2000. Available at: http://profiles.nlm.nih.gov/NN/B/B/L/Q/_/nnbblq.pdf
Slide 14
Evolution of Tobacco Control
1970 - 1998
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Nonsmokers’ rights movement begins (1976)
Federal cigarette tax doubles (1983)
Coalescence of modern advocacy movement (early 1980s)
Synar Amendment enacted (1992)
Environmental tobacco smoke listed as known human
carcinogen (1992)
The Master Settlement Agreement (1998)
Maryland bans smoking in private workplaces (1998)
Mention and discuss only nonsmoker’s rights movement, coalescence of modern
advocacy movement, and The Master Settlement Agreement. Of course, answer any
questions trainees ask about the other items.
Nonsmokers’ rights movement begins (1976)
In 1976, the organization Americans for Non-Smokers Rights was formed. Shortly after, in 1978,
a Roper Report prepared for the Tobacco Institute concluded that the nonsmokers' rights
movement was "the most dangerous development yet to the viability of the tobacco industry that
has yet occurred."1
Federal cigarette tax doubles (1983)
Federal taxes on tobacco have been part of the federal tax system since the Civil War. Between
1864 and 1983, the federal tax on cigarettes fluctuated in response to the revenue requirements of
the government, corresponding mainly to alternating periods of war and peace. In 1951, the
federal cigarette excise tax was increased from 7 cents to 8 cents per pack to help finance the
Korean War. The federal cigarette tax was not increased again until 1983, when it was doubled to
16 cents per pack.2
Coalescence of modern advocacy movement (early 1980s)
Until the early 1980s, the science and grassroots branches of tobacco control worked separately.
The modern advocacy movement was born when these two branches joined together to have a
more credible and powerful effect. The formation of groups such as DOC (Doctors Ought to
Care, 1977) and STAT (Stop Teenage Addiction to Tobacco, 1985) are described in the 2000
Surgeon General’s report Reducing Tobacco Use as two of the groups that bridged the gap
between the grassroots and national public health approaches to tobacco control.3
Synar Amendment Enacted (1992)
Congress adopted the Synar Amendment, as part of the Alcohol, Drug Abuse, and Mental Health
Administration Reorganization Act. The Synar Amendment requires states to enact laws
establishing minimum ages at which anyone can buy tobacco, to enforce those laws, and to show
progressive reductions in the availability of tobacco for sale to minors.4
Environmental tobacco smoke listed as a known human carcinogen (1992)
The EPA analyzed all available data, including data from more than 30 epidemiologic (human)
studies that looked at secondhand smoke and active smoking. After a July 1992 meeting, the
Science Advisory Board endorsed the major conclusions of the report, including its unanimous
endorsement of the classification of environmental tobacco smoke (ETS) as a Group A
(known human) carcinogen. In 1993, EPA released “Respiratory Health Effects of Passive
Smoking: Lung Cancer and Other Disorders.” Soon after, smoking was banned on all domestic
flights, a pivotal victory for smoke-free advocates.5
The Master Settlement Agreement (1998)
The Master Settlement Agreement (MSA) is a historic milestone in tobacco control, one that has
brought great opportunities and challenges. In November 1998, Attorneys General of 46 states,
the District of Columbia, and five commonwealths and territories, settled lawsuits with tobacco
companies to recoup hundreds of billions of dollars in Medicaid expenses resulting from
smoking-related illness and disease. This lawsuit resulted in a $206 billion settlement, payable
over 25 years. Mississippi, Florida, Texas, Minnesota had settled separate lawsuits previously.6
Maryland bans smoking in private workplaces (1998)
Maryland was the first state to ban smoking in workplaces. Previously, California enacted
restrictions, requiring workers to smoke only in ventilated areas. By 1998, twenty other states
required designated smoking areas in workplaces.7
References:
1.
Roper Organization. A Study of Public Attitudes Toward Cigarette Smoking and the Tobacco Industry in 1978,
p 6. Bates Number: TIMN0161665/1718 Available at: http://legacy.library.ucsf.edu/tid/vdr82f00
2.
National Academy of Sciences. Growing up Tobacco Free: Preventing Nicotine Addiction in Children and
Youths. 1994. Available at: http://print.nap.edu/pdf/0309051290/pdf_image/178.pdf
3.
U.S. Department of Health and Human Services. Surgeon General Report: Reducing Tobacco Use. Atlanta,
Georgia: Centers for Disease Control and Prevention; 2000. pp 405-406.
4.
U.S. Department of Health and Human Services. Synar Program: Description and Background.
Washington, DC: Substance Abuse and Mental Health Services Administration; n.d. Available at:
http://prevention.samhsa.gov/tobacco/fctsheet.aspx
5.
Environmental Protection Agency (EPA). Fact Sheet: Respiratory Health Effects of Passive
SmokingWashington, DC: EPA; [1993]. Available at: http://www.epa.gov/smokefree/pubs/etsfs.html
6.
Campaign for Tobacco-Free Kids. Multistate Settlement Agreement Timeline of Key Dates. 1999. Available at:
http://www.tobaccofreekids.org/research/factsheets/pdf/0062.pdf
7.
Centers for Disease Control and Prevention. State Smoking Restrictions for Private-Sector Worksites,
Restaurants, and Bars --- United States, 1998 and 2004. MMWR 2005:54(26);649-653. Available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5426a1.htm
Slide 15
Evolution of Tobacco Control
1999 - 2003
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Philip Morris reports “smoking saves money” to
government of Czechoslovakia (2001)
Department of Transportation bans smoking on all
international flights (2002)
WHO adopts Framework Convention on Tobacco
Control (2003)
New York State smoking ban goes into effect (2003)
Ask trainees to suggest two or three they would like to hear about and discuss their
choices. Make sure that the WHO Framework Convention, and NY initiates smoking
ban are covered.
Since 2000, we have seen more significant events take place. For example —
Philip Morris reports “smoking saves money” to the government of Czech Republic (2001)
Philip Morris commissioned a report for the Czech government that claims that smoking has
economic benefits because smokers die early and are therefore no longer a burden on the
country. Later, the company apologized for causing offense.1
Department of Transportation bans smoking on all international flights (2002)
U.S. Department of Transportation bans smoking on all flights between the United States and
other countries.2
World Health Organization (WHO) adopts Framework Convention on Tobacco Control
(2003)
This is the first treaty negotiated under the auspices of the World Health Organization. It was
adopted by the World Health Assembly on May 21, 2003, and went into effect on February 27,
2005. It has since become one of the most widely embraced treaties in UN history and, as of
November 2009, has 164 parties signed on to it.
The Framework was developed in response to the globalization of the tobacco epidemic and is an
evidence-based treaty that reaffirms the right of all people to the highest standard of health. The
Framework Convention is a milestone in the promotion of public health and is a huge step
forward in cooperation between countries on health-related issues.3
New York State passes comprehensive smoke-free air law (2003)
New York State passed a near-total statewide smoking ban, banning smoking in all bars,
restaurants, and clubs. Exempt are cigar bars already registered as such in New York City, Indian
casinos, personal residences and cars, and clubs staffed by volunteers. The bill supersedes some
New York City exemptions, most notably those involving ventilation systems.
New York also began enforcing a ban on Internet cigarette sales and adopted the United States’
first fire-safe cigarette regulations. A CDC article in MMWR shows a significant decline in
tobacco use in New York City from 2002 to 2006.4
References:
1.
Campaign for Tobacco-free Kids, Special Report: Phillip Morris Has Not Changed. 2003.Available at:
http://tobaccofreekids.org/reports/philipmorris/
2.
U.S. Department of Transportation. Fly-Rights: A Consumer Guide to Air Travel. Washington, DC: Department
of Transportation; 2010. Available at: http://airconsumer.ost.dot.gov/publications/flyrights.htm#smoking
3.
WHO Framework Convention of Tobacco Control website. Available at: http://www.who.int/fctc/en/
4.
Centers for Disease Control and Prevention. Decline in Smoking Prevalence — New York City 2002-2006.
MMWR 2007;56(24):604-608. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a4.htm
Slide 16
Evolution of Tobacco Control
2004 – 2009
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

NASCAR drops R.J. Reynolds sponsorship (2004)
Westin prohibits smoking in all rooms (2005)
Annual reports on state tobacco funding begin (2005)
Adult smoking prevalence drops below 20% (2007)
Federal cigarette tax increases (2009)
FDA authority to regulate tobacco products (2009)
18 states, DC, and Puerto Rico have smoke-free restaurants,
bars, and workplaces (2010)
Again, ask trainees to pick two or three. Then discuss their choices. However, make sure to
discuss the reports on state tobacco funding and FDA’s authority to regulate tobacco products.
NASCAR drops R.J. Reynolds Tobacco Co. as sponsor
In 2004, NASCAR dropped R.J. Reynolds Tobacco Co. as its primary sponsor. The year before
(2003), NASCAR announced it was dropping the 33-year sponsorship as a result of “changing
business dynamics.”1
Westin prohibits smoking in all rooms
In 2005, Westin Hotels and Resorts announced that it would no longer allow smoking in any
rooms, restaurants, bars, or public areas at its 77 properties in the United States, Canada, or the
Caribbean, making it the first major smoke-free hotel chain.2
Annual reports on state funding for tobacco programs
Annual reports by the Campaign for Tobacco-Free Kids, the American Heart Association, the
American Cancer Society, and the American Lung Association, such as the 2005 report “A
Broken Promise to Our Children: The 1998 State Tobacco Settlement Seven Years Later," state
that the nation’s progress in reducing smoking by young people is jeopardized because of the
huge gap between the amount of money states spend on tobacco prevention programs and the
amount tobacco companies spend to market cigarettes and other tobacco products. The first
report showed that tobacco companies spend $28 on marketing for every $1 spent on
prevention3. The 2008 report shows that in the previous 10 years, the states spent just 3.2% of
their total tobacco-generated revenue on programs to prevent or stop tobacco use. In 2009, no
state funded tobacco control programs at the CDC recommended level.4
Adult smoking prevalence drops below 20%
In 2007, for the first time in decades, the adult smoking prevalence dipped below 20% to 19.8%.5
Increase in the number of smoke-free restaurants, bars, and workplaces
By 2010, 18 states, Washington, DC, and Puerto Rico enacted smoke-free laws including all
bars, restaurants, and workplaces. American Nonsmokers Foundation reported that 70% of
restaurants, bars, and workplaces in the United States are smoke-free as of January, 2010.6
The federal cigarette tax increased from 39 cents to $1.01 per pack (2009)
This increase comes at a time when tobacco companies are also increasing their prices because
of the slowing economy and increases in costs of production.7
FDA bill to regulate tobacco products is passed
In June 2009, the Food and Drug Administration (FDA) was granted the authority to regulate
tobacco products. The U.S. Senate voted 79 to 17 to approve the bill, H.R. 1256/S. 982, known
as the Family Smoking Prevention and Tobacco Control Act.8
We will talk later about the purpose of this legislation and the potential benefit for tobacco
control in the United States.
References:
1.
Montgomery L. Nextel to sponsor NASCAR’s top division. Turner Sports Interactive. 2003. Available at:
http://www.nascar.com/2003/news/headlines/wc/06/19/nascar_nextel/
2.
Associated Press. Westin hotel chain to ban smoking indoors. 2005. Available at:
http://www.msnbc.msn.com/id/10338589/
3.
Campaign for Tobacco-free Kids. A Broken Promise to Our Children: The 1998 State Tobacco Settlement
Eleven Years Later. 2005. Available at: http://www.tobaccofreekids.org/reports/settlements/2006/fullreport.pdf
4.
Campaign for Tobacco-free Kids. A Broken Promise to Our Children: The 1998 State Tobacco Settlement
Eleven Years Later. 2009. Available at:
http://www.tobaccofreekids.org/reports/settlements/?utm_source=home&utm_medium=home&utm_campaign=
state_report12009
5.
Centers for Disease Control and Prevention. State-Specific Prevalence and Trends in Adult Cigarette Smoking,
US, 1998-2007 MMWR 2009:58(09):221-226. Available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5809a1.htm?s_cid=mm5809a1_x
6.
American Nonsmokers’ Rights Foundation, States, Commonwealths, and Municipalities with 100% Smokefree
Laws in Workplaces, Restaurants, or Bars. 2010. Available at: http://no-smoke.org/pdf/100ordlist.pdf
7.
Campaign for Tobacco-free Kids. New Federal Tobacco Product Tax Rate Increases. 2009. Available at:
http://www.tobaccofreekids.org/research/factsheets/pdf/0343.pdf
8.
Campaign for Tobacco-free Kids. FDA Authority Over Tobacco: Obama, Congress Act to Protect Kids, Save
Lives. 2009. Available at: http://www.tobaccofreekids.org/reports/fda/
Slide 17
Evolution of Tobacco Control:
What Comes Next?
Activity: Evolution of Tobacco Control: What Comes Next?
Break up the trainees into groups of 4 to 5 individuals. Ask each group to brainstorm about the
future of tobacco prevention and control.
We suggest you assign a flip chart to each group. Ask each group to select one person to write
down the group’s ideas. Allow about 10 minutes for brainstorming. Then have each group share
its ideas with the entire group of trainees.
To get the brainstorming started, ask these questions. Mention that the trainees have a handout
entitled “Evolution of Tobacco Control: What Comes Next?” where they can write down their
comments and ideas. In addition, you might write the questions on a flip chart, so the trainees can
refer to each question in turn.
 What are the successes going to be?
 What are the challenges going to be?
 How will the tobacco industry react to tobacco control successes?
 What should the tobacco control movement be preparing for?
Slide 18
Source: National Cancer Institute, Visuals Online
To summarize, throughout the evolution of the tobacco control movement, the greatest
reductions in tobacco use have occurred through policy changes. Rather than causing “Another
Civil Service Outrage,” government support for policies and programs that reduce tobacco use
are welcomed by the general public.
Your package of materials has a list of resources where you can get more information on the
history and evolution of tobacco control.
Now that you know something of the history of tobacco control and you have some background
information, we can move on to talking about current issues and challenges.
Move to next slide
Picture source:
http://visualsonline.cancer.gov/retrieve.cfm?imageid=1757&dpi=150&fileformat=jpg