The popularity of tobacco use continues to steadily decline as adult use continues to decrease significantly each year. 
(Click to see chart) States and localities are continuing to enact smoke free laws and ordinances which makes the practice even less socially acceptable. There
has been a very significant recent decrease in the percentage of youth who take up the habit. There is even some evidence that the U.S. tobacco industry is
beginning to abandon its efforts to oppose legislative restraints on smoking and even engage in some effort to discourage smoking. In a 2004 Senate vote,
most Republicans joined Democrats in approving an expanded role for the Food and Drug Administration in tobacco control in exchange for a buyout of tobacco
farmers. The effort to curtail tobacco use has
increased throughout the world as more countries continue to tax tobacco heavily and restrict its use in public facilities.
Tobacco was discovered by the European explorers to the New World and its use became popular throughout Europe and Asia in following centuries. But
was not until the late 19th century that manufacturing processes for cigarettes and matches made the use of tobacco cheap and convenient. In the
United States, cigarette smoking per capita grew enormously throughout the 20th century, particularly in the post-World War 2 era when smoking was
constantly promoted through television advertising. (Click to see chart) Although concerns regarding the
health hazards of cigarette smoking began in the 1950's, there was little understanding of the addictive nature of nicotine until quite recently. In
retrospect, it is clearly nicotine addiction that continues the fuel the tremendous demand for tobacco products.
What is the relationship between tobacco use and public health?
The turning point in public attitudes toward tobacco began with the Surgeon General's report in 1964. That report that concluded that cigarettes were
a major cause cancer and several respiratory diseases. The statistical relationship between lung cancer and smoking can be demonstrated by the high lung
cancer rate in countries where smoking is prevalent and the comparatively low rate in countries where smoking is less prevalent. Although cancer, particularly lung cancer
(Click to see chart) , is a major cause of smoking-related mortality,
over half of all tobacco-related deaths are due to other medical conditions.
What has been the result of the Surgeon General's report?
The decades following the Surgeon General's report have propelled tobacco regulation into a major public policy issue. Beginning with the TV
advertising ban in 1971, cigarette usage in the United States has diminished substantially, particularly among adult smokers.
Interestingly, the earlier increase in the popularity of cigarette
smoking can also be linked to the beginning of radio and television advertising. A substantial percentage of high school students still experiment with cigarette use although a low percentage are
regular users.
The reduction in smoking has been the result of a variety of governmental measures undertaken to discourage the public from smoking. The
earliest and perhaps the most important was the ban on cigarette television advertising which began in 1971. Television advertising had been the major
vehicle for cigarette promotion prior to this ban.
Manufacturers have been
required to place warning
labels on cigarette packaging and on print advertisements. A significant number of states tax cigarettes by over 50¢ per pack. 
This increase in taxation places a considerable financial burden on low income individuals,
particularly the mentally ill. Almost 90% of adult schizophrenic sufferers are heavy smokers and on an average must pay 27% of their income on tobacco
products. According to one study, 44% of all cigarettes sold are to mentally ill individuals. See
summary from Schizophrenia.com With varying degrees, many states have also enacted restrictions on smoking in public places. As smoking declines in popularity, public opinion for these restrictions has grown.
Counteradvertising and public education campaigns have also become standard elements of tobacco control, although their funding levels and aggressiveness
vary considerably among the states. An evaluation of the California tobacco control program concluded that it was most effective when it received a high
level of funding and when advertisements emphasized deceptive practices undertaken by tobacco firms.
How have tobacco companies reacted to the attack on their product?
About half of the U.S. cigarette market has been controlled by Phillip Morris; the remainder is divided among just four other companies. Following the Surgeon General's report, these companies have
engaged
in a variety of tactics. Initially in advertisements which are now being used against them in litigation, the companies initially insisted that there was
no proven link between smoking and cancer and the issue was one of an "open controversy".
Although banned from television advertising, the companies substantially increased their investment in product promotion. Even when the figure is
adjusted for inflation, tobacco companies now spend over five times more on promotion today than they did in 1970.
It is widely believed that the "Joe Camel" advertising campaign initiated by R. J.
Reynolds in 1988 led to a significant rise in adolescent smoking. Very little promotional dollars are now spent on advertising; the bulk of promotional
costs are now for price reductions in an effort to counteract increasing excise taxes.
Tobacco companies also began to spend heavily on political contributions and lobbying. In
California, a recent study
has shown a significant correlation between such contributions and the legislative behavior of the donees. The expenditures have unquestionably helped the industry. A California legislative
initiative passed by the voters in 1988 was undermined by Republican Governor Pete Wilson. And despite initial optimism that Democratic Governor Gray Davis
would reverse this trend, he also opposed substantial increases in funding for tobacco control.
How has litigation affected the tobacco companies?
Recently liability lawsuits have become a concern for tobacco companies. A $3 billion California award against Philip Morris in June 2001 was
among the top 10 jury verdicts in the country.
Lung cancer victims began filing liability lawsuits against tobacco companies as early as 1954. In 1983 a deceased smoker was awarded $400,000, but the
decision was overturned and her family could not afford to appeal. In 1992, the US Supreme Court ruled that warning labels on packs of cigarettes do not
shield tobacco companies from lawsuits. In recent years litigation has gained momentum in the wake of evidence that companies purposefully withheld
information about health risks of tobacco and the addictive nature of nicotine.
In 1994 and 1995, Mississippi, Minnesota, West Virginia and Florida filed lawsuits in state court against the tobacco industry to secure reimbursement
from it for health care expenditures for ailments arising from tobacco use. They were shortly joined in their endeavor by 41 other states. Initially a
settlement was proposed which would require Congressional legislation to provide it with the force of law. A bill authored by Senator John McCain had
bipartisan support but the tobacco companies opposed language in the bill which would have required significant limits on advertising and the bill ultimately
died in committee. Ultimately a comprehensive settlement was reached without Congressional legislation. The major provisions of the settlement agreement
are:
- Additional limits have been placed on cigarette promotion including a ban on billboard advertising and free product distribution in areas where
minors have access.
- Tobacco companies are required to contribute $300 million a year for five years to a newly created National Foundation for Public Education. An
additional $5 million per year is to be paid to this foundation for research on tobacco use and other substance abuse.
- The agreement dissolved the Tobacco Institute, the Council on Tobacco Research, and the Center for Indoor Air Research, which had been used by the
tobacco industry for public relation purposes.
- The agreement requires the tobacco companies to pay approximately $195.9 billion to the states between now and 2025 (in current dollars). These
payments are indexed to inflation, but will be reduced if the participating tobacco companies' combined U.S. cigarette sales or their combined percentage
share of the total U.S. cigarette market goes down. The agreement places no restrictions on how the states must spend the settlement funds they
receive.
Critics of the tobacco settlement maintain that it does not sufficiently address many forms of cigarette promotion such as magazine and newspaper
advertising and "in-store" displays. The also note that by failing to ban vending machines, it does not sufficiently prevent minors from accessing
cigarettes. Nor does it require more effective and more visible health warnings on tobacco products; establish Food and Drug Administration authority over
tobacco products; or restrict US tobacco company marketing to youth overseas.
Despite the decreasing demand in developed countries, there has been a marked increase in overall global cigarette production since 1970. The increased
demand has primarily come from developing economies, particularly in Eastern Europe and Asia. As a result of increased global demand, the U.S. domestic production of cigarettes continued to
increase until approximately 1997, long after the domestic demand for cigarettes had decreased. The emergence of smoking prevalence in the less developed world is being addressed
by the World Health Organization. Recognizing the seriousness of the problem, there was widespread approval for the adoption of a Framework Convention on
Tobacco Control (FCTC) - a new legal instrument that could address issues as diverse astobacco advertising and promotion, agricultural diversification,
smuggling, taxes and subsidies.
