DOCUMENT RESUME CG 020 822 Smoking, Tobacco & Health: A

DOCUMENT RESUME

ED 295 082 CG 020 822

TITLE Smoking, Tobacco & Health: A Fact Book.INSTITUTION Center for Health Promotion and Education (CDC),

Rockville, MD. Office on Smoking and Health.PUB DATE 87NOTE 47p.PUB TYPE Reports Research/Technical (1!.3)

EDRS PRICE MF01/PCO2 Plus postage.DESCRIPTORS *Cancer; *Diseases; Drug Addiction; *Heart Disorders;

*Physical Health; *Smoking; *Tobacco; TrendAnalysis

ABSTRACTThis, document "resents an update of a fact book first

published by the Public Health Service in 1969. It deals with themedical, social, and economic aspects of cigarette smoking andidentifies cigarette smoking as the chief preventable cause of deathin the United States. 'The first section, Smoking, Tobacco & Health,examines trends in cigarette smoking for the year's 1900 through 1985and corresponding statistics on lung cancer deaths; discusses thepopularity and addictiveness of cigarettes; and looks at who smokesand why, teenagers and smoking, and former smokers. A section on

. smoking and health compares life expectancies of male smokers andnonsmokers. Cigarette smoking and .its relationship to cancer, heartdisease, and chronic lung disease are examined. The constituents ofcigarettes are identified and the introduction of low-tar andlow-nicotine ,cigarettes is discu,Ised. Also included are discussionsof women and smoking; smoking and the workplace; pipes, cigars, andsmokeless tobacco; and passive smoking. A section on, cigarettemanufacturing and marketing looks at cigarette marketing, cigaretteadvertising, and cigarette taxes. Other sections discuss the growingof tobacco and tha cigarette trade worldwide. (NB)

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U.S. DEPARTMENT OF EDUCATIONOthc of Educational Research and ImprovementEO ATIONAL RESOURCES INFORMATION

CENTER (ERIC)

This document has been reproduced asreceived from the person or organizationoriginating it.

O Minor changes have been made to Improvereproduction duality.

Forcls of view Or opinions slatedmthisdoctment do not necessarily represent officialOERI position or policy.

th Service /

forfifiea ontrof

ier forliea h Piopitio d Eddcaf

of alth,and,Hunlan S icer'

This is an updatelof a ta, , hook\ first published b the Public..

I lealth Ser.\ ice in 1969. Like itspredecessors. it dealsiedical, social, and economicaspects of ei'garette smoking. Itidentifies cigarette smoking as t e

chief preventable cause of death .in the t nited States.

,

,,,Sources for most medical irnfsor-

MatiOil are the annual Reportsof the Surgeon General on theHealth Consequences of Smoking,v,hich are issued by the Depart-ment of pealth and Human Ser-\ ices edch year. Information.onthe tobacco economN comesprincipally from thi= EconomicResearch and the Foreign.Agricultural Services of the ( .S.Department of Agriculture, withadditional data from the t .S.Department of Commerce and theFederal Made Commission.

1

.*

1,

Smoking, Tobacco, & Health

Each year cigarette smokingcauses the deaths of more than300,000 Americans, principallyfrom heart disease, cancer, andchronic obstructive lung disease.It can legitimately be termed themost devastating epidemic ofdisease Sand premature death thiscountry has ever experienced.

The epidemic began some 75years ago. In 1915, most tobaccowas used for pipes, cigars-andchewing tobacco, and fewer than20 billion cigarettes were smoked.Lung cancer, the disease mostclosely associated with cigarettesmoking, was virtually unknown;as late .as 1935, there were fewerthan 5,000 deaths from thisdisease. Today Americans smoke.600 billion cigarettes each year,

1-Per capita consumption of cigarettes (18 years and older), 1925-1985

YearNumber ofCigarettes Year

Number ofCigarettes Year

Number ofCigarettes

1925-29 1,285 1960 4,171 1975 4,1231930-34 1,389 1961 4,266 1976 4,0921935-39 1,779 1962 4,265 1977 4,0511940-41 2,558 1963 4,345 1978 3,9671945-49 '3,459 1964 4,195 1979 3,861

1950 3,522 1965 4,259 1980 3,8511951 3,744 1966 4,287 1981 3,8401952 3,886 1967 4,280 1982 3,7531953 3,778 1968 4,186 1983 3,5021954- 3,546 1969 3,993 1984 3,461

1955 3,597 1970 3,985 1985 3,3841956 3,650 1971 4,0371957 3,755 1972 4,0431958 3,953 1973 4,1481959 4,073 1974 4,141

U.S. Department of Agriculture

and 120,000 men and women dieof lung cancer.

The epidemic of cigarette smok-ing reached its peak in 1963 andis now receding. The percentageof smokers in the population isfalling, per capita consumption isdown to the levels of the 1940s,and deaths from cigarette smok-ing are beginning to fall. However,some 52 million adults and asmany as 2 million teenagers con-tinue to smoke.

Cigarettes became popular forseveral reasons. They are inex-pensive (or were until recently),they are the only form of tobaccowhich large numbers of womenhave ever taken up, and they areprofitable to manufacture, makingit possible for the cigarette com-panies to spend large sums ofmoney'advertising and promotingthem. The most Important reason

2 for the continued use of cigar-

ettes, however, is that for manypeople, cigarette smoking is ad-dictive. Cigarette smoke is rela-tively mild and can be moreeasily inhaled than other tobaccosmoke, enabling the smoker to ab-sorb more nicotine, more quickly.It is nicotine which helps establishthis addiction.

In the early 1940s, aprecipitous rise in lung cancerdeaths took place and by themid 1950s, scientists were able tosay with certainty that cigarettesmoking was the overriding causeof these deaths. Later, theyestablished that cigarette smoking.is also a cause of other diseases,

Cigarette consumption and lung cancer deaths, 1900-1985

Billions of cigarettes

600

400

Deaths

120,000

80,000

2 40,000

Year 1900 1920 1940 1960 1980 1985

U.S. Department of Agriculture, American Cancer Society, National Center for Health Statistics

5

including heart disease, chronicobstructive lung disease, andother cancers.

The turning point in America'sepidemic of cigarette smokingcame on January 11, 1964, whenthe Public Health Service issuedits epochal Smoking and Health:Report of the Advise), Committeeto the Surgeon General. This in-dicted cigarette smoking as acause of illness and prematuredeath and began a national andworldwide effort by Governmentand private agencies to warn thepublic about the hazards ofsmoking.

The effort is continuing; theWorld Health Organization andthe health agencies of virtuallyevery country in the world nowhave anti-smoking programs inprogress. In the United Statesthe effort at the Federal level ismandated by Congress and at

State and local levels is carriedoil by health and educationaldepartments. Private medical andhealth agencies also have ag-gressive programs in effect,notably the American CancerSociety, the American HeartAssociation, the American LungAssociation, and the AmericanMedical Association.

In the years since 1964,cigarette consumption in theUnited States and in otherwestern countries has declined.The cigarette companies .havecontinued to prosper during theseyears, but the tobacco farmer andthe tobacco-growing economy arefaring less well.

Who smokescigarettesand whyProportionately fewer adultssmoke cigarettes today than atany time since the 1950s. The.most significant decline has beenamong men, but there are alsoproportionately fewer women whoare smoking. The decline hastaken place in every age groupand at every income level, but thedecline 'has been greatest amongthe better educated and thosewith higher-income.

.On the average, fewer collegegraduates smoke than personswith less education, fewer whitecollar workers than blue collarworkers, and feWer whites thanblacks, although blacks smokefewer cigarettes.

3

Smokers, formar smokers, and never smoked, 1965-1985

(percent) Current Smokers Former Smokers Never Smoked

1965 1976 1980 1985 1965 1976 1980 1985 1965 1976 1980 1985

All males20 yrs and over 52.4 41.9 38.3 33.2 20.5 28.9 29.3 31.9 27.1 29.2 32.4 34.9

20-24 years 59.2 45.9 39.7 31.0 9.0 12.2 12.1 11.3 31.8 41.9 48.2 57.7

25-34 years 60.7 48.5 43.1 38.2 14.7 18.3 20.6 19.6 24.6 33.2 36.3 42.2

35-44 years 58.2 47.6 42.6 37:6 20.6 27.3 27.6 32.2 21.2 25.1 29.8 30.2

45-64 years 51.9. 41.3 40.8 33:4 24.1 37.1 36.9 42.0 24.0 21.6 22.3 24.6

65 years and over 28.5 23.0 17.9 19.6 28.1 44.4 47.4 52.5 43.4 32.6 34.7 28.0

White males20 yrs and over, age adjusted 51.3 41.0 87.1 32.3 2t2 30.7 31.9 33.4 27.5 28.3 31.0 34.3

Black males20 yrs and over, age adjusted 59.6 50.1 44.9 40.7 12.6 20.2 20.6 22.0 27.8 29.7 34.5 37.2

All females20 yrs and over 34.1 32.0 29.4 27.9 8.2 13.8 15.5 18.7 57.7 54.2 55.1 53.4

20-24 years 41.9 34.2 32.7 32.1 7.3 10.4 11.0 10.9 50.8 55.4 56.3 57.1

25-34 years 43.7 37.5 31.6 32.0 9.9 12.9 14.4 16.6 46.4 49.6 54.0 51.4

35-44 years 43.7 38.2 34.9 31.5 9.6 15.8 18.9 20.0 46.7 46.0 46.2 48.5

45-64 years 32.0 34.8 30.8 29.9 8.6 15.9 17.1 21.4 59.4 49.3 52.1 48.7

65 years and over 9.6 12.8' 16.8 13.5 4.5 11.7 14.2 21.2 85.9 75.5 69.0 65.3

White females20 yrs and over, age adjusted 34.5 32.4 30.0 27.7 8.5 14.6 16.3 19.7 57.0 53.0 53.7 52.6

Black females20 yrs and over, age adjusted 32.7 34.7 30.6 32.0 5.9 10.2 11.8 12.7 61.4 55.1 57.6 55.3

National Center for Health Statistics

Demographic characteristics of smokers 18 years and older, 1983

Percent smoking Percent smoking

Income

Under 5,000$5,000-9,999$10,000-14,999$15,000-19,999$20,000-24,999$25,000-34,999$35,000+

Marital status

Never MarriedCurrently MarriedWidoWedSeparated or Divorced

Education

Less than High SchoolSome High SchoolHigh School GraduateSome CollegeCollege GraduatePost College

Male

39.436.737.136.335.232.1

, 30.6

29.533.627.951.9

36.646.437.131.023.816.3

Females

32.932.027.631.129.227.127.3

30.227.519.645.4

21.539.232.326.417.916.8

Race

WhiteBlackOther

Occupation

White Collar (total)ProfessionalTechnicalExecutiveSales

Administrative

Blue CollarService ProfessionsFarmingNot in the Labor Force

Male

33.439.133.3

27.921.525.627.933.134.4

42.741.230.628.3

Females

28.732.015.3

29.419.930.334.931.631.8

37.836.522.225.5

National Center for Health Statistics 5

Teenagers and smokingTeenagers are also turning awayfrom cigarettes. In the, past tenYears, the percentage of highschool seniors who smoke everyday has declined from 29 percentto less than 20 percent. Youngmen are doing better than youngwomen, and there are now fewerboys smoking than girls.

Cigarettes cause harm to eventhe beginning smoker, with suchresults as reduced lung function,smoker's cough, and otherrespiratory difficulties. The mostharmful effect of teenage smok-ing, however, is the likelihood ofaddiction, The earlier a personstarts smoking, the more difficultit appears to be for such asmoker to quit later on in life.

Seventy-five percent of allteenage smokers come fromfamilies where parents smoke.

a

Former e jokersMost people who smoke wouldlike to quit. At least two-thirds ofall smokers have tried at one timeor another and, in any one year,25 percent try. Quitting is difficultfor many people, but it is by nomeans impossible. There are nowmore than 37 million men and

women in our population whoonce were smokers but who havegiven it up.

For those who succeed, quittingpays off. Ten years after quitting,the death rates of former smokersare approximately the same asthose of people who have iievci'smoked at all.

Daily cigarette smoking by high school seniors 1975-1985

40%

Females

20%

1mmor

males

Year 1975 1980 1985

National Institute on Drug Abuse

Smoking and Health

People who smoke cigarettes runa greater risk of premature deaththan people who do not smoke.This is true at every age, amongmen and women alike. The risk isgreater at young ages; for menunder the 65, the smoker'srisk of death is-approximatelytwice that of the nonsmoker's.

These added risks have acumulative effect. The accompa-nying illustration shows the sur-vival of male smokers andnonsmokers begin wing at age 35.As will be seen, 10 percent of thesmokers die before they reach theage of 55, but only 4 percent ofnonsmokers. By age 65, 28 per-cent of the smokers have died,compared to 10 percent of thenonsmokers. By age 75, 50 per-

Survival of male smokers and nonsmokers, from age 35

% Alive at beginning of year

100

50

Nonsmokers

Smokers

0

Age 35 40 50 60 70 80

Society of Actuaries (Cowell and Hirst)

10

cent of the smokers have died.but only 25 percent of the

Coronary heart disease, smokers vs. nonsmokers

nonsmokers. Nonsmokers 11

Cigarette smoking affects Smokers ahealth and wellbeing and in-terferes with work performance.It carries with it,enormouseconomic costs, an estimatedS23 billion in medical costs each 5year and another S30 billion lost E

to society because of illness and ,8premature death. Medicare alone apays out at least S3 billion an- 2nually to care for those who are 76

- =

ill from cigarette related disease. ,-...cz,

Cancer, hears disease, andchronic king diseaseCigarette ,moking causes up to170,000 deaths each year fromcoronary heart disease, 130,000deaths from cancer, and 50,000deaths from chronic obstructivelung disease.

I More people die from heart

1

45.54 55-64 65-74

Health Consequences of Smoking, 1983

11

disease in the United States thanfrom any other cause, and anestimated 30 percent of corona',heart disease deaths are theresult of cigarette smoking. Peo-ple who smoke are at nearly twicethe risk of dying of heart attackas nonsmokers: men who smokeand arc betweea the ages of 45to 54 are at nearb three thnesthe risk.

The three major risk factors forheart disease are cigarette smok-ing, hypertension, and high bloodpressure. Smoking by itselfdoubles the risk of heart disease:when it is combined with highblood pressure or elevaledcholesterol, the risk is four timesgreater, and when all three riskfactors are present, the risk iseight times greater.

Cancer is second to heartdisease as a cause of death in theUnited States and cigarette smok-

ing is the largest single cause ofcancer. ThirO percent of allcancer deaths and between 80and 90 percent of all lung cancerdeaths are caused by smoking,.

The cancers associated withcigarettes, other than lung cancer.are cancers of the larynx, oralcik to. esophagus, bladder, pan .crews, and kidney.

Chronic obstructive lungdisease is a debilitating disease.with death commonly mceded byyears of suffering and illness:from 80 to 90 percent, of deathsfrom this disease is attributableto smoking. Emphysema, oneform of this disease, has becomeone of the chief causes of chronicdisability in the United States;more than 2 million persons suf-fer from it, at least a quarter ofwhom are so seriously handi-capped that they are no longerable to work or maintain a house-

12

sismamsmswil,Risk factors fr coronary heart disease

(rate per 1.(0 men age 34-59 of entry)

Risk Factors. Smoking,

Elevated Cholesterol,

Hypertension

None of 3

UHealth Consequences of Smoking, 1983

hold. Emphysema in the past hasbeen for the most part a man'sdisease, but in recent years itsincidence among women has in-creased as more women havetaken up smokiiig.

The constituentsof cigarette smokeCigarettes cause the harm theydo because of the substances con-tainedin cigarette smoke andbecause of the smoker's extra-ordinary exposure to thesesubstances over days, months,and years.

More than 4,000 chemicalshave been identified in cigarettesmoke, including some whichcause or promote cancer andothers which are toxic or harmfulin other ways. For many of thesesubstances, there is no safe levelof exposure.

o Three components of cigarette

Lung cancer deaths, smokers vs. nonsmokers

Nonsmokers

Smokers

Nonsmokers

Smokers_____

Ages 45.64 65.76

Hammond Study 13

smoke-are tar, nicotine, and car-bon monoxide. Tar is the materialwhich remains after cigarette

smoke has been passed through afilter and contains most of thecancer-causing substances in the

smoke, carbon monoxide is a gasfound in cigarette smoke, andnicotine is a drug unique to tobac-

Chronic obstructive ling disease deaths, smokers vs. nonsmokers

Nonsmokers 111

Smokers II

Age Group 35.44 45.54 55.64 65.74 75.84

U.S. Veterans Study

Deaths

500

400

300

200

100

co which is related to addictivesmoking. Nicotine is also im-plicated in heart attacks and theonset of cancer.

Smokers tend to develop theirown, unique patterns of smoking,which they vary only slightly fromone day to the next. In doing this,they expose themselves to nico-tine and other substances incigarette smoke more constantlyand to a greater extent than dousers of other drugs and sub-stances of abuse. A two-pack-a-day smoker spends from three orfour hours each day with a cigar-ette in mouth, hand, or ash tray,takes about 400 puffs, and in-hales up to 1,000 milligrams oftar each day.

The body's uptake of carbonmonoxide and nicotine follow verysimnar patterns. rising quickly inthe morning, continuing to rise

i2 during the day, and subsiding at

night. Carbon monoxide makesup nearly 4 percent of cigarettesmoke. When it is inhaled, it com-

bines with hemoglobin in theblood to form carboxyhemoglobin.which interferes with the body's

A smoke 's level of nicotine over 24 hours

Approximated Bloodnicotine

concentration (ng/ml)

Hour 8 am 8 pm 8 am

Benowitz or 1 Jacob 15

Martality ratioiliii selected iiiiiiseciiiokers and exsmokers

Cause Never Smoked Dormer 5n okers in Current Smokers

1.0

All causes

1,04 1.29

1.67

1.19

"' 2:03

.361.36

2.36

1.49

Bronchitis-emphysema'1.0

so

4.84

1.64

gin

11.23

5.35

17.45

7.68

II

21.98

9.91

1.0

Coronaryheart disease

'1.241.02

1.56

:1.14

11

1.31

1.94

1.30

Lung Cancer 1.0L MN

1.24

3.89

11111

9.63

335

II

-

16.70,

6.21

23.70

r

7.82

0 Less than 10 10-20 21-39 40 or more 0 Less than 10 10-20 21-39 40 on more

,Cigarettes smoked per day

U.S. Veterans Study (Frot and (thaw)I

I16

14

ability to obtain and utilize oxy-gen.. Carbon monoxide is impli-cated in many of the diseaseprocesses associated withcigarette smoking, includingharmful effects on the develop-ment of the fetus. Smokers havelevels of carboxyhemoglobin fromtwice to 15 times higher thannonsmokers.

Low-tar and low-nicotinecigarettesCigarette smoking is "dose-responsive"the more onesmokes, the greater the risk. Ex-posure is determined by thecigarette brand which issmoked, the number of cigarettessmoked, how many puffs aretaken, and how deeply the smokeis inhaled.

Many smokers have switched tolower tar and nicotine cigarettesin the hope of reducing the risksof smoking. To some extentthey may'have benefittedfrom this, but the benefit isminiscule comparect tothe benefits of quitting entirely.Some reduction in therisk of lung and laryngeal cancermay result from smoking loweryield cigarettes, but there is nodata to suggest that other healthrisks are substantially reduced.

The Federal 'tirade Commissiontests cigarette brands for tar,nicotine, and carbon monoxide;what it measures, however, doesnot necessarily correspond towhat a smoker actually obtains. Acigarette found to be in the 1 to 5mg tar range can become a 15 to20 mg tar cigarette if the smokertakes more or deeper puffs, oreven partially blocks the yen-Waling holes'or channels whichare found in many cigarettefilters.

The average smoker nowsmokes 31 cigarettes per day,compared to an ave;age of 26cigarettes 30 years ago. Onereason is that those smokerswho have shifted to lower yieldcigarette brands may have in-creased the number of cigarettesthey smoke in compensation.

17

-=- 11`omennd4smoklingMen began smoking in largenumbers immediately before

--Vol' Id-War-I, and lung-cancer smoking-intensively-during and--deaths among_men began to rise after World War II and 20 years20 years later. Women began after that, lung cancer deaths

Women's deaths, lung cancer and breast cancer 1950-1985Deaths

40.000

30,000

Breast Cancer

Lung Cancer

20,000

10,000

"1950 19 55 1960 1965 1970 1975 1980 1985

American Cancer Society15

18

--among-women -began_to_rise.1985, lung cancer surpassedbreast cancer as the chief causeof cancer death among women.

Smoking during pregnancyposes serious risks. Spontaneousabortion, preterm births, low-weight babies and fetal andinfant deaths all occur more fre-quently when a pregnant womansmokes. If mothers smoke afterthe baby is born, this is harmful,too. If the baby is nursed, itreceives nicotine in its milk, andif people smoke near the baby,the baby incurs an increased riskof bronchitis and pneumonia.

Women who smoke experiencea greater risk.of coronary heartdisease than other women theirage, especially if they use oralcontraceptives.

to

Risks-from-smoking during.pregnancy-

Nonsmokers II Smokers

Spontaneous abortion

Preterm births

Full-term low birth weights

Prenatal deaths

0 1.0 2.0


Smoking and the workplaceciPretim_smoking_and_occupa,tional exposures both contributeto the incidence of cancer andchronic lung disease. In some I toocases, as with coal miner's BlackLung disease, the two exposures Nonsmokers, no exposure to asbestos

work independently to increasethe risk and severity of disease, 1111 5.17

while in other cases they interactAsbestos workers who do not smoke

synergistically to create moredisease-then would be anticipated 10.85simply by adding the separateeffects. This is the case withasbestos: asbestos workers whodo not smoke have a 5-fold risk of"..lung cancer over nonsmokers whoare not exposed to asbestos, butthose who work with asbestosand who smoke cigarettes have a50-fold risk. Those who are heavysmokers have an 87-fold risk.

Lung cancer mortality risks, asbestos exposure and smoking ____

Smokers, no exposure to asbestos

All asbestos workers who smoke

53.24

87.36

Asbestos workers who smoke more than 1 pack a day


20

Pipes, cigars, and smokelesstobacco-The use of pipes, cigars, andsmokeless tobacco has beendeclining for many years, exceptfor one product, moist snuff. °Sixtyyears ago, three of every fourpounds of tobacco grown in theUnited States were used for prod-ucts other than cigarettes; today,only one pound out of seven isused for thErse products.

Tobacco in any form presentshealth risks. Those who smokepipes and cigars have higherdeath rates than nonsmokers,although not nearly as high ascigarette smokers, aad experiencegreater risks of cancers of theoral cavity, larynx, pharynx andesophagus. Smokeless tobacco,particularly snuff, increasesthe risks of oral cancer'and non-cancerous oral disease.

Per capita consumption of cigars, pipe tobacco, chewing tobacco and snuff. (18 years and older)


Passive smoking smoke; so are 11011smokus who n ico Linercarbon-monoxide-and--Citaratfisinokers are not the live or wor,. hi the coinpany_pf other constituents of tobaccoonly persons exposed Lc cigarette sul Nonsmokers absorb smoke just as smokers do,

A nonsmokers absorption of *dine

urinarycotinine(ng/rtil)

hours per week exposed to

sidestream smoke0-1.5 1.5-4.5

30

15

4.5-8.6

Wald, 1984

8.6-20 20-80NM&

althOugh in smaller amounts; howmuch they absorb depends on thesmoke concentrations, the qualityof the ventilation, and the timespent in the area. Nonsmokersheavily exposed to other people'ssmoking may "smoke" theequivalent of one or two cigar-ettes a day.

Tobacco smoke is highly annoy-ing and physically irritating tomany people, and can worsen thesymptoms of asthma, chronicbronchitis, and allergies. There isevidence to suggest that it mayalso cause disease, including lungcancer, and it is known to be aspecial risk to infants and youngchildren. Children whose parentssmoke are more apt to have bron,chitis and pneumonia early in life,and small but measurable dif-ferences in pulmonary function.

Mans, States and local jurisdic-tions and pit ate employers ha% eadopted Ins and regulations toprotect the nonsmoker, either bybanning smoking in public areasand workplaces or by requiringthat smoking be restricted to cer-tain areas.

Cigarette Manufacturing and Marketing

Few businesses are as closelyheld or as profitable as manufac-turing cigarettes. For more than70 years, there lime been six ma-jor cigarette companies, whichare now subsidiaries of largercompanies which tobacco profitshelped create. The companies arePhilip Morris Inc., R.J. ReynoldsIndustries, Balms Inc. (Brow n andWilliamson), American BrandsInc., Grandma USA Inc. (Liggett& MyPrs), and Loews Corp.(Lori!: ard).

All six companies have diver-sified into ma* lines of business,including food and beverages,alcoholic 5merages, retail stores,fast-food companies, and finan-cial services. Cigarettes are themost profitable of their companylines; in 1982, among the fivelargest companies, domestictobacco was responsible for 56percent of total sales but 81 per-cent of total profits.

The structure of the cigarettebusiness is shown in the accom-panying illustration, whichdescribes the 1982 business year.'Total sales in 1982 were $23.4billion, of whi,:h S6.8 billion wentto Federal, State and localGovernments in taxes, S6.5 billionto distributors, and the rest tomanufacturers. In 1984, saleswere 528.7 billion and taxes, S9.3billion.

Unit sales of cigarettes andother tobacco products haveremained static or have been fall-ing, but the companies have com-pensated by raising prices andreducing costs, and the profits oftobacco manufacturers haverisen.

lit 1982. the companies operated14 cigarette factories employing

41.500 workers with a S1.1 billionpayroll. The factories were lo-cated in North Carolina. Ken-tucky. Virginia. and Georgia.

The method which the com-panies most, commonly use in pro-cessing tobacco for cigarettesconsists of working the stem andmidrib portions of the tobaccoleaf into a fibrous mass and form-ing it. as in the manufacturing ofpaper. into a web or humogenizedsheet which is blended withnatural tobacco and shredded.The tobacco then goes to amachine which makes a con-111111011S cigarette, cuts it to therequired length. and attaches afilter if required. Other-machinesmake the packages and cartonsand fill them.

Sales and profits of U.S. tobacco corporations. 1975-1984(millions of dollars)

YearNet sales

less excise taxNet incomebefore taxes

Percent incometo sales

19751976197719781979

9,98711,96413,69615,49315,331

1,3961.6381,9382.5912.740

14.014.314.216.717,9

19801981198219831984

17,47120,22820,12621,18523,558

3,0273,5603,5583,4404,235

11 317.618.616.217.9

U.S. DepOment of Agriculture 2C 23

24

The- cigarette product haschanged over the years. In 1945,five cigarette brands, all un-filtered and 70 mm in length, ac-counted for 90 percent, of allcigarette sales. lb the 1950s,filtered cigarettes becamepopular. In the 1960s, low-yieldcigarettes made their appearanceand in the 1970s, new ultra low-yield cigarettes began to bemarketed. In 1954, the averagetar yield was 36.5 mg; in 1968, itwas 21.6 mg and today it is 12.9mg. The decline has been ac-complished by new tobacco pro-cessing methods, the introductionof new filters of varying designand materials, and changes in thedesign and construction of thecigarette. One Of the results ofthese changes has been a reduc-tion in the amount /)1' tobaccoused in the cigarette.

Average tar content of U.S. cigarettes, 1968-1983

Milligrams

25

20

15

10

5

Year 1968 1976 1983

Federal Trade Commission 27

Cigarette marketingMore, than 50 brauds of cigarettesare offered for sale, packaged inmore than 200 varictis andsizes. The choice is broad: oneleading brand, for example, is-Of-

,fered in eight different packages,in hard pack and soft pack, in 85and 100 mm lengths, and with taryields of 16 mg and 10 mg, whileanother is offered in six pack-ages, with and without filters, in

hard and soft packs, in 70 mm,80 mm, 85 mm and 100 mmlengths, and with tar yields of 21mg, 16 mg, and 9 mg.

Like many other consumerproducts, cigarettes are produced

Prices of cigarette packages, 1965-1985

State & federal taxes

200

150

100

0

Year 1965 1970

The Tobacco Institute

1975 1980 1985

and promoted to appeal to dif-ferent audiences. Some brandsare "upscale" or "high end," of-fered at premium prices: somebrands are aimed at womensmokers: other are "macho"brands. Historically, mentholcigarettes have been preferred,bymany black smokers and mentholbrands are consequently pro-moted heavily to this audience.

Since 1965, the retail price ofcigarettes has riserPfrom anaverage of 30 cents to an averageof 51.05 a pack. As a conse-quence, and for the first timesince the depression years of the1930s, price competition is occur-ring in the cigarette business.Several strategies are beingemployedpacks of 25 ratherthan of 20 cigarettes are beingoffered at the same price, rebatesand coupons are offered, and

28 .new, generic' brands ear'e being

Tobacco sales by outlet, 1982

(percent)

IWO I Ordinirchathines

.

stores

Bureau of Census

2

produced and sold at discountedprices.

One-half of all cigarettes aresold in supermarkets and otherfood stores, mostly by the carton.In recent years, -sales by,gasolinestations have been increasingwhile sales from vendingmachines have been declining.

The companies distributecigarettes to retailers throughtobacco wholesalers and directsales. In 1982. there were 1,895wholesale establishments; sincethen, this numbe" has fallen.

!M.Cigarette advertising and promotion, 1983(millions of dollars)

Newspapers 201

Magazines 388

Outdoor 295

Transit 27

Sampling 126

Public Entertainment 77

Other Expenditures 787

$1,901

Federal Trade Commission

r.

Cigarette advertisingCigarette companies were oncethe largest advertisers on televi-sion and radio; when Congressbanned such advertising in 1971,they turned to the print mediaand are now the largest nationaladvertisers in these media.Altogether, in 1983, they spent$1.9 billion hi advertising andpromotion, which is more thanthey spent in wages and salariesand nearly as much as they spentfor tobacco.

There are four restraints oncigarette advertising aside fromthe general sanctions against un-fair and deceptive advertisingwhich apply to all advertisers. Bylaw, cigarettes cannot be adver-tised on radio or television, warn-

ings must be displayed onpackages and advertising, andyields of tar and nicotine must.bcdisplayed in advertising, but are

not required on packages. By in-dustry agreement, advertisementsare not to appear )11 youth media'or use illustrations or themes

SURGEON 'GENERAL'S WARNING: SmokingBy Pregnant Women May Result in , atal injury,Premature Birth, And Low Birth Weight.

aimed at young people. There ex-ists no machinery for monitoringor enforcing this 'agreement.

The ban on television and radio

SURGEON GENERAL'S WARNING: SmokingCauses Lung Cancer, Heart Disease,Emphysema, And May Complicate Pregnancy.

SURGEON GENERAL'S WARNING: Cigarette SURGEON GENERAL'S WARNING: quitting Smoking

Smoke Contains Carbon Monoxide. Now Greatly Reduces Serious Risks to YOur Health.

advertising in 1971 allowed thecigarette companies to reducetheir advertising expenditures, atleast temporarily, and it cut downthe number of anti-smoking'publicservice announcements whichwere then being aired on radioand television, in response to aFederal Communications Commis-sion ruling. Stations still broad-cast anti-smoking announcements,but on a voluntary basis and insmaller numbers.

In 1985, a new Federal lawcame into effect which requirescigarette companies to print nn,stronger health warnings inadvertisements and on packages.There are four warnings in all,which are rotated every threemonths. The warnings arc basedon the medical information con-tained in the Reports of theSurgeon General on the HealthConsequences of Smoking.

Cigarette taxesCigarettes are taxed by theFederal Government, by all 50states and the District of Colum-bia, and by several hundredmunicipalities. The Federal taxis 16 cents a package while theState and local taxes range from2 cents to 28 cents a package.The Federal tax was raised from8 cents to 16 cents a package in1983. In 1965, State and Federaltaxes accounted for approximate-ly 51. percent of the price of retailcigarettes. In 1985, State andFederal taxes represented only 30percent of the retail price ofcigarettes.

29

State cigarette tax per pacis,.1985

be

Lit

't

4

c

bt

I C

ic

4(

't

18C

t

'Mt

'41

,'it.

171

71

?5C

26C

23 4C

Growing Tobacco

l'obaceo is this country's sixthmost. important field crop and itsfifth most important farm export.

It is the leading source of agricul-tural income in two States, NorthCarolina and Kentucky, and a

Production and prices of leaf tobacco, 1947.49 1985

Year

'Production(millions of

pounds)

Unit price(dollars oer

pound)

Total crop value(millions of

dollars)

1947.49 2,019 $ .46 $ 9261955 2,193 .53. 1,1661960 1,944 '.61 1,1841965 1,855 .65 1,207

, 1970- 1,906 .73 1,389

1975 2,182 1.02 2,238- 1980 1,786 1.52 2,721

1983 . 1,428 1.75 2,4961984 1,728 1.81 3,1281985 . 1,547 1.65 2,552

, U.S. DepartMent of Agriculture

major contributor to income infive other States.

About 180,000 farms grewtobacco in 1985, producing a cropof 1.5 billion pounds valued at$2.5 billion. This is a decline from1954, when 512,000 farms pro-duced 2,193 million pounds oftobacco. In that year the crop ae-counted.for 4 percent of the Na-tion's total agricultural incomeand 10 percent of its agriculturalexports. In 1983, this had drop-ped to 2 percent of farm incomeand 4 percent of agricultural ex-ports. Cotton is the-only othermajor American crop which hasshown a significant economicdecline in these years.

Although the cigarette com-panies are producing almost twice 31

.32

as many cigarettes as in 1950,they are using only a little moretobacco now than they did then.The market for tobacco used inother tobacco prodti'i hasdeclined greatly.

Cigarette companies are nowbuying 1.7 pounds of tobacco forevery 1,000 cigarettes they pro-duce, compared to 2.7 pounds in-1950. They have accomplishedthis by utilizing' more of thetobacco plant, using various leafexpansion procesSes, and puttingless tobacco into their product.

The American cigarette blendhas always utilized Orientaltobaccos, but until a few yearsago the companies did notimport other types of tobaccos.Now they do, and up to 20 percentof the burley and flue-curedtobaccos'in American cigarettescome from Brazil, Zimbabwe,India, Malawi, Thailand, and

other countries.American tobacco, although ofhigher quality, is more expensivethan competing tobaccos fromabroad.

Growing cigarette tobaccoSome 160,000 tobacco farms pro-duce the three types of tobaccoused in cigarettes, which areburley, flue-cured, and Southern

Share of cash receipts by agriculturaltommodities, 1954 ad 1983

1954 percent 1983

Livestock and livestock

products 55 50

Food grains 8 7

Feed crops 9 12

Cotton 9 3

Oil bearing crops 3 10

Fruits and tree nuts 4 4

Vegetables 5 6

Tobacco 4 2

Other crops 3


Maryland. lit 1984, domesticburley accounted for 33 liercentof the tobacco used in cigarettes.domestic flue-cured 35 percent.and Southern Maryland 2 percent

while the remainder was im-ported. Kentucky produces two -

thirds of all burley and NorthCarolina produces two-thirds ofall flue-cured tobacco.

Shire of exports by agricultural commodities, 1954 and 1983

1954 percent 1983

Livestock and livestock products 11 10

Grains 25 45

Cotton 25 5

Oil bearing crops 10 24

Fruits and nuts 6 5

Vegetables 3 3

Tobacco 10 4

Other crops 10 4


36

Many changes havelaken placeLobaeto4rming: total acreage

has declined, yields per acre haveincreased, the farms are largerand there is more mechanization.The changes are most striking inthe case of flue-cured tobacco. Infewer than 15 years, labor hourshave dropped from 425 hours peracre to 173 hours, owing to aswitch from tied to untied leafsales, a changeover Lb laborsaving harvesting &vices, includ-ing bulk barns and mechanicalharvesters, and more efficientpreharvest operations. In the caseof burley, a satisfactory harvesterhas not yet been developed andthe smaller size of operating unitsimpedes more efficient farming,but even here, labor hours havedropped from an average 360hours per acre to 300 hours.

Tobacco farms are small. Theaverage farm which grows burley

is 86 acres, with 40 acres ofcropland and from one to threeacres planted in tobacco, whilethe average farm producing flue-cured tobacco has 114 acres ofcropland will 14 acres planted intobacco. As might be expected,

the majority of tobacco farmerssupplement their income withother crops and jobs off the farm.

Tobacco is a high-value crop,with gross receipts in recentyears averaging more than$3,000 per acre.

The Federal ProgramTobacco, along with corn, wheat,cotton. peanuts, and rice, is oneof the basic crops grown under aFederal price support and supplycontrol program in which farmersagree to limit their production in

Tobacco utilized per 1,000 cigarettes, 1960.-1984 Pounds

3000

2000

1000

Year 195034 AmONL"111!1=1.

U.S. Deoartment of riculture

1970 A984

return;: for a guaranteed buyer anda guaranteed minimum price. Theprogram is voluntary, accepted orrejected by vote of farmers in agiven region, and is operatedthrough regional tobaccocooperatives. If a farmer is notable to sell his crop to a privatebuyer at auction time, he sells it,to the cooperative which places itin,storage until a buyer can befound.

For many years the Federalprogram kept supply and demandin relatively good balance andgave strong protection to thesmall, family-owned farm. Most ofthe tobacco placed on loan waseventually sold, making the pro-gram more successful from afinancial standpoint than Mostother pricesupport programs. Inthe early 1980s, however, seriousdifficulties began to appear in theoperation of the program and.-

Domestic and foreign tobacco utilized in U.S. cigarettes, 1971-1984

(million pounds)

Year 1971 1984

1,500

1000

U.S. Department of Agriculture 35

39

Congress has instituted sweepingchanges through two acts oflegislation, one pd-,sed in 1982and the other in 1986.

One of the purposes of the1982 legislation was to transferall but the administrative costs ofthe tobacco program from the

Government to the farmer. This-No-net-cost" program was tobegin with the 1982 crop year.but in 1986 Congress exempted

Acreage, production, and crop value of clgarettetype tobacco, selected States, 1982

State Number Acreage Production Crop value Share ofof farms farm receipts

(thousands of acres) (millions of pounds) (millions of dollars) (percent)

North Carolina 29,489 11.5 700.7 S 1,233.4 30.0

Kentucky 74,166 3.5 577.1 922.9 31.8

South Carolina 3,530 17.0 124.2 218.5 18.9

Tennessee 36,515 2.3 178.1 280.4 13.3

Virginia 13,485 4.7 125.4 217.9 13.0

Georgia 3,005 14.9 105.5 189.1 5.9

Ma;; land 2,489 10.0 37.5 57,7 5.5


36

Tobacco loan stocks at beginning of marketing year, burley and lluecured, 1960-1985(millions of pounds)

Million Pounds

1,500

Year 1960 1965 1975

1,000

1985

U.S. Deprinient of Agriculture4 0

the 1983 burley crop, which wasof poor quality.

Over the years, the tobaccoprogram has resulted in overpric-ing American tobacco in theworld market by an estimated 46to 60 cents a pound which hashampered exports abroad andhas led American companies toimport large amounts of tobaccofrom foreign countries. The 1986Act seeks to correct this by set-ting up procedures wherebyguaranteed minimum prices canbe lowered and acreages reduced.The cigarette companies are givena role in setting quotas: theymust henceforth provide theSecretary of Agriculture withestimates of their tobacco needsa year in advance, under condi-tions of confidentiality, and willthen be required to buy at least90 percent of these estimates,subject to penalty. 37

In the past few years, stocks ofunsold tobacco have risen to thehighest levels in history as aresult of increased foreign buyingby the cigarette companies, aslackening demand, and the poorburley crop of 1983. At the end ofthe 1985 crop year, loans cover-ing these stocks stood at $3.5billion in principal and interest.These funds can never be re-covered in full and a loss of morethan $1 billion is forecast. Muchof the tobacco is of low quality,and higher prices were paid for itthan for similar tobaccos current-ly available in the market.

The 1986 legislation sets upprocedures for disposing of theseunsold stocks. Surplus inventoriesfrom the 1976-1981 crop yearsare to be offered to the cigarettetobacco buyers -at 10 cents on thedollar, at the taxpayer's expense;

38 unsold tobacco from' the 1983

burley crop is to be offered onterms and conditions set, by theCommodity Credit Corporation,also at the taxpayer's expense;and tobacco from the 1982-1984crops is to be offered at 90 centson the dollar, the incurred lossesto be at the farmer's expense.

The quota provisions of thetobacco program are beingchanged. Nearly 200,000 farmersgrow tobacco, but 350,000 otherpersons and institutions onfarms with quotas and rent orlease their quotas rather thangrow tobacco themselves. Al-though rents have declined inrecent years, quota rent stillrepresents about $500 millionannually or nearly one-fifth thevalue of the entire tobacco crop.Institutional owners, with someexceptions, must now dispose oftheir quotas, and beginning in1987, those who hold flue-cured

quotas must forfeit them if tobac-co has not been planted (or con-sidered planted) during at leasttwo of the last three years.

An issue of national policy iswhether it is appropriate for theGovernment and the taxpayer'smoney to be involved in anymanner in the grc ing of tobac-co. Many persons and somehealth agencies have t. '.en theposition that this runs counter tothe public good in seeming toencourage a product clearly iden-tified as a threat to health.Others disagree, saying that nopublic health issue is involved,that providing support to farmersdoes not encourage people tosmoke.

4 I

The Cigarette Trade Worldwide

Cigarettes are produced, pro-moted, and sold everywhere inthe world. The United States par-ticipates in this worldwide tradein two wayssome 12 percent ofall tobacco used in cigarettes inthe world comes from the UnitedStates, and two of the four trans-national companies which controlmuch of the world 'trade in cigar-ettes, Philip Morris and R.J.Reynolds, are based in the UnitedStates. The other major trans-nationals are British AmericanTobacco in the United Kingdomand Ruperts/Rothman in the Ger-man Federal Republic, which isnow partially owned by PhilipMorris.

In 1974, the four major trans-nationals produced one-third.of

Estimated world cigarette output by major manufacturing groups, 1974

Domestic U.S. and U.K. companies

UNCTAD, June 1978

42

d tobacco growing 1964.66 -1995,

(Actual) (Projected)

196446 1969-71 974-76 1979-81 1982 1985 1990 1995

:Health Organization 43

the world's cigarettes and con-trolled even more than thisthrough arrangements with Statemonopolies and smaller privatefirms. In the years since, theirshare is believed to have risenfurther, with the two Americancompanies gaining propOrtion-ately more.

The transnationals operate byexporting manufactured brands,by owning all or part of localtobacco companies, and by licens-ing their brand names. Movementof manufactured cigarettes acrossnational borders makes up thesmallest,share of the ttansna-tionals' business; in 1985, only55 billion cigarettes were pro-duced in America for export, lessthan 10 percent of totalmanufactured.

American farmers are growingless tobacco than a generationago but tobacco growing in othercountries of the world has morethan doubled in the last 25 years.

In the late 1950s, the UnitedStates grew approximately one-half of, all the tobacco grownin the world outside of China,whereas today it accounts foronly 15 percent. Most of the newproduction has come from thedeveloping countries, wheretobacco has become an importantsource of national income.

China is a special case; thegovernment of that 'country hasencouraged tobacco growing andcigarette consumption has risengreatly, until China is now boththe largest producer and thelargest consumer of tobaccoprodticts in the world.

Cigarettes consumption ishighest in the developed countriesbut it is declining there, and as aresult the cigarette companies arepromoting their brands aggres-sively in other countries of theworld. The percentage of peoplewho smoke in some of these coun-tries is higher than in the UnitedStates,.but'fewer cigarettes aresmoked. In some countries, thesmokers are mostly men; inChina, according to World HealthOrganization estimates, 90 per-cent of men smoke but only3' percent of women, while in

42 Morocco, 90 percent of.men

Per capita consumption of cigarettes by total population, selected countries, 1982

Country Per capitaconsumption

Cyprus 3,117 Sweden 1,543

Canada 2,797 Brazil 1,051

United States 2,678 Colombia 873

Spain 2,658 Nicaragua 846

Poland 2,517 Thailand 606

West Germany 1,867 Iraq 574

Italy 1,854 Angola 375

United Kingdom 1,818 Zimbabwe 319

USSR 1,715 Kenya 283

France 1,608 Uganda 146


45

smoke but no women at all. InPapua, New-Guinea, on the otherhand, 85 percent of men. smokeand 80 percent of women.

The World Health-Organizationhas warned against both the pro-liferation of tobacco growing inthe developing world and the pro-motion of smoking in these coun-tries. It has said that the ThirdWorld's 'limited available landand limited resources should bedevote° to food and other crops, .and that the Widespread' advertis-ing and promotion of cigarette&should be forbidden. In 9 §78, theWorld Health Organization stated,"Failing immediate action, smok-ing diseases will appear indeveloping countries'before com-municable diseases and malnutri-tion -have been controlled, andthat the gap .between rich andpoor countries will thus be furtherexpanded."

46

DUNS Publication No. (CDC) 87-8397

47

Documents

DOCUMENT RESUME CG 020 822 Smoking, Tobacco & Health: A