History of Tobacco Control in the United States Kristie L. Foley, Ph.D. Associate Professor of Medical Humanities Davidson College Szeged, Hungary 18 June 2011

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

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 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: 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: : Congress required all cigarette

Adult per capital cigarette consumption in US from

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 ▫1R01TW R01TW