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.
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 products.
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 by minors.
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, and glamour.
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