In the 30 years since the first Surgeon General's report, progress has been made in educating the public about the dangers of tobacco use.
In the 30 years since the first Surgeon General's report, progresshas been made in educating the public about the dangers of tobaccouse.
National health objectives have been established to reduce tobaccouse as well as to reduce exposure to environmental tobacco smoke(ETS). These objectives include setting specific, measurable goalsfor preventing the initiation of tobacco use (especially amongyoung persons) and promoting tobacco use cessation. Other objectivesinvolve the development of public policies that address smoke-freeair, preemption, tobacco advertising, and excise taxes on tobaccoproducts.
By regulating the sale and use of tobacco and by increasing taxeson tobacco products, states have contributed toward efforts toachieve year 2000 national health objectives. As of June 30, 1995,1,238 state laws addressed tobacco use.
Four primary aspects of tobacco control laws are identified ineach state: smoke-free indoor air, youth access to tobacco products,advertising of tobacco products, and excise taxes on tobacco products.
The smoke-free indoor air primarily involves government work sites,private work sites and restaurants. Forty-one states restrictsmoking in state government work sites and limit smoking to designatedsmoking areas. Two require no smoking or designated smoking areaswith separate ventilation and seven states completely prohibitsmoking. In contrast, only 21 state laws restrict smoking in privatework sites; of these only California's law requires either nosmoking or separate ventilation for smoking areas.
Thirty-one states have laws that regulate smoking in restaurants.More than half of the states have laws that restrict smoking inchild care centers. Forty-two states restrict smoking in hospitals,42 on selected forms of public transportation, 30 in grocery storesand 23 in enclosed arenas.
All states prohibit the sale and distribution of tobacco productsto persons under 18 years of age, and 35% of states designatean enforcement authority in the legislation. All state laws penalizethe business owner, manager, and/or clerk for violation of thesale of cigarettes to minors. Fourteen state laws include thepossibility of suspension or revocation of a license to sell tobaccoproducts for violation of youth access laws. A total of 32 statelaws prohibit purchase, possession, or use of tobacco productsby minors.
Although no state has completely banned the sale of tobacco productsthrough vending machines, none allow such sales to minors, and32 states provide additional restrictions to reduce youth accessto vending machines. Thirty-three state laws require some formof retail licensure for the sale of tobacco products. Eighteenstate laws include chewing tobacco, snuff, or both in their licensingrequirements. All state laws that require businesses to be licensedto sell tobacco products also penalize businesses for violationof licensing requirements.
All states tax cigarettes (see Table on facing page); the averagetax is 31.5¢ per pack and ranges from 2.5¢ per packin Virginia to 75¢ per pack in Michigan. In all states, thetax is a fixed amount, not a percentage of the price per pack.Tobacco companies are now making cigarettes more affordable byintroducing generic cigarette brands and lowering prices on premiumbrands. Forty-two states also tax smokeless tobacco products.
Nine states (California, Illinois, Kentucky, Louisiana, Michigan,Pennsylvania, Texas, Utah, and West Virginia) have laws that restrictthe advertising of tobacco products. In 1993, the tobacco industryspent more than $6 billion for cigarette advertising and promotion,an increase of 15.4% from 1992. The smokeless tobacco industryspent more than $119 million on advertising and promotion in 1993,a 3.5% increase from 1992. Tobacco advertising creates a climatethat increases the social pressure on young people to use tobaccoby implying that using tobacco promotes independence, adventure,and glamour.
Tobacco use is the leading preventable cause of death in the US.Approaches that involve both educating the public regarding thehazards of use and developing tobacco-control policies are relevant.Public health policies that prevent tobacco addiction among youngpersons and also protect nonsmokers from exposure to ETS can playa prominent role in improving the health of the nation.
Adapted from Morbidity and Mortality Weekly Report, November3, 1995, Vol.44, No. SS-6