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Tobacco control is a field of international
public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
science, policy and practice dedicated to addressing
tobacco use
Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believed ...
and thereby reducing the
morbidity
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
and
mortality
Mortality is the state of being mortal, or susceptible to death; the opposite of immortality.
Mortality may also refer to:
* Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...
it causes. Since most
cigarette
A cigarette is a narrow cylinder containing a combustible material, typically tobacco, that is rolled into thin paper for smoking. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhaled via the opp ...
s and
cigar
A cigar is a rolled bundle of dried and fermented tobacco leaves made to be smoked. Cigars are produced in a variety of sizes and shapes. Since the 20th century, almost all cigars are made of three distinct components: the filler, the binder l ...
s and
hookah
A hookah (Hindustani language, Hindustani: (Nastaleeq), (Devanagari), IPA: ; also see #Names and etymology, other names), shisha, or waterpipe is a single- or multi-stemmed instrument for heating or vaporizing and then smoking either tobacco ...
s contain/use tobacco, tobacco control also concerns these.
E-cigarette
An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such ...
s do not contain tobacco itself, but (often) do contain
nicotine
Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
.
Tobacco
Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
control is a priority area for the World Health Organization (
WHO
Who or WHO may refer to:
* Who (pronoun), an interrogative or relative pronoun
* Who?, one of the Five Ws in journalism
* World Health Organization
Arts and entertainment Fictional characters
* Who, a creature in the Dr. Seuss book '' Horton He ...
), through the
Framework Convention on Tobacco Control
The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is a treaty adopted by the 56th World Health Assembly held in Geneva, Switzerland on 21 May 2003. It became the first World Health Organization treaty adopted under ...
. References to a tobacco control
movement may have either positive or negative connotations, depending upon the commentator.
Tobacco control aims to reduce the
prevalence of tobacco use
Prevalence of tobacco use is reported by the World Health Organization (WHO), which focuses on cigarette smoking due to reported data limitations. Smoking has therefore been studied more extensively than any other form of consumption.
Smoking is ...
and this is measured with the "age-standardized prevalence of current tobacco use among persons aged 15 years and older".
[United Nations (2017) Resolution adopted by the General Assembly on 6 July 2017, Work of the Statistical Commission pertaining to the 2030 Agenda for Sustainable Development]
A/RES/71/313
Connotations
The tobacco control field comprises the activity of disparate health, policy and legal research and reform advocacy bodies across the world. These took time to coalesce into a sufficiently organised coalition to advance such measures as the
, and the first article of the first edition of the ''
Tobacco Control
Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use and thereby reducing the morbidity and mortality it causes. Since most cigarettes and cigars and hookahs contain/use ...
'' journal suggested that developing as a diffusely organised movement was indeed necessary in order to bring about effective action to address the health effects of tobacco use.
The tobacco control movement has also been referred to as an ''anti-
smoking
Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have bee ...
movement'' by some who disagree with its aims, as documented in internal
tobacco industry
The tobacco industry comprises those persons and companies who are engaged in the growth, preparation for sale, shipment, advertisement, and distribution of tobacco and tobacco-related products. It is a global industry; tobacco can grow in any ...
memoranda.
Early history of tobacco control
The first attempts to respond to the health consequences to tobacco use followed soon after the introduction of tobacco to Europe. Pope
Urban VII
Pope Urban VII ( la, Urbanus VII; it, Urbano VII; 4 August 1521 – 27 September 1590), born Giovanni Battista Castagna, was head of the Catholic Church, and ruler of the Papal States from 15 to 27 September 1590. His thirteen-day papacy was th ...
's thirteen-day papal reign included the world's first known tobacco use restrictions in 1590 when he threatened to excommunicate anyone who "took tobacco in the porchway of or inside a church, whether it be by chewing it, smoking it with a pipe or sniffing it in powdered form through the nose". The earliest citywide European smoking restrictions were enacted in
Bavaria
Bavaria ( ; ), officially the Free State of Bavaria (german: Freistaat Bayern, link=no ), is a state in the south-east of Germany. With an area of , Bavaria is the largest German state by land area, comprising roughly a fifth of the total lan ...
,
Kursachsen
The Electorate of Saxony, also known as Electoral Saxony (German: or ), was a territory of the Holy Roman Empire from 1356–1806. It was centered around the cities of Dresden, Leipzig and Chemnitz.
In the Golden Bull of 1356, Emperor Charles ...
, and certain parts of
Austria
Austria, , bar, Östareich officially the Republic of Austria, is a country in the southern part of Central Europe, lying in the Eastern Alps. It is a federation of nine states, one of which is the capital, Vienna, the most populous ...
in the late 17th century.
In Britain, the still-new habit of smoking met royal opposition in 1604, when
King James I
James VI and I (James Charles Stuart; 19 June 1566 – 27 March 1625) was King of Scotland as James VI from 24 July 1567 and King of England and Ireland as James I from the union of the Scottish and English crowns on 24 March 1603 until ...
wrote ''
A Counterblaste to Tobacco
''A Counterblaste to Tobacco'' is a treatise written by King James VI of Scotland and I of England in 1604, in which he expresses his distaste for tobacco, particularly tobacco smoking.Steve Luck, ''The Complete Guide to Cigars: An Illustrated G ...
'', describing smoking as: "A custome loathsome to the eye, hateful to the nose, harmeful to the brain, dangerous to the lungs, and in the black stinking fume thereof, nearest resembling the horrible
Stigian smoke of the pit that is bottomeless." His commentary was accompanied by a doctor of the same period, writing under the pseudonym "Philaretes", who as well as explaining tobacco's harmful effects under the system of the four humours ascribed an infernal motive to its introduction, explaining his dislike of tobacco as grounded upon eight 'principal reasons and arguments' (in their original spelling):
Later in the seventeenth century, Sir
Francis Bacon
Francis Bacon, 1st Viscount St Alban (; 22 January 1561 – 9 April 1626), also known as Lord Verulam, was an English philosopher and statesman who served as Attorney General and Lord Chancellor of England. Bacon led the advancement of both ...
identified the addictive consequences of tobacco use, observing that it "is growing greatly and conquers men with a certain secret pleasure, so that those who have once become accustomed thereto can later hardly be restrained therefrom".
Smoking was forbidden in
Berlin
Berlin ( , ) is the capital and largest city of Germany by both area and population. Its 3.7 million inhabitants make it the European Union's most populous city, according to population within city limits. One of Germany's sixteen constitue ...
in 1723, in
Königsberg
Königsberg (, ) was the historic Prussian city that is now Kaliningrad, Russia. Königsberg was founded in 1255 on the site of the ancient Old Prussian settlement ''Twangste'' by the Teutonic Knights during the Northern Crusades, and was named ...
in 1742, and in
Stettin
Szczecin (, , german: Stettin ; sv, Stettin ; Latin language, Latin: ''Sedinum'' or ''Stetinum'') is the capital city, capital and largest city of the West Pomeranian Voivodeship in northwestern Poland. Located near the Baltic Sea and the Po ...
in 1744. These restrictions were repealed in the revolutions of 1848. In 1930s Germany, scientific research for the first time revealed a connection between lung cancer and smoking, so the use of cigarettes and smoking was strongly discouraged by a heavy
government sponsored anti-smoking campaign.
Origins of modern tobacco control
After the Second World War, the German research was effectively silenced due to perceived associations with Nazism. However, the work of
Richard Doll
Sir William Richard Shaboe Doll (28 October 1912 – 24 July 2005) was a British physician who became an epidemiologist in the mid-20th century and made important contributions to that discipline. He was a pioneer in research linking smoking ...
in the UK, who conclusively identified the causal link between smoking and
lung cancer
Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissue (biology), tissues of the lung. Lung carcinomas derive from tran ...
in 1952, brought this topic back to attention. Partial controls and regulatory measures eventually followed in much of the developed world, including partial advertising bans, minimum age of sale requirements, and basic health warnings on tobacco packaging. However,
smoking prevalence and associated ill health continued to rise in the developed world in the first three decades following Richard Doll's discovery, with governments sometimes reluctant to curtail a habit seen as popular as a result - and increasingly organised disinformation efforts by the tobacco industry and their proxies (covered in more detail below). Realisation dawned gradually that the health effects of smoking and tobacco use were susceptible only to a multi-pronged policy response which combined positive health messages with medical assistance to cease tobacco use and effective marketing restrictions, as initially indicated in a 1962 overview by the British
Royal College of Physicians
The Royal College of Physicians (RCP) is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination. Founded by royal charter from King Henry VIII in 1 ...
and the
1964 report of the U.S. Surgeon General.
In the United States, the 1964 report of the Advisory Committee to the Surgeon General represented a landmark document that included an objective synthesis of the evidence of the health consequences of smoking according to causal criteria.
[Anthony J. Alberg, Donald R. Shopland, K. Michael Cummings; The 2014 Surgeon General's Report: Commemorating the 50th Anniversary of the 1964 Report of the Advisory Committee to the US Surgeon General and Updating the Evidence on the Health Consequences of Cigarette Smoking, ''American Journal of Epidemiology'', Volume 179, Issue 4, 15 February 2014, Pages 403–412, https://doi.org/10.1093/aje/kwt335] The report concluded that cigarette smoking was a cause of lung cancer in men and sufficient in scope that “remedial action” was warranted at the societal level. The Surgeon General report process is an enduring example of evidence-based public health in practice.
Comprehensive tobacco control
At the global level
The concept of multi-pronged and therefore 'comprehensive' tobacco control arose through academic advances (e.g. the dedicated Tobacco Control journal), not-for-profit advocacy groups such as
Action on Smoking and Health
Action on Smoking and Health (ASH) is the name of a number of autonomous pressure groups (charities) in the anglosphere that seek to publicize the risks associated with tobacco smoking and campaign for greater restrictions on use and on cigar ...
and government policy initiatives. Progress was initially notable at a state or national level, particularly the pioneering smoke-free public places legislation introduced in New York City in 2002 and the Republic of Ireland in 2004, and the UK efforts to encapsulate the crucial elements of tobacco control activity in the 2004 'six-strand approach' (to deliver upon the joined-up approach set out in the white paper 'Smoking Kills' ) and its local equivalent, the 'seven hexagons of tobacco control'. This broadly organised set of health research and policy development bodies then formed the
Framework Convention Alliance The Framework Convention Alliance (FCA), also called the Framework Convention Alliance for Tobacco Control, is a confederation of nearly 500 organizations from more than 100 countries which banded together to support the negotiation, ratification a ...
to negotiate and support the first international public health treaty, the
, or FCTC for short.
The FCTC compels signatories to advance activity on the full range of tobacco control fronts, including limiting interactions between legislators and the tobacco industry, imposing taxes upon tobacco products and carrying out demand reduction, protecting people from exposure to
second-hand smoke
Passive smoking is the inhalation of tobacco smoke, called secondhand smoke (SHS), or environmental tobacco smoke (ETS), by persons other than the intended "active" smoker. It occurs when tobacco smoke enters an environment, causing its inhalat ...
in indoor workplaces and public places through
smoking ban
Smoking bans, or smoke-free laws, are public policies, including criminal laws and occupational safety and health regulations, that prohibit tobacco smoking in certain spaces. The spaces most commonly affected by smoking bans are indoor work ...
s, regulating and disclosing the contents and emissions of tobacco products, posting highly visible health warnings upon tobacco packaging, removing deceptive labelling (e.g. 'light' or 'mild'), improving public awareness of the consequences of smoking, prohibiting all tobacco advertising, provision of cessation programmes, effective counter-measures to smuggling of tobacco products, restriction of sales to minors and relevant research and information-sharing among the signatories.
WHO subsequently produced an internationally-applicable and now widely recognised summary of the essential elements of tobacco control strategy, publicised as the mnemonic
MPOWER tobacco control strategy. The six components are:
* Monitor tobacco use and prevention policies
* Protect people from tobacco smoke
* Offer help to quit tobacco use
* Warn about the dangers of tobacco
* Enforce bans on tobacco advertising, promotion and sponsorship
* Raise taxes on tobacco
One of the targets of the
Sustainable Development Goal 3 of the
United Nations
The United Nations (UN) is an intergovernmental organization whose stated purposes are to maintain international peace and international security, security, develop friendly relations among nations, achieve international cooperation, and be ...
(to be achieved by 2030) is to "Strengthen the implementation of the
in all countries, as appropriate." The indicator that is used to measure progress is the "age-standardized prevalence of current tobacco use among persons aged 15 years and older".
In 2003,
India
India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
passed the
restricted advertisement of tobacco products, banning smoking in public places and other regulation on trade of tobacco products. In 2010,
Bhutan
Bhutan (; dz, འབྲུག་ཡུལ་, Druk Yul ), officially the Kingdom of Bhutan,), is a landlocked country in South Asia. It is situated in the Eastern Himalayas, between China in the north and India in the south. A mountainous ...
, passed the
Tobacco Control Act of Bhutan 2010
The Tobacco Control Act of Bhutan ( dz, འབྲུག་གི་ཏམ་ཁུ་དམ་འཛིན་བཅའ་ཁྲིམས་ཅན་མ་, translit='Drug-gi tam-khu dam-'dzin bca'-khrims can-ma) was enacted by the Parliament of B ...
to regulate tobacco and tobacco products, banning the cultivation, harvesting, production, and sale of tobacco and tobacco products in Bhutan.
Tobacco control policies
Age restriction
Tobacco policies that limit the sale of cigarettes to minors and restrict smoking in public places are important strategies to deter youth from accessing and consuming cigarettes.
[Maria T. Botello-Harbaum, Denise L. Haynie, Ronald J. Iannotti, Jing Wang, Lauren Gase, Bruce Simons-Morton; Tobacco control policy and adolescent cigarette smoking status in the United States, ''Nicotine & Tobacco Research'', Volume 11, Issue 7, 1 July 2009, Pages 875–885,] Amongst youth in the United States, for example, when compared with students living in states with strict regulations, young adolescents living in states with no or minimal restrictions, particularly high school students, were more likely to be daily smokers.
These effects were reduced when logistic regressions were adjusted for sociodemographic characteristics and cigarette price, suggesting that higher cigarette prices may discourage youth to access and consume cigarettes independent of other tobacco control measures.
In December 2022, New Zealand became the first country to pass a bill that effectively raises the minimum age for cigarette consumption annually, in an effort to prohibit their sale to future
generations. The bill specifically prohibits the sale of cigarettes to anyone born on or after 1 January 2009.
= Graphic warning labels
=
Smokers are not fully informed about the risks of smoking.
[Hammond D, Fong GT, McNeill A'', et al.'' Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey ''Tobacco Control'' 2006;15:iii19-iii25.] Tobacco packaging warning messages
Tobacco package warning messages are Warning label, warning messages that appear on the Cigarette pack, packaging of cigarettes and other tobacco products concerning their Health effects of tobacco, health effects. They have been implemented in a ...
which are graphic, larger, and more comprehensive in content are more effective in communicating the health risks of smoking. Smokers who noticed the warnings were significantly more likely to endorse health risks, including lung cancer and heart disease.
In each instance where labelling policies differed between countries, smokers living in countries with government mandated warnings reported greater health knowledge.
Graphic warning labels on cigarette packs are noticed by the majority of adolescents, increase adolescents’ cognitive processing of these messages and have the potential to lower smoking intentions.
[Sarah D. Kowitt, Kristen Jarman, Leah M. Ranney and Adam O. Goldstein, Believability of Cigar Warning Labels Among Adolescents, ''Journal of Adolescent Health'', 60, 3, (299), (2017).] The introduction of graphic warning labels has greatly reduced smoking among adolescents.
= Smoke-free public places
=
Smoking in indoor workplaces was first prohibited nationwide by the Republic of Ireland in 2003, with most other leading economies following suit with
similar ordinances in subsequent years.
= Smoking cessation
=
Smoking cessation services borrow from the methodologies of other addiction recovery interventions to assist smokers to quit. As well as reducing morbidity and mortality for individual patients, these have been repeatedly found to reduce the overall cost to health systems of treating smoking-related disease.
Reception and further international collaboration
Now an accepted element of the public health arena, tobacco control policies and activity are seen to have been effective in those administrations which have implemented them in a co-ordinated fashion.
The tobacco control community is internationally organised - as is its main opponent, the tobacco industry (sometimes referred to as 'Big Tobacco'). This allows for sharing of effective practice (both in advocacy and policy) between developed and developing states, for instance through the World Conference on Tobacco or Health held every three years. However, some significant gaps remain, particularly the failure of the US and Switzerland (both bases for international tobacco companies and, in the former case, a tobacco producer) to ratify the FCTC.
Journal
''
Tobacco Control
Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use and thereby reducing the morbidity and mortality it causes. Since most cigarettes and cigars and hookahs contain/use ...
'' is also the name of a journal published by
BMJ Group
BMJ (branded as BMJ Group until 2013) is a British publisher of medical journals. Established in 1840, the company is owned by the British Medical Association.
Publications
* 1840: '' Provincial Medical and Surgical Journal'' (later renamed th ...
(the publisher of the
British Medical Journal
''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
) which studies the nature and implications of tobacco use and the effect of tobacco use upon health, the economy, the environment and society. Edited by
Ruth Malone, Professor and Chair, Department of Social & Behavioral Sciences, University of California, San Francisco, it was first published in 1992.
Opposition
Direct and indirect opposition from the tobacco industry continue, for instance through the tobacco industry's efforts at misinformation via suborned scientists
[HM Governmen]
"Industry Recuritment of Scientific Experts"
, Tobacco Industry Documents in the Minnesota Depository: Implications for Global Tobacco Control Briefing Paper No. 3 (February 1999) . Accessed 2011-10-04. and '
astroturf
AstroTurf is an American subsidiary of SportGroup that produces artificial turf for playing surfaces in sports. The original AstroTurf product was a short-pile synthetic turf invented in 1965 by Monsanto. Since the early 2000s, AstroTurf has m ...
' counter-advocacy operations such as
FOREST
A forest is an area of land dominated by trees. Hundreds of definitions of forest are used throughout the world, incorporating factors such as tree density, tree height, land use, legal standing, and ecological function. The United Nations' ...
.
See also
*
Action on Smoking and Health
Action on Smoking and Health (ASH) is the name of a number of autonomous pressure groups (charities) in the anglosphere that seek to publicize the risks associated with tobacco smoking and campaign for greater restrictions on use and on cigar ...
*
Anti-Cigarette League of America
*
Anti-tobacco movement in Nazi Germany
*
List of smoking bans
Smoking bans are public policies, including criminal laws and occupational safety and health regulations, which prohibit tobacco smoking in certain spaces. Laws pertaining to where people may smoke vary around the world. China and the United Sta ...
*
List of cigarette smoke carcinogens
Commercial tobacco smoke is a mixture of more than 5,000 chemicals. According to the U.S. Department of Health and Human Services, the following are known human carcinogens found in cigarette smoke:
See also
* Composition of electronic cigarett ...
*
National Non-Smoking Week
National Non-Smoking Week is a yearly event in Canada. Established in 1977, it continues to be observed on the third full week of January, starting on Sunday. Coordinated by the Canadian Council for Tobacco Control, it aims to:
*educate Canadians ...
*
Patrick Reynolds, an anti-smoking activist
*
Philip Morris v. Uruguay
The Philip Morris v. Uruguay case ( es, Caso Philip Morris contra Uruguay) it was a judicial process started on 19 February 2010 and concluded on 8 July 2016, in which the multinational tobacco company Philip Morris International (PMI), whose ...
*
Plain tobacco packaging
Plain tobacco packaging, also known as generic, neutral, standardised or homogeneous packaging, is packaging of tobacco products, typically cigarettes, without any branding (colours, imagery, corporate logos and trademarks), including only the b ...
*
Smoking age
smoking age is the minimum legal age required to purchase or use tobacco products. Most countries have laws that forbid sale of tobacco products to persons younger than certain ages, usually the age of majority.
This article does not discuss l ...
*
Smoking ban
Smoking bans, or smoke-free laws, are public policies, including criminal laws and occupational safety and health regulations, that prohibit tobacco smoking in certain spaces. The spaces most commonly affected by smoking bans are indoor work ...
*
Smoking bans in private vehicles
*
Terrie Hall
Terrie Linn McNutt Hall (July 19, 1960 – September 16, 2013) was an American anti-smoking and anti-tobacco advocate. She was a survivor of ten cancer diagnoses, undergoing 48 radiation treatments, and nearly a year's worth of chemotherapy, befo ...
(1960 – 2013), anti-smoking activist who died from smoking
*
Tobacco advertising
Nicotine marketing is the marketing of nicotine-containing products or use. Traditionally, the tobacco industry markets cigarette smoking, but it is increasingly marketing other products, such as electronic cigarettes and heated tobacco products ...
*
Tobacco packaging warning messages
Tobacco package warning messages are Warning label, warning messages that appear on the Cigarette pack, packaging of cigarettes and other tobacco products concerning their Health effects of tobacco, health effects. They have been implemented in a ...
*
Tobacco politics
Tobacco politics refers to the politics surrounding the use and distribution of tobacco.
In the United States, from the 1950s until the 1990s, tobacco industries wielded great influence in shaping public opinion on the health risks of tobacco. ...
*
Tobacco-Free College Campuses
*
Tobacco-Free Pharmacies
A tobacco-free pharmacy is a retail pharmacy where the sale of tobacco products is not available. Outside the United States, it is illegal in countries such as in France and most of Canada for pharmacy stores to sell cigarettes and similar produc ...
*
Vaping
An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such ...
*
WHO Framework Convention on Tobacco Control
The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is a treaty adopted by the 56th World Health Assembly held in Geneva, Switzerland on 21 May 2003. It became the first World Health Organization treaty adopted under ...
*
Word of Wisdom
The "Word of Wisdom" is the common name of an 1833 section of the Doctrine and Covenants, a book considered by many churches within the Latter Day Saint movement to be a sacred text. The section defines beliefs regarding certain drugs, nutritious ...
*
World No Tobacco Day
World No Tobacco Day (WNTD) is observed around the world every year on 31 May. The yearly celebration informs the public on the dangers of using tobacco, the business practices of tobacco companies, what the World Health Organization (WHO) is ...
Notes and references
Bibliography
*
*
External links
''Tobacco Control''journal
''Tobacco Policy''
{{smoking nav
Health movements