In the 30 years since the first Surgeon General's report, progress
has been made in educating the public about the dangers of tobacco
National health objectives have been established to reduce tobacco
use as well as to reduce exposure to environmental tobacco smoke
(ETS). These objectives include setting specific, measurable goals
for preventing the initiation of tobacco use (especially among
young persons) and promoting tobacco use cessation. Other objectives
involve the development of public policies that address smoke-free
air, preemption, tobacco advertising, and excise taxes on tobacco
By regulating the sale and use of tobacco and by increasing taxes
on tobacco products, states have contributed toward efforts to
achieve 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 in
each 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 restrict
smoking in state government work sites and limit smoking to designated
smoking areas. Two require no smoking or designated smoking areas
with separate ventilation and seven states completely prohibit
smoking. In contrast, only 21 state laws restrict smoking in private
work sites; of these only California's law requires either no
smoking 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 in
child care centers. Forty-two states restrict smoking in hospitals,
42 on selected forms of public transportation, 30 in grocery stores
and 23 in enclosed arenas.
All states prohibit the sale and distribution of tobacco products
to persons under 18 years of age, and 35% of states designate
an enforcement authority in the legislation. All state laws penalize
the business owner, manager, and/or clerk for violation of the
sale of cigarettes to minors. Fourteen state laws include the
possibility of suspension or revocation of a license to sell tobacco
products for violation of youth access laws. A total of 32 state
laws prohibit purchase, possession, or use of tobacco products
Although no state has completely banned the sale of tobacco products
through vending machines, none allow such sales to minors, and
32 states provide additional restrictions to reduce youth access
to vending machines. Thirty-three state laws require some form
of retail licensure for the sale of tobacco products. Eighteen
state laws include chewing tobacco, snuff, or both in their licensing
requirements. All state laws that require businesses to be licensed
to sell tobacco products also penalize businesses for violation
of licensing requirements.
All states tax cigarettes (see Table on facing page); the average
tax is 31.5¢ per pack and ranges from 2.5¢ per pack
in Virginia to 75¢ per pack in Michigan. In all states, the
tax is a fixed amount, not a percentage of the price per pack.
Tobacco companies are now making cigarettes more affordable by
introducing generic cigarette brands and lowering prices on premium
brands. Forty-two states also tax smokeless tobacco products.
Nine states (California, Illinois, Kentucky, Louisiana, Michigan,
Pennsylvania, Texas, Utah, and West Virginia) have laws that restrict
the advertising of tobacco products. In 1993, the tobacco industry
spent more than $6 billion for cigarette advertising and promotion,
an increase of 15.4% from 1992. The smokeless tobacco industry
spent more than $119 million on advertising and promotion in 1993,
a 3.5% increase from 1992. Tobacco advertising creates a climate
that increases the social pressure on young people to use tobacco
by implying that using tobacco promotes independence, adventure,
Tobacco use is the leading preventable cause of death in the US.
Approaches that involve both educating the public regarding the
hazards of use and developing tobacco-control policies are relevant.
Public health policies that prevent tobacco addiction among young
persons and also protect nonsmokers from exposure to ETS can play
a prominent role in improving the health of the nation.
Adapted from Morbidity and Mortality Weekly Report, November
3, 1995, Vol.44, No. SS-6