Clay Farris Naff Nicotine and Tobacco
Clay Farris Naff Nicotine and Tobacco
Clay Farris Naff Nicotine and Tobacco
Drugs
Heroin
Marijuana
Methamphetamine
Performance-Enhancing Drugs
Current Issues
Biomedical Ethics
The Death Penalty
Gun Control
Illegal Immigration
World Energy Crisis
Nicotine
and
Tobacco
by Clay Farris Naff
Drugs
San Diego, CA
Contents
Foreword
Nicotine and Tobacco at a Glance
Overview
How Harmful Are Nicotine and Tobacco?
Primary Source Quotes
Facts and Illustrations
6
8
10
22
29
33
38
45
49
54
60
65
69
77
82
88
90
92
98
102
104
105
110
Foreword
A
Foreword
Foreword
and statistics. The clearly written objective narratives provide context
and reliable background information. Primary source quotes are carefully selected and cited, exposing the reader to differing points of view.
And facts and statistics sections aid the reader in evaluating perspectives.
Presenting these key types of information creates a richer, more balanced
learning experience.
For better understanding and convenience, the series enhances information by organizing it into narrower topics and adding design features
that make it easy for a reader to identify desired content. For example, in
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impact of illegal immigration has an objective narrative explaining the
various ways the economy is impacted, a balanced section of numerous
primary source quotes on the topic, followed by facts and full-color illustrations to encourage evaluation of contrasting perspectives.
The ancient Roman philosopher Lucius Annaeus Seneca wrote, It is
quality rather than quantity that matters. More than just a collection of
content, the Compact Research series is simply committed to creating,
finding, organizing, and presenting the most relevant and appropriate
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invites, intrigues, and fosters understanding.
Nicotine and
Tobacco
at a Glance
Prevalence
History
Use of tobacco began among Native Americans at least 1,500 years ago.
It spread to the rest of the world after Christopher Columbuss 1492 voyage to the New World.
Usage
Consumption Rate
Around the world, more than 15 billion cigarettes are smoked each day.
Geographic Trends
Addictive Effects
The nicotine in tobacco is highly addictive. Most people who start using tobacco find it difficult to quit, despite the health hazards tobacco use presents.
Carcinogenic Effects
Tobacco damages virtually every organ in the body, including the skin. It
contributes to heart disease and worsens diabetes.
Business
Tobacco companies make up a major international industry, with estimated annual revenues of $200 billion worldwide.
Laws
Treatment
Smokers who try to quit unaided have a failure rate of about 80 percent. Replacement nicotine and cessation programs cut the failure rate
in about half.
Trends
In the United States, smoking rates have been falling since the 1960s.
Today, about 22 percent of Americans smoke.
Overview
Literally one-third of all human cancer could be prevented if we could just . . . solve the tobacco addiction
problem.
Overview
10
Overview
This tobacco farm in Kentucky has more than 2,000 acres of tobacco fields.
Nicotine, which occurs naturally in tobacco, is one of the most widely used
drugs in the world.
change in the near future, despite a rapid rise in the obesity rate and
a significant drop in the rate of tobacco use in the United States. The
prevalence of smoking among American adults remains above 20 percent, and the decline in U.S. tobacco use has been more than offset by a
rise in global consumption.
Worldwide, health officials forecast that tobacco use will lead to a cancer
toll that exceeds any single cause of premature death in history. We are
looking at about 1 billion [cancer] deaths this century if present trends
continue, says Judith Mackay, lead author of The Tobacco Atlas.1 If
11
12
Overview
Peter Jennings, longtime ABC News anchor and smoker, died on August 7,
2005, after a short battle with lung cancer. Some researchers claim to have
identified more than 60 cancer-causing agents in cigarette smoke.
some researchers claim to have identified more than 60 cancer-causing
agents in cigarette smoke. Most of these threats have complex chemical
names, but they include solvents such as benzene and heavy metals such
as cadmium. The role nicotine plays is to make it excruciatingly difficult
to stop exposing oneself to this symphony of carcinogens.
Unlike many other addictive drugs, nicotine is not a narcotic. Since it
does not impair cognitive functions, it can be used by people while carrying out normal activities. This makes steady tobacco consumption legally
13
You may wonder why a drug that nearly everyone, including the major
tobacco companies, agrees is addictive and dangerous remains legal. The
14
Overview
15
By the time medical science caught up with popular myths about tobacco, smoking was a well-established and widespread social custom. More
importantly, it was a major U.S. industry with considerable influence
among lawmakers.
Indeed, it was not until 1953 that scientists first demonstrated the
carcinogenic properties of tobacco. Researchers who painted the backs
of lab mice with tar from tobacco found
that those mice developed cancerous tumors in far greater numbers than mice not
By the time
exposed to tar.
medical science
The tobacco industry responded to
caught up with
these
and other experiments by trying to
popular myths
keep the public in doubt about the danabout tobacco,
gers of smoking and by trying to keep resmoking was a
strictions on tobacco and its contents to a
well established
minimum. Over the next several decades,
and widespread
consumer groups and health organizations
social custom.
battled to curb the sale of tobacco and to
make its hazards known. The American
Lung Association, which had formed decades earlier to fight the spread of tuberculosis, in 1960 declared that
smoking was a major cause of lung cancer.
The tobacco companies, however, fought back hard and spent billions to suppress or discredit scientific research that questioned the safety
of cigarettes, to limit regulation, and to stave off lawsuits. They largely
succeeded. Although warnings on cigarette packages were mandated and
tobacco advertising was limited, attempts to regulate nicotine as a drug
were defeated. Congress passed a special exemption for nicotine, and the
16
Overview
Supreme Court later ruled that the U.S. Food and Drug Administration
had to abide by Congresss decision.
By the mid-1990s, however, tobacco companies began to lose credibility. In hearings before Congress, tobacco company executives were compelled to admit that their product was addictive and dangerous. In a 1998
settlement with state attorneys general, tobacco companies agreed to stop
advertising to youth and to give billions to antismoking campaigns.
In 2006 U.S. District Court Judge Gladys Kessler ruled that tobacco
companies had intentionally deceived the public: Cigarette smoking
causes disease, suffering, and death. Despite internal recognition of this
fact, defendants have publicly denied, distorted, and minimized the hazards of smoking for decades.3 Tobacco companies were generally relieved
that Judge Kessler did not subject them to monetary penalties, but at
least one, Altria, and its subsidiary Philip Morris disputed her findings.
Philip Morris USA and Altria Group Inc. believe much of todays decision and order are not supported by the law,4 said William Ohlemeyer,
an Altria vice president. The company intended to appeal, Ohlemeyer
indicated.
Usage Trends
17
to several factors: the end of such advertising as the Joe Camel campaign
that targeted youth, the use of tobaccoNicotine remains
settlement funds to pay for antismoking
unregulated and
public education campaigns directed at
tobacco remains
young people, and the tightening of loa widely availcal laws against selling tobacco products
able legal prodto underage consumers.
uct in the United
The main reason for the overall deStates.
cline in smoking is a growing awareness
of the dangers of tobacco. Attempts
to create a safe cigarette have so far
failed. Low-tar, low-nicotine cigarettes
have the paradoxical effect of making smokers smoke more as they struggle to satisfy their craving for nicotine. Late in 2005 British American
Tobacco said it had developed a cigarette that would cut the disease risks
by 90 percent, but health experts remained deeply skeptical. Nottingham
University professor of epidemiology John Britton remarks, Anything
involving inhaling smoke is unsafe. These new cigarettes could be more
like jumping from the 15th floor instead of the 20ththeoretically the
risk is less but you still die.5
Such perceptions, along with the growing social stigma attached to
smoking, have had a profound effect on tobacco usage rates in the United States. Additionally, external pressures on smokers to rein in or give
up their habit have greatly increased. In particular, evidence of the hazard
presented by secondhand smoke to nonsmokers has led to restrictions on
smoking in the workplace, in public places such as schools and government offices, and in regulated places where people congregate, such as
restaurants, theaters, and museums. Additionally, new taxes on cigarettes
have raised the cost of smoking, and many insurance companies and
employers offer incentives to smokers to quit.
These developments have not gone unchallenged. Smokers rights
groups have formed to fight bans on smoking in public places. Some deny
outright the validity of the science that justifies restrictions on smoking.
Others argue that libertarian considerations should outweigh the concerns
of the government in regulating adult behavior. Despite their objections,
however, across the United States restrictions on smoking have increased
18
Overview
and the popularity of tobacco usage has fallen. Among the places a person
can no longer legally smoke are prisons, hospitals, and airports. Beyond
U.S. borders, however, a very different picture has taken shape.
While Americans have curtailed their use of tobacco, worldwide consumption has been on the rise. Indeed, from 1970 to 1990 global cigarette sales
leaped by 74 percent. One reason is increased prosperity in much of the
world, especially Asia. Cigarettes, which used to be a luxury in countries
such as China and India, are now widely affordable in the region. Thus,
in 2004, Asia accounted for 56 percent of global cigarette sales.
An ironic contributor to the rise in tobacco consumption is the liberation of women. Smoking used to be an exclusively male privilege in
most cultures. That has begun to change nearly everywhere, starting with
the United States. Following the introduction of cigarettes marketed exclusively to women in the early 1970s, the rate of womens tobacco use in
the United States rose sharply and is now closer to parity with men than
anywhere else in the world. An unhappy consequence is that for American women born after 1960, early death from lung cancer is now on par
with that of American men.
The same may soon be true around the world, where one of every
five smokers is a woman. The World Health Organization has taken note
of the trend: Though fewer women than men are smokers, an increasing number of young women are taking up cigarettes. Recent reports
describe an alarming increase in smoking rates among women. Further,
data from different sources show the gap in smoking rates between men
and women is narrowing.6
Women who take up tobacco use may find it extremely difficult to
put down. Studies show that the addictiveness of nicotine affects women
more powerfully than it does men. All other things being equal, these
studies show, once hooked it is more difficult for a woman to quit than
a man. That may be one reason why the rate of smoking has fallen much
faster for American men than for women: Whereas U.S. male smoking
prevalence dropped by 24 percent between 1965 and 1993, the prevalence of female smoking dropped by less than half that rate (only 11
percent) during the same period, according to the Centers for Disease
Control and Prevention.
19
20
Overview
nicotine in tobaccomay prove to have medicinal applications. Colleen
McBride, director of the cancer prevention, detection, and control program at Duke University Medical Center, has experimented with treating various ailments with nicotine delivered through the same patches
that are used to help smokers quit. McBride says that nicotine in controlled doses can be helpful. The benefits of nicotine, she claims, can be
compared with those of caffeine. Nicotine has a lot of therapeutic uses.
Theres growing evidence that it may be useful in treating Parkinsons
disease, Alzheimerstheir level of concentration, their ability to focus.
Those of us who are caffeine users understand that.9
Jean Nicot, who did so much to promote the belief that tobacco was
healthful, would no doubt be gratified to know that the drug that bears
his name may have some redeeming qualities after all.
All the same, for the vast majority of those who are regularly exposed
to nicotine, it represents a mortal threat. It binds them to the tobacco
habit, and that means an elevated risk of premature death from cancer,
emphysema, heart disease, and other tobacco-linked pathologies.
So far, only the United States and a few other developed countries
such as Britain have achieved significant reductions in tobacco use; yet,
there are signs that others will follow. The Himalayan kingdom of Bhutan recently became the first country to entirely ban the sale of tobacco
products. Iran has banned smoking in public buildings. Other countries
are debating new restrictions on the use of tobacco as well. Many have
signed an international tobacco-control convention, which, if enforced,
could help curb smoking.
To be sure, not everyone believes that the global smoking rate will
go down. Indeed, David Betteridge, a spokesman for British American
Tobacco, the worlds second-largest tobacco company, expects the market to grow. Fewer people are smoking in percentage terms, he said in
September 2006, but because of huge population growth around the
world, we are looking at a market about the same size in ten years time,
and beyond that maybe even bigger.10
However, if the United States, which has made large reductions in tobacco use, decides to join the international effort, the outcome might be
different. An effective global treaty, health experts say, could pave the way
to a world in which fewer people are at risk of premature and preventable
death due to nicotine-driven addiction to tobacco.
21
How Harmful
Are Nicotine
and Tobacco?
Jack E. Henningfield, Pharmacology of Nicotine, Addicted to Nicotine: A National Research Forum. May 19, 2006.
National Institute on Drug Abuse. www.nida.nih.gov.
N
How Harmful Are Nicotine and Tobacco?
22
The brain soon develops a tolerance for nicotine, which means that more
is required to achieve the same satisfaction. Addiction quickly sets in.
Once it does, symptoms of withdrawal occur if the nicotine supply is not
frequently renewed. The time it takes to become addicted varies considerably. For some people it is a matter of a few days; for others, it is a few
months. A small portion of users are able to dabble in tobacco without
ever becoming addicted. This variation in response leads scientists to believe that there is a genetic predisposition to nicotine addiction that is
stronger in some people and weaker in others.
The trouble with addiction to nicotine is how it is satisfied. More
than 96 percent of nicotine addicts get their fix from cigarettes. Even
those who use tobacco in other forms, such as cigars, pipes, or chew, are
at risk, but cigarettes deliver tobacco smoke deep into the lungs, where
it can do the most damage. Nearly all smokers start when they are teens, a time of life
when caution is paid little heed. Moreover,
the damage done by tobacco is slow and cuThe onset of
mulative, so the risks are not apparent (even
addiction can
if they are known) at the time when addicbe especially
tion most commonly takes hold.
swift for
The onset of addiction can be espeyoung people.
cially swift for young people. Researchers at
the University of Massachusetts found that
12- to 13-year olds who smoked only a few
cigarettes experienced the same symptoms of
nicotine addiction as heavy-smoking adults. The researchers investigated
681 youngsters at schools in central Massachusetts over a four-year period. Some of the 12- and 13-year-olds became addicted within days of
their first cigarette, according to research reported in 2000 in the British
23
24
Once a person decides to quit, the first step is to reduce the amount of
nicotine in the body. This takes time. The bodys nicotine reserves drop
by about half every 2 hours. At that rate, it can take up to 3 days for the
blood to become nicotine-free. It is no coincidence that 3 days is how
long a person who quits typically lasts before resuming smoking. Fortunately, there are now sophisticated cessation programs to help people
gradually wean themselves from nicotine dependency. These programs
help the brain resensitize itself and adjust to functioning normally in a
nicotine-free environment. Moreover, the individual needs to develop
new behavior patterns to break the conditioning that triggers tobacco
use in dozens of situations. For example, many smokers are habituated
to light up a cigarette when having a morning cup of coffee; such people
may need to eat a carrot stick or switch to drinking cola in order to break
the association of coffee and cigarettes.
The worst physical symptoms of nicotine withdrawal may persist for
weeks. After that, the toughest challenges are psychological. The craving
for nicotine continues, often infiltrating dreams or intruding into waking thoughts. In some people, this knocking-on-the-door phenomenon goes on for decades after they quit. Nevertheless, with motivation,
25
Chemical Assault
26
27
28
Kenneth E. Warner, quoted in Brian D. Smedley and S. Leonard Syme, eds., Promoting Health: Intervention Strategies from
Social and Behavioral Research. Washington, DC: National Academy Press, 2000, pp. 41718.
Jackson has been a classical performer, punk rocker, and swing musician. He
also writes nonfiction essays on smoking and other subjects.
* Editors Note: While the definition of a primary source can be narrowly or broadly defined, for the purposes of Compact
Research, a primary source consists of: 1) results of original research presented by an organization or researcher; 2) eyewitness
accounts of events, personal experience, or work experience; 3) first-person editorials offering pundits opinions; 4) government officials presenting political plans and/or policies; 5) representatives of organizations presenting testimony or policy.
29
Hagman gained fame as the star of the television shows I Dream of Jeannie and
Dallas, then put his celebrity into antismoking advocacy with the 1987 film Larry
HagmanStop Smoking for Life, the proceeds of which benefited the American Cancer
Society.
David Kessler, quoted in Online Newshour, Smoke Screening, August 23, 1996. www.pbs.org.
Kessler was the U.S. Food and Drug Administration commissioner during the
Clinton administration. He led the failed effort to regulate nicotine as a drug.
Smoking harms nearly every organ of the body, causing many diseases and compromising smokers health
in general. Nicotine, a component of tobacco, is the
primary reason that tobacco is addictive.
Nora D. Volkow, quoted in NIDA Research ReportTobacco Addiction, NIH publication no. 06-4342, rev. ed., 2006.
www.nida.nih.gov.
Volkow is director of the National Institute on Drug Abuse. Volkow received her
medical degree in 1981 from the National University of Mexico at Mexico City
and performed her residency in psychiatry at New York University.
30
William L. Dunn Jr., Motive and Incentive in Cigarette Smoking, Philip Morris memorandum, 1971. www.umich.
edu.
Dunn was a leading scientist and vice president of the Philip Morris tobacco
company.
Just like smoking cigarettes, chewing smokeless tobacco can eventually rip apart your body and kill you.
Its that simple, really. Theres no such thing as a safe
tobacco product.
Dowshen is chief medical editor of the KidsHealth Web site. He serves as a pediatric endocrinologist at the Alfred I. DuPont Hospital for Children in Wilmington, Delaware.
Smokers United is a smoking advocacy Web site that promotes a libertarian view
of tobacco use.
31
John Wyke, quoted in Kevin Mansi, Banning Cigarette Ads Can Save Lives, Claims Expert, Daily Record, December
6, 2000. http://no-smoking.org.
Wyke is director of the Beatson Institute for Cancer Research, in Glasgow, Scotland.
Jay Brooks, quoted in Miranda Hitti, "Peter Jennings Loses Battle with Lung Cancer," WebMD Medical News, August 8,
2005. www.webmd.com.
Brooks is chief of hematology and oncology at the Ochsner Clinic in Baton Rouge,
Louisiana.
32
Breaking addiction to nicotine is extremely difficult for most people. Experts say the substance is as strongly addictive as opiates such as heroin.
Some 87 percent of lung cancer casesroughly nine out of tenare
related to smoking.
An estimated 25 million Americans will die of smoking-related diseases in this century.
The U.S. Centers for Disease Control and Prevention estimate that
tobacco-caused illnesses and deaths cost the U.S. economy $157 billion a year in losses.
33
nerve cell
Nicotine
Dopamine
34
Smokers hands and feet often get cold because of damage to the
circulatory system caused by tobacco.
Diminished sense
of smell and taste
Premature wrinkles
Chronic Bronchitis
More frequent
colds and more
lung infections
Addiction to nicotine
Heart disease
Stomach ulcers
Emphysema
(a chronic disease
in which the small
air sacs in the
lungs become
damaged causing
difficulty breathing)
35
industrialized
countries
developing
countries
Deaths in millions
7
million
projected
6
5
4
3
3
million
2
1
0
2.1
million
2.1
projected
million
1.3
.3
million
1950
million
.2
million
1975
2000
2025 to
2030
36
Long-term smokeless-tobacco users are 50 times more likely to develop oral cancer and gum disease, and to lose their teeth than nonusers.
Attributable to
cigarette smoke
Oropharynx
Esophagus
Other causes
Cancer Type
Stomach
Pancreas
Larynx
Lung
Bladder
Kidney
Myeloid Leukemia
20
40
60
Number of deaths (in thousands)
80
100
Female
Attributable to
cigarette smoke
Esophagus
Cancer Type
Stomach
Other causes
Pancreas
Larynx
Lung
Bladder
Kidney
Myeloid Leukemia
Cervix
20
40
60
Number of deaths (in thousands)
80
100
37
How Dangerous
Is Exposure to
Secondhand Smoke?
We . . . believe that the conclusions of public health officials concerning environmental tobacco smoke are
sufficient to warrant measures that regulate smoking
in public places.
or nonsmokers, secondhand smoke used to be an annoyance, especially in restaurants, movie theaters, or other public places. Now,
however, secondhand smoke is widely considered a serious health
hazard. That recognition has not come easily, though, and it is still not
universally accepted.
In 1992 the U.S. Environmental Protection Agency (EPA) released a
report declaring environmental tobacco smoke (another term for secondhand smoke) to be a Class A carcinogenthat is, a substance that has been
shown to cause cancer in humans. The EPA concluded that annually 3,000
Americans die of exposure to secondhand smoke. That figure has become
widely disseminated but has also been hotly disputed.
In 1998 a federal judge found that the EPA had not followed proper
procedures in coming to its conclusions. In his ruling U.S. District Court
Judge William Osteen wrote, In this case, EPA publicly committed to a
conclusion before research had begun; excluded industry by violating the
Acts procedural requirements; [and] adjusted established procedure and
scientific norms to validate the Agencys public conclusion. . . .12
However, that was not by any means the last word on the subject. As
with all questions of science, ultimately the facts settle the issue. Since
38
39
Children at Risk
Some critics, however, are unsatisfied that any of these findings have
been established by rigorous science. The mere presence of carcinogens
40
41
42
In any event, as far as policy makers are concerned, the debate seems to
be over. There is a broad and accelerating trend toward banning smoking
in places where the public may be exposed to what the surgeon general
terms involuntary smoking.
Twelve states and numerous localities have enacted bans on smoking in public places, including privately owned public accommodations,
such as bars and restaurants,
though most laws provide some
exceptions for adult-only estabThere is a broad and
lishments. Americans for Nonaccelerating trend
Smokers Rights estimates that
toward banning smok39 percent of Americans now
ing in places where
live in smoking-restricted lothe public may be
calities. The group reports that
exposed to what the
at least 159 communities have
surgeon general terms
enacted local restrictions on
involuntary smoking.
smoking.
The federal government has
also intervened to protect nonsmokers. A 1997 executive order signed by President Bill Clinton banned
smoking at all federal facilities. Federal law now banned smoking on domestic flights, and most airports have eliminated all indoor smoking.
The private sector is rapidly moving to curb smoking as well. Many
employers have limited or banned tobacco use in workplaces. Their
43
44
There is no risk-free level of secondhand smoke exposure, with even brief exposure adversely affecting the
cardiovascular and respiratory system.
Richard H. Carmona, Remarks at Press Conference to Launch Health Consequences of Involuntary Exposure to Tobacco
Smoke: A Report of the Surgeon General, June 27, 2006. www.surgeongeneral.gov.
Carmona became the 17th surgeon general of the U.S. Public Health Service on
August 5, 2002.
Robert Hayes Halfpenny, The Ten Biggest Lies About Smoke & Smoking, The Smokers Club, Inc., 2005. www.
smokersclubinc.com.
Aviva Patz, Boost Your Childs Health, Parenting, December/January 2004, p. 100.
45
Mayo Clinic, Secondhand Smoke: Avoid Dangers in the Air You Breathe, March 8, 2006. www.mayoclinic.com.
Sidney Zion, Judge Smokes Out Tobacco Lie, New York Daily News, July 23, 1998. www.junkscience.com.
California Air Resources Board, Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant,
as Approved by the Scientific Review Panel, Appendix III, June 24, 2005, p. 10. ftp://ftp.arb.ca.gov.
Statistically, you are much more likely to die in a bicycle accident, or from being left-handed and using
right-handed things, than from exposure to smoke. (I
swear Im not making this up!)
Jackson has been a classical performer, punk rocker, and swing musician. He
also writes nonfiction essays on smoking and other subjects.
46
Matthew L. Myers, New Study Adds to Evidence Smoke-Free Laws Reduce Heart Attacks, Shows Need to Make All
Workplaces Smoke-Free, Tobacco-Free Kids, September 6, 2006. www.tobaccofreekids.org.
Myers is president of the Campaign for Tobacco-Free Kids. An attorney by training, he previously headed up the Federal Trade Commissions monitoring of tobacco advertising.
Carol M. Browner, U.S. Senate Committee on Environment & Public Works, Environmental Tobacco Smoke Issues
Relative to the June 20 Agreement, April 1, 1998. http://epw.senate.gov.
Annie Tegen, quoted in Wendy Koch, 39% Live in Areas Limiting Smoking, USA Today, December 28, 2005. www.
usatoday.com.
Tegen is spokeswoman for the civic group Americans for Non-Smokers Rights.
47
American Nurses Association, Environmental Tobacco Smoke, December 12, 1997. www.nursingworld.org.
The American Nurses Association (ANA) represents the nations nearly 3 million
registered nurses. Among other activities, the ANA advances the nursing profession by lobbying on health-care issues affecting nurses and the public.
Ron Davis, Statement on surgeon generals report on secondhand smoke, June 27, 2006. www.amaassn.org.
Davis is president-elect of the American Medical Association. A doctor and epidemiologist, he is also director of the Center for Health Promotion and Disease
Prevention at the Henry Ford Health System in Detroit.
Carla Stovall, U.S. Senate Committee on Environment & Public Works, Environmental Tobacco Smoke Issues Relative
to the June 20 Agreement, April 1, 1998. http://epw.senate.gov.
Stovall was the attorney general of Kansas at the time she gave the congressional testimony from which this quotation is drawn.
48
49
Coronary heart
disease
Secondhand smoke
can cause:
Acute respiratory
and ear infections
in children
Lung
Cancer
Severe asthma
and slow lung
growth in chlldren
Source: U.S. Surgeon General, The Health Consequences of Involuntary Exposure to Tobacco Smoke, June 27, 2006.
50
The U.S. surgeon general has declared that scientific evidence indicates that there is no risk-free level of exposure to secondhand
smoke.
2000
1500
1000
500
0
1985 & Prior
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006*
2500
Year
51
100
90
80
75%
Men
70
Women
60
50
40
30
24%
20
13%
12%
10
11%
0
Exposed at
home as child
(men & women)
Exposed at
home as
an adult
Exposed at
work
52
92%
80%
80%
70%
60%
50%
40%
41%
30%
20%
10%
0
Independant
Independant
Restaurants
Restaurants
Chain
Restaurants
State Restaurant
Associations
53
Every day in the U.S., 2,000 teens become newly addicted to smoking. Think about it: most will not be
able to quit for 17 years, and over 800 of those teens
will later die from cigarettes.
ver since U.S. surgeon general Luther Terrys 1964 report linking
tobacco and cancer, the federal government has constantly warned
of the dangers of smoking. Today, even the tobacco companies concede that their product is dangerous. Yet tobacco use in America persists,
especially among young people.
Youths constitute the one segment of the population that is largely indifferent to risk. Though there are exceptions, on average adolescents are more
inclined to take risks and less likely to weigh long-term risks than are adults.
Another factor contributing to teen tobacco use is easy accessibility. In many
states, it continues to be relatively easy for underage persons to buy cigarettes
or other tobacco products. Even when such products are locked away, access
is possible if a parent, older sibling, or other adult smoker lives in the teens
household. Finally, and perhaps most fundamentally, the risks involved in
smoking actually add to its sex appeal, which for teenagers is a powerful incentive. Researchers call this the forbidden fruit syndrome.
With these facts in mind, it may come as no surprise that 80 percent
of smokers begin smoking by the age of 18. Surveys show that currently
half of all teenagers try tobacco by the end of high school and that about
a quarter become regular users.
54
55
Smokeless Tobacco
Smoking is not the only way that youngsters use tobacco. Since 1970,
according to the Campaign for Tobacco-Free Kids, smokeless tobacco
has gone from a product used primarily by older men to one used predominantly by young men and boys. The product, also known as snuff,
spit, or chewing tobacco, is consumed by placing a pinch or wad in the
mouth, between cheek and gums.
In 1970 males 65 and older were almost 6 times as likely as young
men to use smokeless tobacco regularly. By 1991, however, young males
were 50 percent more likely than older ones to be regular users. Despite
some recent declines in youth smokeless-tobacco use, as many as 10 percent of boys in U.S. high schools and just over 1 percent of high-school
girls currently use smokeless-tobacco products.
Although these products do not produce smoke, they are addictive and
hazardous. Smokeless tobacco causes oral lesions on the cheeks, gums, and
tongue and can lead to oral cancer. Studies have found that up to 78 percent of
smokeless-tobacco users have oral lesions. Other dangers lurk in its use as well.
Among these are rotting teeth, throat and stomach cancer, and heart disease.
The rise in smokeless-tobacco use among young people has been attributed to the same causes as the rise in youth smokingdirect and indirect marketing. The direct marketing involves ads and logos at sporting
events, such as car races. The indirect marketing involved celebrities, especially athletes, who are shown using the products.
57
Some people mistakenly believe that the effects of smoking only show up
in late middle age. This is not true. Although sometimes subtly, tobacco
use nevertheless affects teenagers right from the start. It can impede the
rate of lung growth and the level of maximum lung function. Regular
smoking causes frequent coughing in young people and leads to increased
respiratory illnesses. It hampers young peoples physical fitness in terms
of both performance and enduranceeven among young people trained
in competitive running. Smoking also affects the heart early on. The resting heart rate of a young adult smoker averages 2 to 3 beats per minute
faster than that of a typical nonsmoker.In
sum, studies show that teens who smoke are
2.4 times more likely than their nonsmokSome people
ing peers to report poor overall health.
mistakenly
Among the many causes for concern
believe that
about youth smoking is that it is often a
the effects of
gateway to other risky behaviors. Accordsmoking only
ing to the U.S. Centers for Disease Conshow up in late
trol and Prevention, teens who smoke
middle age.
are 3 times more likely than nonsmokers
to use alcohol, 8 times more likely to use
marijuana, and 22 times more likely to use
cocaine. Smoking is also associated with a
host of other risky behaviors, such as fighting and engaging in unprotected sex. No one would argue that tobacco is a direct cause of
these risky behaviors, but the correlation is extremely important all the
same. The reason is that teens, even more than adults, are susceptible
to influence by their peers. Teenagers tend to segregate themselves into
cliques, and one of the important demarcation lines is between smokers
and nonsmokers. In other words, if young adults get in with a group
whose members are smokers, he or she is far more likely to be exposed
to the risky and often illegal behaviors listed above than if a group of
nonsmokers is chosen.
58
59
[Advertising] will leverage the nonconformist, selfconfident mindset historically attributed to the CAMEL user to address smokers desire to project an image that elevates them in the eyes of their peers.
R.J. Reynolds Tobacco Company internal memo, Camel New Advertising Campaign, March 12, 1986. www.the
smokinggun.com.
This extract is from a memo that laid out the strategy leading to the Joe Camel
advertising campaign. It is one of thousands of tobacco company documents that
became public in the course of litigation.
Bennett S. LeBow, Frontline Online, Inside the Tobacco Deal: Interviews: Bennett LeBow, PBS, undated. www.
pbs.org.
LeBow is the chief executive officer of the Brooke Group, which owns Liggett Tobacco, the smallest of the six major tobacco companies. He was the first to settle
with state attorneys general in their lawsuit over the harm caused by tobacco.
* Editors Note: While the definition of a primary source can be narrowly or broadly defined, for the purposes of Compact
Research, a primary source consists of: 1) results of original research presented by an organization or researcher; 2) eyewitness
accounts of events, personal experience, or work experience; 3) first-person editorials offering pundits opinions; 4) government officials presenting political plans and/or policies; 5) representatives of organizations presenting testimony or policy.
60
Defendants [the major tobacco companies] have consistently made false and misleading statements that
their expenditures on advertising and marketing were
directed exclusively at convincing current smokers to
switch brands, not at enticing children.
Gladys Kessler, Memorandum Opinion, United States v. Philip Morris et al. September 28, 2000.
www.usdoj.gov.
Kessler is a federal judge in the U.S. District Court for the District of Columbia.
Smoking in movies is a risk factor for smoking initiation among US adolescents. Limiting exposure of
young adolescents to movie smoking could have important public health implications.
James D. Sargent et al., Exposure to Movie Smoking: Its Relation to Smoking Initiation Among US Adolescents, Pediatrics. vol. 116, no. 5, November 2005. http://pediatrics.aappublications.org.
Sarah M. Greene, Alcohol, Tobacco Campaigns Frequently Aimed at Women, Children and Minorities, IPRC Newsline, Spring 1992. www.drugs.indiana.edu.
Greene holds a masters degree in public health and serves as a research associate at the Center for Health Studies in Seattle, Washington.
61
Richard Peto, quoted in "The Burden of Tobacco Use," Absolute Advantage, 2006, p. 24. www.welcoa.org.
Bob Dole, quoted in SCARC Action Alert, Presidential Nominee Dole Questions Smokings Addictiveness, Danger;
National Attention Turns to Tobacco Money in Politics, July 31, 1996. www.tobacco.org.
Dole, a former U.S. senator from Kansas, was majority leader of the Senate from
1995 until 1996, when he became the Republican Partys candidate for president.
We overlook the fact that anti-tobacco doctors and activists, who advocate teenagers use nicotine through
Smoke Free delivery methods, are teaching our kids
in the classroom. Drug companies dont need to advertise near schools, their activists are discreetly promoting Tobacco Free nicotine patches, gums and inhalers face-to-face with kids in the classroom.
Norman E. Kjono, Targeting Kids for Drugs, FORCES, April 14, 1998. www.forces.org.
62
Tim Pawlenty, quoted in Office of Governor Tim Pawlenty, Governor Pawlenty Proposes Banning Specialty and Candy
Flavored Cigarettes in Minnesota, February 10, 2005. www.governor.state.mn.us.
Pawlenty, governor of Minnesota, in 2005 became the nations first state leader to
propose legislation to ban the sale of flavored cigarettes.
Michael H. Popkin, "Dr. Popkin Interviews," Keep Kids from Smoking.com, undated. www.keepkidsfromsmoking.
com.
Goerlitz is a professional actor, producer, and public speaker. Once best known
for his role as the Winston Man in cigarette commercials, he has become an
antismoking advocate.
63
Tobacco companies have been aggressively targeting Latinos, especially Latino youth, resulting in increased smoking and increasingly severe health damage to the Latino community.
Guillermo Brito, quoted in National Latino Council on Alcohol and Tobacco Prevention, Letter to Anbal Acevedo Vil,
Governor of Puerto Rico, August 23, 2005. www.nlcatp.org.
Brito is executive director of the National Latino Council on Alcohol and Tobacco
Prevention.
Lloyd Johnston, quoted in Joe Serwach, Teen Smoking Rates and Illicit Drug Use Continue to Drop, University
Record Online, January 3, 2006. www.umich.edu.
64
Young people who smoke generally experience more health problems in their teens than those who do not, especially respiratory
problems.
The younger the smoker, the swifter and stronger the addiction to
nicotine generally is.
After a rise from 1991 to 1997, cigarette smoking among youths has
fallen, showing a very large and statistically significant downward
trend since 1999.
In 2003 approximately 22 percent of all American teens were cigarette smokers, and another 6 percent used tobacco in some other
form, such as cigars or chewing tobacco.
65
Girls
25%
Boys
24%
22%
20%
20%
20%
20%
19%
18%
17%
15%
15%
14%
14%
10%
11%
8%
7%
5%
l
To
ta
We
s
Pa tern
cif
ic
uth
As east
ia
So
e
Eu
rop
Me East
dit ern
err
an
ea
n
Am
eri
cas
Afr
ic
This chart indicates that from 19992005, tobacco use by 13to 15-year-olds was highest in the Americas at 22 percent. In
all the world regions, use was higher among boys than girls.
Source: Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, May 26, 2006. www.cdc.gov.
66
0.9
0.80
0.8
0.7
0.63
0.6
0.5
0.40
0.4
0.3
0.2
0.1 0.04
0
1999
0.01
2000
2001
2002
2003
67
16
13.0+
14
12
2002
2003
2004
2005
12.2+
11.9+
10.8
10
8
6
4.5 4.5
4.8+
4.2
2.0 2.0
2.3
2.1
Cigarettes
Cigars
Smokeless
Tobacco
Pipe
Tobacco
68
xperts agree that the reduction of tobacco use can best be achieved
by preventing people from ever getting involved with the substance
in the first place. Above all else, that means stopping the marketing
of tobacco to youth; however, assisting and encouraging those who are
already addicted is important, too. The strategies for each goal are somewhat different, but each involves difficult questions of balancing individual freedoms and corporate rights with the common good. Attempts
to reduce tobacco use through prevention fall into several categories: restrictions on marketing, public education, school-based prevention programs, controlling access, and tax policies.
Few people start using tobacco once they are out of their teens, so experts agree that youth must be protected from tobacco advertising and
promotion. Efforts to do so have a long and tangled history. In 1971 the
federal government banned all tobacco advertising from television. This
presented a huge marketing obstacle to the industry, but tobacco firms
proved ingenious at circumventing it.
Their chief strategy has been to sponsor events that appear on television. The year following the ban, Philip Morris, the largest of the tobacco
companies, became the sponsor of the newly formed Womens Tennis
69
Starstruck
Not all the marketing is channeled through new media. Another key
tobacco marketing strategy, critics claim, is to have Hollywood actors
70
Public Education
71
law has required that cigarette packages carry a now-famous health warning: Caution: Cigarette Smoking May Be Hazardous to Your Health.
In 1984, after the Federal Trade Commission concluded that the original warning had had little effect, a new, more explicit set of warnings was
issued. Among them was this: SURGEON GENERALS WARNING:
Smoking Causes Lung Cancer, Heart Disease, Emphysema, and May
Complicate Pregnancy. Two years later, a similar warning was applied to
smokeless tobacco, and eventually cigars came to bear surgeon generals
warnings as well. Nevertheless, all such warning labels have proven virtually useless in deterring youth from purchasing tobacco. A 1997 Stanford
University study concluded that sizable proportions of adolescent smokers are not seeing, reading, or remembering cigarette warning labels. . . .
The current warning labels are ineffective among adolescents.28
A very different approach grew out of the 1998 MSA. The tobacco
companies settlement with state attorneys general forced them to put up
approximately $200 billion for tobacco prevention. A small portion of
those funds went into creating and funding the American Legacy Foundation, dedicated to promoting the rejection of
tobacco. Using its allocation of $300 million
a year for 5 years, the foundation funded a
Norway and
number of aggressive new antismoking camFinland . . .
paigns aimed at youth. The most notable of
have imposed
these is the truth tobacco education advercomplete protising campaign. Created by and for young
hibitions on
people, the campaign aims to show the imtobacco adpact of tobacco in highly emotive ways. One
vertising and
of its most famous ads shows teenagers piling
sponsorships.
up 1,200 body bags outside the New York
offices of a major tobacco company to dramatize the daily death toll of tobacco. Not
content to remain in one medium, the truth campaign also launched ads
on the Internet.
The impact has been dramatic. According to a study published in
June 2002 in the American Journal of Public Health, the percentage of
kids ages 12 to 17 who were aware of any antitobacco campaign doubled
during the first ten months of the truth campaign. More significant,
the percentage of young people using tobacco fell dramatically. From a
72
School-Based Prevention
The public school is the one place where tobacco marketing has little
chance to swamp the message that tobacco is highly addictive and dangerous. School-based tobacco prevention programs can be effective, according to various government and private studies. The typical effect of
a well-designed program seems to be about a 20 percent reduction in
tobacco use. The key, however, is to craft a multilayered message that
works. Experts say that it is important to focus on the immediate effects
of tobacco, not just on the long-term hazards. At least as important is
to focus on social norms. As children enter their teenage years, they are
strongly influenced by peer behavior. Knowing that about three-quarters
of young people do not smoke helps prevent others from taking up the
habit, experts say. Providing youth with specific training to resist both
marketing and peer pressure is also important, they say. Finally, involving
parents and having a credible and appealing spokesperson for the message are key to its effectiveness.
73
A Lack of Consistency
Most prevention programs are organized at the individual school level, and thus quality varies widely. Oregon is one state whose schoolbased tobacco prevention efforts have been singled out for excellence.
During the 1999 to 2000 school year, certain schools there adopted
a CDC-recommended tobacco prevention approach with multilayered strategies that included teaching near- and long-term health
consequences, social consequences (such as clinging offensive odors,
stained teeth, and stigma), and peer norms. A study of those schools
found that smoking among eighth graders dropped by 22 percent in
one year, compared with only an 8 percent decline in schools that
did not offer the CDC-endorsed program. Oregons voters funded
the program through a ballot initiative that raised the states tax on
cigarettes by 30 cents a pack.
Unfortunately, research suggests that most school-based programs
are substandard. A 2002 study by the American Legacy Foundation finds
that only 38 percent of middle-school students and 17 percent of highschool students receive at least 3 of the 4 recommended prevention strategies. Cheryl Healton, president and CEO of the foundation, cites a
distressing gap between what has been demonstrated to be effective and
what is practiced in schools.31
74
In any event, not all schools have tobaccoprevention programs, and some do not offer the programs until too late. According
Research sugto the CDC, 90 percent of high schools
gests that most
offer some tobacco prevention, but only
school-based
86 percent of junior high and even fewer
[antismoking]
elementary schools do the same. Critics
programs are
point out that smoking starts as early as
substandard.
fifth grade in many cases, and the younger
the child, the swifter and deeper the addiction. Another step in reducing tobacco use,
therefore, would be to make high-quality tobacco prevention education
universal in public schools, starting in the early grades.
Cessation Programs
For the millions who are already tobacco users, the challenges of quitting
are steep. In recent years, however, it has become somewhat easier for a
motivated addict to kick the habit. There are 2 major reasons for this.
First, programs to help smokers or other tobacco users quit have become
more sophisticated. Gone are the days of cold turkeyattempting
to quit all at oncewhich frequently resulted in disheartening failure.
Historically, more than 4 in 5 smokers surveyed have said they want to
quit. According to the American Heart Association, up to 40 percent
of participants in modern cessation programs succeed in breaking their
addiction for good. That is about twice the success rate of traditional
tobacco-quitting programs.
The other big advance in cessation is nicotine-replacement therapy.
Transdermal patches deliver nicotine through the skin for those attempting to quit smoking. Similarly, nicotine gum gives the addict a dose of
nicotine to help him or her get through the process of breaking habits
associated with tobacco use. The American Heart Association says that
nicotine-replacement therapy doubles the chances of a successful break
with tobacco. In the future, additional medical aids to quitting are likely
to emerge. Researchers funded by the National Institute on Drug Abuse
have found a compound called methoxsalen that significantly reduces a
smokers urge for nicotine. Other breakthroughs may follow as research
efforts continue.
75
76
Alfred Munzer, quoted in Centers for Disease Control and Prevention, Public Meeting for Framework Convention on
Tobacco Control, March 15, 2000. www.cdc.gov.
77
Tommy G. Thompson, Remarks of the United States Health and Human Services Secretary Tommy G. Thompson on
the Framework Convention on Tobacco Control World Health Assembly, United States MissionGeneva, May 21, 2003.
www.us-mission.ch.
Thompson, then secretary of the U.S. Department of Health and Human Services, made the above remarks at the May 21, 2003, U.S. announcement of support
for the Framework Convention on Tobacco Control, a treaty sponsored by the
World Health Organization.
President Bush committed [the United States] to preventing tobacco use and protecting public health, but
he has gone back on his word. The pocket veto of this
treaty is yet another wet kiss to Big Tobacco, and it is
a disgrace that this country will not be able to participate in global negotiations because of the presidents
inaction.
Tom Harkin, Bush Pocket Veto of Global Treaty Another Wet Kiss to Big Tobacco, November 7, 2005. http://harkin.
senate.gov.
78
Betsy A. Kohler, quoted in National Cancer Institute, Annual Report to the Nation Finds Cancer Death Rates Continue to
Drop; Lower Cancer Rates Observed in U.S. Latino Populations, September 6, 2006. www.cancer.gov.
Kohler is president of the North American Association of Central Cancer Registries, a professional organization that develops and promotes uniform data standards for tracking and reducing the incidence of cancer.
Truth was an early victim in the battle against tobacco. The big lie, repeated ad nauseam in anti-tobacco
circles, is that smoking causes more than 400,000 premature deaths each year in the United States. That
mantra is the principal justification for all manner of
tobacco regulations and legislation, not to mention
lawsuits by dozens of states.
Robert A. Levy and Rosalind B. Marimont, "Lies, Damned Lies, & 400,000 Smoking-Related Deaths," Regulation, vol.
21, no. 4, 1998. www.cato.org.
Levy is a senior fellow in constitutional studies at the Cato Institute and an adjunct professor at Georgetown University Law Center. Marimont, a mathematician and scientist, retired after a career with the National Institute of Standards
and Technology (formerly the Bureau of Standards).
Elizabeth M. Whelan and Alicia M. Lukachko, A Critical Assessment of Lies, Damned Lies, & 400,000 SmokingRelated Deaths by Robert Levy and Rosalind Marimont, published in Regulation, Fall 1998, American Council on Science
and Health, October 1, 1999. www.acsh.org.
Whelan, president and founder of the American Council on Science and Health,
holds a doctorate in public health from Harvard University. Lukachko, who holds
a masters degree in public health, is the councils assistant director of public
health.
79
Sandra Day OConnor, FDA v. Brown & Williamson Tobacco Corp. (98-1152). www.law.cornell.edu.
U.S. Supreme Court Justice OConnor, the first woman to serve on the nations
highest judicial body, wrote the majority opinion in the above-cited case. She
retired in 2005.
Colby is the author of a book titled In Defense of Smokers, which he claims debunks most of the scientific studies that underlie official pronouncements about
the dangers of smoking.
Matthew L. Myers, quoted in Campaign for Tobacco-Free Kids, Landmark National Cancer Institute Report Concludes
Cigarette Tax Increases and Tobacco Prevention Programs Reduce Youth Smoking, April 2, 2002. www.tobaccofreekids.org.
Myers, an attorney and former Federal Trade Commission staff member, is president of the Campaign for Tobacco-Free Kids.
80
We are encouraged by the continued decline in cigarette smoking among U.S. adults and want to congratulate those who have successfully quit. Quitting
smoking is the most important step smokers can take
to improve their overall health and reduce their risk
of disease.
Julie Gerberding, quoted in Centers for Disease Control and Prevention, Lower Adult Smoking Rates with More
Adults Quitting, November 10, 2005. www.cdc.gov.
Gerberding was appointed director of the U.S. Centers for Disease Control and
Prevention in 2002. She also serves as an associate professor of medicine at Emory
University in Atlanta.
John L. Kirkwood, quoted in American Lung Association, American Lung Association Challenges States to Go Smokefree by 2010, American Lung Association, January 10, 2006. www.lungusa.org.
Kirkwood is president and chief executive officer of the American Lung Association, which advocates tobacco control and healthy air quality.
81
82
MN
ID
WY
NV
CA
WI
SD
AZ
CO
IL
KS
MO
OK
NM
PA
OH
IN
WV VA
DE
MD
DC
NC
TN
SC
MS
TX
MI
KY
AR
NH
MA
RI
CT
NJ
NY
IA
NE
UT
ME
VT
ND
AL
GA
LA
FL
AK
Equal to or above the national average
of 79 cents per pack
HI
Marketing to youth continues. New flavored cigarettes with youthoriented names like Twista Lime appeal to more than twice as many
teens as they do to smokers over age 19.
83
Desire to Smoke
(participant self-evaluation
scale from 0-100)
6.8
Placebo
(Sugar Pill)
44
11.8
34
10mg
Methoxsalen
12.1
30mg
Methoxsalen
29
84
WA
MT
OR
MN
ID
WY
NV
CA
VT
ND
WI
SD
NE
UT
AZ
CO
IL
KS
OK
NM
MO
PA
OH
IN
WV VA
DE
MD
DC
NC
TN
SC
MS
TX
MI
KY
AR
NH
MA
RI
CT
NJ
NY
IA
ME
AL
GA
LA
AK
FL
HI
85
+16.1%
+8.7%
+6.5%
Americas
no change
Western
Europe
Africa and
Middle East
-8.0%
Largest predicted
regional decrease
New Zealand
UK
South Africa
US
Czech Republic
-24.9%
-21.6%
-17.3%
-13.0%
-2.5%
Eastern
Europe and
former Soviet
Union
Asia,
Australasia
and Far East
Largest predicted
regional increase
Zimbabwe
Brazil
Pakistan
Norway
Latvia
+55.7%
+40.2%
+35.9%
+30.5%
+26.5%
87
for the tobacco industry. His Kansas City firm, Shook, Hardy & Bacon,
successfully defended tobacco companies against dozens of lawsuits by
employing a strategy Hardy outlined in 1970: to keep close wraps on all
industry doubts about the safety of their product.
88
with tobacco as a staff member for the Federal Trade Commissionresponsible for regulating tobacco advertisingwent on to lead a coalition
of antismoking organizations. In that role he helped shape legislation
and court cases restricting tobacco. He is now president of the Campaign
for Tobacco-Free Kids.
Jeffrey Wigand: Wigand served as vice president for research and devel-
89
Chronology
1950
1791
1492
1847
1665
1500
1600
1700
1800
1900
1940
1950
1950
1809
French chemist
Louis Nicolas
Vanquelin isolates
nicotine from
tobacco.
1963
1753
90
1960
1953
1560
Chronology
London physician
John Hill reports
cases in which snuff
appears to have
caused nasal cancers.
1913
Chronology
1964
1982
2006
1987
1971
1965
1970
1975
1980
1968
1985
1990
2004
Congress authorizes a
buyout of tobacco farmers, bringing to an end
decades of federal subsidies
for the crop.
1995
2000
2005
1998
Aiming to encourage
women to smoke, Philip
Morris introduces the
Virginia Slims brand with
the slogan, Youve come
a long way, baby.
1979
1984
2005
91
Related Organizations
Action on Smoking and Health (ASH)
2013 H St. NW
Washington, DC 20006
phone: (202) 659-4310
Web site: www.ash.org
ASH is a nonprofit antismoking organization based in the United States.
Its principal activity is to serve as the legal-action arm of the nonsmoking community, bringing or joining in legal actions concerning smoking
and ensuring that the voice of the nonsmoker is heard. It also serves as a
public advocate of the nonsmokers rights movement.
Altria Group
120 Park Ave., 16th Floor
New York, NY 10017
phone: (917) 663-4000
Web Site: www.altria.com
Key People
Related
andOrganizations
Advocacy Groups
Altria is the corporate parent of Philip Morris, the worlds largest tobacco
company in terms of revenue (The China National Tobacco Company
and Japan Tobacco move more product but for less income.) Philip Morriss lineup of cigarettes is led by Marlboro, the most popular worldwide
brand. Philip Morris was started in 1847 by a London tobacconist of the
same name.
Related Organizations
tion, advocacy, and service. The ACS has been a leader in the effort to
promote smoking cessation and in legal and public policy efforts to restrict tobacco advertising. It was founded in 1913 by a group of doctors
in New York City.
94
Related Organizations
New York , NY 10168
Web site: www.ctr-usa.org
The Council for Tobacco ResearchUSA was created by a consortium of
tobacco companies with a mandate to research tobacco and health issues.
Critics charge that its true mission is to cast doubt on the link between
smoking and lung cancer. Following the 1998 Master Settlement Agreement the council became an online repository for various documents
related to smoking and health.
FORCES International
PO Box 533
Sutton, WV 26601
phone: (304) 765-5394
Web site: www.forces.org
FORCES International is a nonprofit organization representing the interests of smokers. The acronym stands for Fight Ordinances and Restrictions to Control and Eliminate Smoking. It was founded in 1995 to
fight what it claims is junk science regarding the hazards of secondhand
smoke. Standing on libertarian principles, it also opposes school-based
tobacco-prevention programs, which it regards as state indoctrination of
youth.
95
Tobacco Institute
Web site: www.tobaccoinstitute.com
96
Related Organizations
The Tobacco Institute was created as the umbrella trade-advocacy organization for the U.S. tobacco industry. It lobbied and funded research
friendly to the tobacco industry. Following the 1998 settlement of the
state attorneys general lawsuit, it has limited its Internet presence to providing documents related to smoking and health.
97
Don Oakley, Slow Burn: The Great American Antismoking Scam (and Why
It Will Fail). Gainsesville, VA: Eyrie, 1999.
Fred C. Pampel, Tobacco Industry and Smoking. New York : Facts On File,
2004.
Leah Ranney et al., Tobacco Use: Prevention, Cessation, and Control.
Rockville, MD: Agency for Healthcare Research and Quality, 2006.
Robert G. Robinson et al., Pathways to Freedom: Winning the Fight
Against Tobacco. Atlanta: Centers for Disease Control and Prevention, 2006.
Diana K. Sergis, Cipollone v. Liggett Group: Suing Tobacco Companies.
Berkeley Heights, NJ: Enslow, 2001.
U.S. Deptartment of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, Risks
98
Periodicals
Center for the Advancement of Health, Smoke-Filled Cars: New Fodder for the Next Clean Air Fight, ScienceDaily, October 4, 2006.
www.sciencedaily.com.
Charleston (WV) Daily Mail, editorial, Over-Regulation Is a Bad Habit,
Too: Consenting Adults Have the Right to Associate Freely in Smoky
Bars, October 4, 2006. www.dailymail.com.
Krisha McCoy, Smokers May Be More Likely to Contract HIV, HealthDay, September 21, 2006. www.healthday.com.
Robert Preidt, Genes May Tie Smoking, Drinking, HealthDay, April
24, 2006. www.healthday.com.
William Reid, Tobacco Settlement Monies Went Up in Smoke for
Blacks, Black World Today, June 26, 2002. www.tbwt.org.
Marisa Schultz, Amy Lee, and Eric Lacy, Workers Fume as Firms Ban
Smoking at Home, Detroit News, January 27, 2005.
Michael Siegel, On the Deafening Silence of the Tobacco Control
Movement: The Need for Some Moral Courage, Rest of the Story:
Tobacco News Analysis and Commentary, October 5, 2006. http://tobaccoanalysis.blogspot.com.
P.D. Thacker, Pundit for Hire: Smoked Out, New Republic, February
2, 2006.
Michael J. Thun, editorial, More Misleading Science from the Tobacco
Industry, British Medical Journal, July 30, 2003.
Elizabeth M. Whelan, The Intolerance and Arrogance of the ModernDay Anti-Smoking Movement, American Council on Science and
Health, April 21, 2006.
99
Web Sites
101
Source Notes
Overview
Source Notes
102
Source Notes
Consequences of Involuntary Exposure
to Tobacco Smoke: A Report of the Surgeon General, June 27, 2006. www.
surgeongeneral.gov.
21.
American Heart Association, Tobacco Industrys Targeting of Youth,
Minorities and Women, 2006. www.
americanheart.org.
22. University of Michigan News Service,
Decline in Teen Smoking Appears to
Be Nearing Its End, December 19,
2005. www.monitoringthefuture.org.
23. University of Michigan News Service,
Decline in Teen Smoking Appears to
Be Nearing Its End.
24. Jim Lobe, Tobacco Companies Pressed
to Halt Youth Smoking Prevention
Campaigns, OneWorld U.S., October 25, 2005. www.tobacco.org.
26.
Office on Smoking and Health,
CDC, Cigarette Use Among High
School StudentsUnited States,
19912005, Morbidity and Mortality
Weekly Report, July 7, 2006. www.cdc.
gov.
27. Quoted in Smoking in Movies Gets
Kids Hooked, KRON, November
13, 2003. www.kron4.com.
28. Thomas N. Robinson and J.D. Killen,
Do Cigarette Warning Labels Reduce
Smoking? Paradoxical Effects Among
Adolescents, Archives of Pediatrics &
Adolescent Medicine, vol. 151, March
1997. www.archpedi.ama.assn.org.
29. Joel M. Moskowitz, Impact of the
Truth Campaign on Cigarette Smoking, American Journal of Public Health,
March 31, 2005. www.ajph.org.
30. Quoted in What Past Clients Say,
Tobaccofree.org. www.tobaccofree.org.
31. Quoted in Mary Herdoiza, Study
Finds that Multi-Strategy, SchoolBased Tobacco Prevention Programs
Can Reduce Youth Smoking, American Legacy Foundation news release,
March 13, 2002. www.american
legacy.org.
103
List of Illustrations
How Harmful Are Nicotine and Tobacco?
34
35
36
37
50
51
52
53
104
66
67
68
83
84
85
86
Index
Barnard, Neal, 78
Betteridge, David, 21
Brimelow, Peter, 77
Brito, Guillermo, 64
Britton, John, 18
Brookes, Jay, 32
Browner, Carol M., 47
Brundtland, Gro Harlem, 20
California Air Resources Board, 46
Calment, Jeanne, 31
Campaign for Tobacco-Free Kids, 57,
76, 82
cancer(s)
smoking-related, deaths from, 9
by cite and gender, 37 (chart)
see also lung cancer
Carmona, Richard H., 43, 45
Centers for Disease Control and
Prevention (CDC), 66, 73
on deaths from heart disease aggravated by secondhand smoke, 49
on school-based prevention efforts,
75
on smoking as gateway to other
risky behavior, 58
on smoking-related health costs,
33, 82
on trends in female smoking, 19
cessation
challenges of, 2526
success rates in, 9
cessation programs, 75
Medicaid coverage of, by state, 85
(map)
children, effects of secondhand
smoke on, 40, 49
Christian Science Monitor (newspaper), 86
Index
acetylcholine, 24
addiction, nicotine, 14, 30
difficulty in overcoming, 2425
opiate vs., 33
treatment of, 9
vulnerability of youth to, 2324,
65
ways of satisfying, 23
advertising/marketing
battles over, 6970
international bans on, 71
most popular cigarette brands
among youth and, 68
tobacco industry spending on, 67,
70
youth as target of, 18, 5556, 57,
59
American Academy of Otolaryngology, 83
American Cancer Society, 37 (chart)
American Heart Association, 75
American Journal of Public Health, 72
American Legacy Foundation, 72, 73
American Lung Association, 16
on secondhand smoke, 39, 40
American Nonsmokers Rights Foundation, 51
American Nurses Association, 48
Americans for Non-Smokers Rights,
43
105
106
dopamine, 24
Dowshen, Steven, 31
Dunn, William L., Jr., 29
emphysema, 27
Environmental Protection Agency
(EPA), 3839
on lung cancer deaths from secondhand smoke, 49
environmental tobacco smoke. See
secondhand smoke
Food and Drug Administration, U.S.
(FDA), 54, 69
lack of authority of, to regulate
tobacco, 80
Foundation for a Smokefree America,
74
Gerberding, Julie, 81
Glantz, Stanton, 71
Goerlitz, David, 63
Greene, Sarah M., 61
Hagman, Larry, 30
Harkin, Tom, 78
Hayes Halfpenny, Robert, 45
Healton, Cheryl, 74
illnesses, tobacco-related, 27
costs of, 33, 82
International Union Against Cancer,
59
International Union Against Tuberculosis and Lung Disease, 59
Jackson, Joe, 31, 41, 46
Joe Camel campaign, 5556
Johnston, Lloyd, 59, 64
Journal of the American Medical
Index
Association, 35, 55
Kessler, David, 29, 54, 69
Kessler, Gladys, 17, 61
Kirkwood, John L., 81
Kjono, Norman E., 62
Kohler, Betsy A., 79
Lancet (journal), 71
LeBow, Bennett S., 60
Levy, Robert A., 79
Lopez, Alan D., 20
Lukachko, Alicia M., 79
lung cancer, 9, 27, 30
nonsmokers risk for, from secondhand smoke exposure, 51
percent of cases as smoking-related,
33
Mackay, Judith, 11
Marimont, Rosalind B., 79
marketing. See advertising/marketing
Master Settlement Agreement, 56,
70, 72
Mayo Clinic, 46
McFadden, Michael, 47
Medicaid, coverage of smoking cessation programs under, 85 (map)
Mdici, Catherine de, 15
methoxsalen, 75
effectiveness of, 84 (chart)
Moskowitz, Joel M., 73
Munzer, Alfred, 77
Myers, Matthew L., 47, 80
National Institute on Drug Abuse
(NIDA), 14, 34, 75, 84
Nicot, Jean, 15, 21
nicotine, 8
benefits of, 21
107
108
Index
anti-tobacco education aimed at,
7273
indifference of, to risk, 54
smoking among
cigarette taxes as deterrent to,
76, 80
gender differences in, 66
risky behaviors and, 58, 66
(chart)
tobacco industrys attempts to encourage, 5556, 57, 59, 70, 83
109
110