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Policy Date: 1/1/1998
Policy Number: 9808

The American Public Health Association,
Acknowledging that the detrimental effects of tobacco use have long been known to have a severe, negative impact on the public's health;1 and
Recognizing that comprehensive, well-funded, sustainable national tobacco control legislation is crucial to achieving long-term reductions in the prevalence of smoking by youth and adults;2 and
Reaffirming the long-standing policies of the American Public Health Association in support of strong tobacco control actions to protect the public's health (APHA Public Policy Statements 1948-present, Cumulative, American Public Health Association, Washington, DC); therefore
1. Congratulates President Clinton and the Koop-Kessler Committee on initiating tobacco control efforts in 1997 by their (a) review of the national tobacco control proposal; (b) call for unfettered authority of the Food and Drug Administration (FDA) to regulate nicotine and all tobacco products; (c) emphasis on the importance of tax and price increases on all tobacco products to deter smoking by young people; and (d) call for a properly designed national tobacco control policy;3
2. Recommends that legislation for a national tobacco control policy be developed that meets five basic principles: (1) protection of children against inducements to use tobacco and encouragement not to use it;4 (2) aid to addicted adults and children in cessation of tobacco use;5 (3) right of every person to breathe air not contaminated by tobacco smoke;6,7 (4) the same right of parties injured by tobacco to sue for compensation as they have with other products;8 and (5) require meaningful community-driven strategies for stabilizing the economies of tobacco-dependent communities;
3. Recommends that national tobacco control legislation (a) ban all advertising, promotion, and sponsorship of tobacco products;9 (b) substantially and repeatedly raise the tax on cigarettes and other tobacco products;10 (c) require the tobacco industry immediately to implement strengthened health warnings stating that tobacco is addictive, causes heart disease and cancer, and can kill; (d) reaffirm the full authority of FDA to regulate nicotine as an addictive drug and all tobacco products as drug delivery devices,11 (e) require a large comprehensive sustained professionally designed anti-tobacco education program and well-designed cessation programs and quality assurance mechanisms funded, but not controlled by, the tobacco industry;12 (f) require the complete public disclosure of all tobacco industry documents that relate to the development, promotion and sale of tobacco products and/or the health consequences of tobacco products;13 and (g) require that all tobacco products be fire-safe;1 and
4. Specifically recommends that national tobacco control legislation neither preempt any state or local authority from further regulating tobacco nor grant the tobacco industry immunity from liability.14


  1. US Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 89-8411.

  2. Smoking control strategies in developing countries: Report of a WHO Expert Committee. Geneva: World Health Organization, 1983.

  3. Koop CE, Kessler DA (co-chairs). Final Report of the Advisory Committee on Tobacco Policy and Public Health. Washington, DC, July 1997.

  4. Lynch BS, Bonnie RJ eds. Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths. Committee on Preventing Nicotine Addiction in Children and Youths. Institute of Medicine. Washington, DC: National Academy Press, 1994.

  5. US Agency for Health Care Policy and Research. Clinical Practice Guidelines, Number 18. Smoking Cessation. US Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research, Centers for Disease Control and Prevention. AHCPR No. 96-0692, April 1996.

  6. US Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. US EPA, Office of Research and Development, Office of Air and Radiation. EPA/600/6-90/006F. December 1992.

  7. California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke, Final Report. Sacramento, CA: California Environmental Protection Agency, Office of Environmental Health Hazards Assessment.

  8. Koop CE, Kessler DC, Lundberg GD. Reinventing American tobacco policy, sounding the medical community's voice. JAMA. 1998;279:550-552.

  9. Roemer R. Legislative Action to Combat the World Tobacco Epidemic. 2d ed. Geneva: World Health Organization, 1993.

  10. Grossman M, Chaloupka FJ. Cigarette Taxes. The Straw to Break the Camel's Back. Public Health Reports. July/August 1997; Vol 112; p. 291-297.

  11. Food and Drug Administration. Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco to Protect Children and Adolescents; Final Rule. Fed. Regist. Wednesday, August 28, 1996.

  12. US Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.

  13. Glantz SA, Slade J, Bero LA, Hanauer P, Barnes DE. The Cigarette Papers. Berkeley, CA: University of California Press, 1996.

  14. Bloch MH, Daynard R, Roemer R. A Year of Living Dangerously. The Tobacco Control Community Meets the Global Settlement. Public Health Reports. November/December 1998. Vol 113;488-497.