Introduction

People have been using tobacco products in some manner or another since the early 1500s, though the history goes well beyond that. At one point, smoking was the norm in our culture, even a coming-of-age transition. A culture shift that began fifty or more years ago, backed by science and research, has dramatically reduced the number of people who use tobacco in the United States. Yet the problem persists, striking costly blows to our health and economy, and every new user is likely to become hooked on nicotine. The recent introduction of new smokeless forms of tobacco presents new challenges to the antitobacco movement. This e-booklet will explore the long history of tobacco, its cultural influences, and the nature of nicotine addiction. We’ll also discuss different routes to recovery and why prevention is so critical with this drug.

History

Tobacco: America’s Gift to the World

History tells us that Columbus and other early explorers were searching for a new route to Asia, as well as riches such as gold and spices, when they stumbled upon the New World. Who knew that one discovery of this era, the tobacco plant, would have such a profound effect on the world—and such devastating health consequences. Columbus is said to have had his first glimpse of tobacco when he stepped onto a small island in the Bahamas and the locals offered him dried tobacco leaves. Again and again, he and his crew witnessed natives using this plant and decided to bring it back with them to Spain.

A plant native to the Americas, tobacco was in use long before the European explorers caught sight of it. Archaeologists trace tobacco to the Andes area of South America, where it was first cultivated between 5000 and 3000 BCE. From there, the plant spread northward. Drawings carved in stone reveal that the Mayans used tobacco somewhere between 600 and 900 AD. By the time Columbus arrived in the region in 1492, tobacco use had spread throughout the Americas and to the Caribbean Islands.

When tobacco was introduced to Europeans, the medicinal value of the plant was of keen interest. This was an era where doctors would typically treat patients with various oils or herbs. And, unlike most plants that were thought to heal a specific ailment, tobacco was tested as a remedy for maladies and injuries of virtually all forms. Among other applications, it was ground up and swallowed or placed upon wounds. Before long, Europeans considered it a panacea and used it to treat everything from tumors to ringworm to the plague. In 1560, a French ambassador was introduced to tobacco while in Portugal; he brought the plant back with him and gave it to the queen, who suffered from migraines. The ambassador’s name was Jean Nicot, and cultivated tobacco eventually took on the scientific name Nicotiana tabacum.

Tobacco was not limited to medicinal use. Explorers to the New World had seen the natives smoking tobacco in pipes of various shapes and sizes. With this in mind, they began smoking the dried leaves as well; eventually, they also chewed it and later rolled and smoked it.1 By the mid-1500s tobacco was well known for its pleasurable effects.

Yet, even from the beginning, tobacco had its critics. King James I of England was one. In 1604, he raised the import tax on tobacco forty-fold and wrote a book lambasting its effects, A Counterblaste to Tobacco. In 1610, Sir Francis Bacon wrote about its habit-forming characteristics that were difficult to break.2 In time, doctors began questioning how effective tobacco was as a therapy. By the end of the seventeenth century, its perceived value as an effective pharmaceutical was in decline, though the pharmacies of the day still made it available. Still, cure-all or not, tobacco was to retain a prominent role on the continent and beyond.

Native Americans and Tobacco

Throughout history Native American peoples have used tobacco in their spiritual ceremonies and rituals. They have also used it for medicinal purposes.3 And though Columbus and his companions witnessed Native American peoples enjoying tobacco as a part of their rituals, they did not smoke it every day.

Most Native Americans smoked tobacco in a pipe, which calls to mind the peace pipe that is used during ceremonies and symbolizes respect for one another. Smoking tobacco in a pipe still remains an important part of many Native American ceremonies, but many Native Americans now smoke cigarettes and use other recreational forms of tobacco as well.

When King James granted the Virginia Company of London permission to become the first English colony in the New World, profit was one of the things on his mind. The colonists arrived in 1607 but were unable to make use of the riches of this new land. It wasn’t until 1610 with the arrival of John Rolfe, who would eventually marry Pocahontas, that the colonists turned their efforts toward growing and exporting tobacco. As a lucrative, in-demand crop, tobacco was also one of the keys to the colony’s survival.4

Tobacco continued to grow in importance in the Virginia colony. The rise of tobacco plantations, and the necessary labor for growing and harvesting the crop, would even be a factor in the development of slavery.5

While the Virginia Company may have been the first to profit from tobacco in the New World, others were soon to follow. Today, the United States’ largest producers of tobacco are North Carolina, Kentucky, Virginia, and Tennessee. Although small family tobacco farms have become rare and tobacco production in the United States has declined since the 1950s, it has grown throughout the world. The production of cigarettes increased with advances in technology and agriculture. Today, tobacco is produced in almost every nation, with an annual output of approximately six trillion cigarettes.6

As smoking gained popularity, tobacco companies grew and became more powerful. Beginning in the 1920s, advertisers began targeting women, who took up the habit in droves. Cigarette companies such as Lucky Strike reached women through ad campaigns that emphasized the connection between smoking and weight control. Women were happy to oblige. The nineteenth amendment had just been passed, granting women the right to vote, so women were eager to exercise their newfound freedom.7 Of course, men still continued to smoke, and in increasing numbers. In World Wars I and II, soldiers were issued tobacco and rolling papers—or rolled cigarettes—as part of their rations, a move that was intended to offer stress relief but undoubtedly encouraged use that led to addiction.8

By the midseventies, tobacco and its products—especially cigarettes—seemed to be everywhere. Kids made ashtrays for their parents in art class; the Marlboro Man greeted us on roadside billboards as we drove to and from the office; and whether you were at a baseball game, a medical clinic, or on an airplane, you or the person next to you may have been lighting up and taking deep drags. Cigarette use had become a ubiquitous and established part of our culture. While some restaurants featured “no-smoking sections,” you certainly couldn’t step inside a bar and expect to breathe clean air. But science was catching up with the behavior of the masses, and it wouldn’t be long before the smoking culture and the tobacco industry were in for a shock.

Hear, Hear—News from the Surgeon General

The U.S. Surgeon General is charged with providing leadership in medicine, and protecting and advancing the health of the nation. So when he or she releases a report, even on something as mundane as tobacco use, people stop and listen. The first Surgeon General’s report on smoking was released in 1964—on a Saturday, so as not to send the stock market into a tailspin—and it confirmed that tobacco use was hazardous to our health and even led to cancer.9 All of a sudden, the country was shaken out of its hazy stupor.

That first Surgeon General’s report on smoking was created by an advisory committee on smoking and health that had been brought together to investigate the health ramifications of smoking. Although the report stopped short of calling nicotine an addictive drug, it pronounced a definite connection between smoking and lung cancer and also asserted that the risk increased with the amount of cigarettes smoked.10

The report marked the beginning of a shift in consumers’ beliefs about tobacco as well as in their behavior, if only in small ways at first. Science had spoken, and now the government stepped in to take action. As a first move, Congress ordered that cigarette packaging contain a health warning. Next, it banned tobacco advertising on television and radio.11

For their part, the tobacco companies responded to the public’s newfound fear of their products by creating new, “safer” cigarettes. Now, and for many years to come, consumers could walk into a gas station and find “low,” “light,” and “mild” versions of their favorite cigarettes. Advertisements claimed, among other things, that their products were low-tar, ultra low-tar, or the lowest tar available, all while being “kindest to your taste.” One advertisement stated, “You don’t cut down on your smoking…The big duke filter does it for you.”12 These product claims implied that smoking these cigarettes meant less risk. Yet research did not bear this out—reducing the level of tar and nicotine was not proven to safeguard users from the hazards of smoking.13

Lawsuits

The evidence that smoking endangered our health and that the tobacco industry was well aware of this continued to mount. Starting in 1994 with Mississippi, states began filing lawsuits against the tobacco industry for the public health costs associated with tobacco use. The lawsuits contended that the tobacco industry had engaged in consumer fraud, conspired to manipulate nicotine levels in cigarettes, and marketed their products to minors.

Prior to these state lawsuits, individuals with lung cancer and other diseases had sued cigarette manufacturers, making claims of fraud and that the companies knew their products were hazardous but had not warned the users. In these cases, the tobacco companies denied such claims, arguing that tobacco was neither harmful nor addictive and that smokers knew the risks they were taking. Whether in the initial rulings or in appeals court decisions, tobacco always came out the winner in these lawsuits.14

But lawsuits with states were a different matter, and the tobacco industry would not prevail this time; instead, they would settle. The first states to reach agreements with the industry, in early 1998, were Minnesota, Mississippi, Texas, and Florida. The terms of each settlement differed by state, but each included awards in the billions. During the Minnesota lawsuit, in particular, the industry was forced to turn over internal documents it had previously withheld—35 million pages worth—and the content of those reports and memos incriminated the industry as well as gravely damaged its credibility.15

An article published in the Journal of the American Medical Association summarized the significance of what was unearthed: “These documents reveal that for decades, the industry knew and internally acknowledged that nicotine is an addictive drug and cigarettes are the ultimate nicotine delivery device; that nicotine addiction can be perpetuated and even enhanced through cigarette design alterations and manipulations; and that ‘health-conscious’ smokers could be captured by low-tar, low-nicotine products, all the while ensuring the marketplace viability of their products.”16 These documents would become a key part of the settlement that was reached six months later with the remaining states and territories that had sued the industry.

The clandestine reports and memos included the following statements:

The Master Settlement Agreement

The settlement between the five largest tobacco companies17 and the remaining forty-six states plus five territories and the District of Columbia was the largest recovery in the history of the United States. The historic $206 billion settlement would be paid out in yearly installments for twenty-five years, followed by annual payments for an indefinite period. The monies would help pay states for treating tobacco-related illnesses and would fund prevention programs.

In addition to the financial award to states and territories, the agreement included a host of terms limiting the sales and marketing of tobacco, especially to youth. Through numerous regulations, the settlement essentially aimed to prevent young people from taking up the habit and to protect those who were already users. The settlement agreement brought permanent relief to consumers by

Fifteen years later, have these restrictions and regulations been effective? American Legacy Foundation, a national foundation whose creation was mandated in the terms of the Master Settlement Agreement, studies and educates the public about the impact of tobacco. The foundation reported that in the first ten years since the settlement, consumption of cigarettes in the United States decreased by approximately 28 percent, or 135 billion cigarettes. Yet in the past few years, the rate of tobacco use has stalled.18 Even so, government efforts to reduce smoking in the United States are continuing.

The Tobacco Buyout

One such effort is to reduce the amount of tobacco grown. Toward that end, President George W. Bush signed the Fair and Equitable Tobacco Reform Act into law in October 2004, thereby ending the tobacco quota program for farmers that had been in place since the Depression. The quota program, which had dictated the amount of tobacco farmers could grow and sell and guaranteed prices, was replaced by the Tobacco Transition Payment Program—otherwise known as the tobacco buyout. This new program lifted restrictions on how much tobacco farmers could grow while eliminating price support. It was designed to both reduce the amount of tobacco grown in the United States and to aid growers whose profits had declined due to less demand for tobacco and competition from growers outside the country. The buyout program agreed to pay farmers, based on previous tobacco yields, annual payments for ten years as they transitioned to other crops or other activities.

The program has been an undeniable success. In Maryland alone, 86 percent of eligible farmers took the deal, with 75 percent of those growers signed up in the first year it was offered.19 In the eyes of some, this program has cost more than the settlements paid to farmers; another price was the end of a three-hundred-year tradition of tobacco farming. According to the 2007 Census of Agriculture, the number of tobacco farms in the United States dropped from more than 93,000 in 1997 to just more than 16,000 in 2007.

FDA Control

Legislation has continued to place greater controls on “big tobacco” in an effort to protect the nation’s health. The Family Smoking Prevention and Public Tobacco Control Act, passed in 2009, was viewed as a major breakthrough in the regulation of tobacco product. With it, the FDA finally gained the authority to regulate tobacco products, including distribution and marketing. What’s more, the legislation banned most flavored cigarettes (except menthol and natural tobacco) and raised federal excise taxes. It also banned new vending machines with tobacco products and restricted those already in use to places where only people over age twenty-one can frequent. The act prohibited tobacco companies from using so-called reduced-harm claims on their product labels—no more low-tar, low-nicotine, and so on—or advertising as of June 2010.20 It also called for new, larger warning labels on tobacco products—the first update in twenty-five years. However, in 2011, the big tobacco companies filed a lawsuit against the FDA over the proposed new warning labels, arguing that the larger size of the warnings and the accompanying graphics would cover too much of their product labels. In 2012, an appeals court ruled in favor of the tobacco companies, agreeing that the proposed labels violated free speech protection.21

Cultural Shift

With the staggering amount of scientific evidence that seems to link smoking and other tobacco use with a variety of diseases, and with the unprecedented controls and restriction on smoking, the culture has shifted away from smoking and largely embraced tobacco-free living. Indeed, today it is not uncommon to see smokers banished to the back door or beyond, as more and more workplaces and public locations ban smoking on their premises. In a culture that by and large prides itself on tolerance, smoking seems to be the exception. Children who wrinkle up faces in disgust or complain loudly when they happen to smell cigarette smoke are rarely scolded by parents (who perhaps want to promote that antismoking attitude). The days of smoking at one’s office Mad Men style are long gone.

Who Is Still Smoking?

The number of smokers has dropped sharply in the past forty years, falling more than 50 percent from 1965 to 2009.22 Still, cigarettes and other tobacco products have not gone away, with an estimated 46.6 million adults—about one in five people—still smoking as of 2009. Here’s a look at who is still shelling out five to twelve dollars for a pack of cigarettes:

Men are smoking more than women: About 23.5 percent of men compared to 17.9 percent of women smoke.

White people are smoking more than any other group: More than 22 percent of non-Hispanic whites smoke followed by 21 percent of non-Hispanic blacks, 14.5 percent of Hispanics, and 12 percent of Asians in the United States.

Adolescents: The 2012 Monitoring the Future study found that 10.6 percent of students in grades eight, ten, and twelve had smoked within the past thirty days.23

Pregnant women: As of 2005, 10.7 percent of all women smoked during pregnancy, down almost 45 percent from 1990.24

Worldwide, even as tobacco use is going down among countries with higher standards of living, it is increasing as a whole. According to the World Health Organization, nearly 80 percent of the world’s one billion smokers now live in low- and middle-income countries.25

Over the past one hundred years, tobacco use in the United States has seemed to ride a roller coaster of highs and lows. While use skyrocketed after World War I and World War II, it has declined rapidly in the forty years since the Surgeon General’s first report on the deadly effects of tobacco. The lawsuits by individual states and their historic settlements have changed the industry forevermore, as have the resulting restrictions and move to government oversight. Yet, the story of tobacco is far from over. The health consequences of new forms of smokeless tobacco are still being examined, and the youth culture’s gravitation toward what’s new and novel is still being played out.