Tobacco

Tobacco is a highly important source of preventable deaths in the United States. Whether smoked, chewed, or used as snuff, tobacco can cause an enormous range of disabling and fatal diseases, including heart disease, strokes, emphysema, and numerous cancers. As many as half of all smokers will die because of their tobacco use, losing an average of 15 years from their normal life expectancy. Tobacco use also increases morbidity and mortality among “passive smokers,” those who live and work around smokers (WHO, 2017a). Similarly, both active and passive smoking can cause birth defects and infant mortality. Un- fortunately, quitting smoking is difficult because nicotine (the active ingredient in tobacco) is highly addictive.

Given nicotine’s addictiveness, it’s easy to understand why individuals con- tinue smoking once they have started. But why do individuals begin smoking in the first place, especially when many initially find tobacco vile tasting and even nauseating? To answer this question, we need to look at the role played by tobacco manufacturers.

Since the 1960s, when research first proved the link between smoking and lung cancer, tobacco manufacturers have labored to convince the public—especially youths, women, and minorities—to associate tobacco with positive attributes rather than with death and disability. To target youths and minorities, manufacturers have advertised in movie theaters and at sports events. To target women, manufacturers have played on women’s desire for equality, excitement, personal fulfillment, and weight loss. This strategy was exemplified by the campaign for Virginia Slims—the name was not accidental—and its slogan, “You’ve come a long way, baby.”

Since the 1990s, successful legal attacks on tobacco manufacturers and ad- vertisers have eroded their ability to attract new customers. For example, tobacco companies can no longer use cartoon characters in advertisements and now must limit their sponsorship of sports and entertainment events. Public health cam- paigns have also had an impact. Partly because of these campaigns, Americans in- creasingly support the idea of “smoke-free” areas and a smoke-free culture.

As cigarettes have become less popular, however, tobacco manufacturers have begun promoting electronic cigarettes (commonly known as e-cigarettes) as a safer and “cooler” alternative. “Vaping” e-cigarettes has become widely popular, espe- cially among adolescents attracted in part by flavors such as bubble gum that are targeted at their age group. Unfortunately, although e-cigarettes seem clearly safer than regular cigarettes and can help people stop smoking the latter, they still contain nicotine and still can lead to addiction. More research is needed before we can fully assess their benefits and harms.