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Congress banned smoking on all airline flights of 2 hours or less in 1987, and 3 years later effectively extended that prohibition to all domestic flights. Smoking was also banned in federal buildings and in child care facilities that received federal funds.

The 1992 release of the Environmental Protection Agency’s landmark report, Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders, added to the momentum for smoke-free spaces (EPA 1992). The report concluded that secondhand smoke is a Class A carcinogen, meaning that it is a definite cause of human cancer. According to the Environmental Protection Agency report, secondhand smoke causes some 3,000 deaths from lung cancer a year among nonsmokers.

Secondhand smoke gave new momentum to the efforts of tobacco control advocates, setting the stage for a fundamental shift in the political dynamic of tobacco control and in the public discourse and understanding of tobacco control efforts during the last decade of the 20th century.

ADVANCES IN TOBACCO CONTROL: 1988–2005

The tobacco control movement coalesced around the secondhand smoke issue, which turned out to be only the first of several issues to pose unprecedented challenges to commercial tobacco interests. While the science on the adverse effects of secondhand smoke continued to emerge, a second scientific front opened to counter the industry focus on freedom of choice: advances in neuroscience demonstrated that nicotine is a highly addictive drug. This finding permanently transformed the debate about smoking and reshaped the public policy agenda. The emphasis on addiction also cast smoking among adolescents and youth in a new light and stimulated a third front in the tobacco wars.

Nicotine: An Addictive Drug

Historically, the term addiction has been associated with stereotypical images of compulsive drug use, deviance, and criminality; heroin has been viewed as the prototypical addictive drug in the United States (HEW 1964). Beginning in the mid-1960s, however, scientific criteria for addiction (often labeled “drug dependence”) have emphasized the hallmark behavioral features of drug use, including a loss of control, and experts in the field have attempted to disassociate the clinical condition itself from the social and moral connotations and images traditionally linked with the term addiction. Equally important have been the major advances in neuroscience research that have identified the neurobiological substrates of addiction (IOM 1996) (see Chapter 2).

By the early 1980s, researchers reported that laboratory animals worked to acquire nicotine; this behavior is a hallmark of addiction to a substance.



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