Regulating Tobacco's Demise
In a 2012 survey, 18.1 percent of American adults (20.5 percent of men and 15.8 percent of women) said they smoked. This was down from 42.4 percent in 1965, a success stemming in part from public-policy initiatives ranging from ad campaigns to taxes to smoke-free public areas.
Mindful of this dramatic decline, scholars in the tobacco-cessation policy arena have recently begun a discussion of "endgame" strategies. Two strategies in particular dominate the discussion: reducing the nicotine content of cigarettes to make them less addictive, and further regulating sales, particularly at the local-government level, including bans on entire categories of tobacco products. For example, the board of health of Westminster, Mass. -- having reached its limit on bubblegum-flavored cigars, electronic cigarettes, and other new tobacco-based products that have a strong appeal to underage potential smokers and are now flooding municipal retail establishments -- is considering a proposal to ban the sale of all tobacco products.
This discussion is premature, however, because the fight against smoking has not been quite as effective as some would like to think. Most of the decline was reached by 1990, when 25.5 percent of adults remained smokers. Smoking-attributable deaths in the U.S. have remained above 400,000 for more than a decade. And perhaps most importantly, the vast majority of those who try cigarettes still do so before they turn 18, the minimum age at which purchasing tobacco is legal. Before implementing endgame strategies that are sure to prove difficult politically, regulators should further reduce youth smoking using the strategies that have already proven effective.
States certainly have the money to expand their assorted anti-smoking efforts. The state attorneys general settled their lawsuits against the major tobacco companies in November 1998, with estimated settlement funds of $246 billion over the first 25 years to be used by state governments to finance solutions to tobacco-related public-health problems. Broken Promises to Our Children: The 1998 State Tobacco Settlement 15 Years Later, a 2013 report issued by the Campaign for Tobacco-Free Kids, finds that state governments spend only a small portion of their tobacco revenues (including tobacco taxes) on tobacco-cessation programs and public-health advertising campaigns. For example, in Fiscal Year 2014, the states will collect an estimated $25 billion in revenue from the tobacco settlement and tobacco taxes, but will spend only $481.2 million -- 2 percent -- on smoking prevention and cessation programs. This is just 15 percent of the spending recommended by the U.S. Centers for Disease Control and Prevention, which itself leaves most tobacco revenue for states to spend on other priorities.
Also, a 2014 surgeon general's report concludes that advertising and promotional activities by the tobacco industry are directly responsible for the onset and continuation of smoking among adolescents and young adults. According to data collected by the Federal Trade Commission in 2011, tobacco companies spend $8.8 billion a year to market cigarettes and smokeless tobacco; this translates into tobacco companies' spending about $18.30 to market and advertise tobacco products for every one dollar that state governments spend to reduce tobacco usage. Since so many forms of direct advertising and promotion of tobacco products have been curtailed over the years, the entertainment media, and specifically the motion-picture industry, are among the few remaining outlets for transmitting positive imagery of smoking tobacco products to significant consumer audiences. The surgeon general's report estimates that youth were exposed to 14.9 million in-theater tobacco-use impressions in youth-rated films in 2012, with 14.8 million of those impressions delivered by PG-13 rated movies.
The First Amendment precludes direct government restrictions on these movies, but, as the surgeon general suggested, the motion-picture industry could perform a public service by awarding any film with smoking or other pro-tobacco imagery an R rating (with exceptions for historical figures who actually smoked or films that depict the dangers of smoking). Research suggests that this change would reduce in-theater exposures from a current median of about 275 annual exposures per adolescent from PG-13 movies down to approximately ten or fewer, resulting in adolescent smoking reduced by an estimated 18 percent. Such a move may not pay immediate dividends to the movie industry, but it would create goodwill from lawmakers that could prove beneficial in the future.
It is indeed time to get the smoking rate back on a sharply downward trajectory, but the situation does not yet call for endgame strategies. Ramping up the fight against youth smoking -- both by stepping up the efforts that public-health regulators have undertaken for years, and by reducing kids' exposure to smoking in movies -- is much more promising in the near term.
Thomas A. Hemphill is an associate professor of strategy, innovation, and public policy in the University of Michigan-Flint School of Management.