The focus on youth and the revelations in industry documents caught on with the public. A 1993 Roper poll asked a sample of registered voters whether they mostly agreed or mostly disagreed with the following statement: “Even though tobacco companies say they don’t want kids to smoke, they really do everything they can to get teenagers and young people to take up smoking” (Marttila and Kiley Inc. 1993a). Of those polled, 64 percent said they mostly agreed, while 73 percent of the respondents reported an unfavorable or very unfavorable overall impression of the tobacco industry (Marttila and Kiley Inc. 1993b).

FDA Commissioner Kessler decided to focus the FDA regulatory approach on tobacco use among youth. Kessler, a pediatrician, called nicotine addiction a “pediatric disease” (Hilts 1995). On August 23, 1996, he joined President Bill Clinton in the White House Rose Garden to announce historic regulations that, for the first time, would put cigarettes under FDA control. The regulations declared cigarettes “nicotine-delivery devices” (DHHS 2000). Relying on the scientific foundation laid in the 1994 reports by the Surgeon General and the IOM, the new FDA regulations limited youth access to tobacco and controlled tobacco advertising and promotion targeted at young people. Immediately, tobacco companies challenged the regulations in federal court, initiating litigation that would eventually find its way to the U.S. Supreme Court (DHHS 2000).

In the early 1990s, while the FDA was exploring a federal role in regulating tobacco, states and localities had already begun to take action to contain the tobacco problem. Grassroots antitobacco advocacy was a driving force behind the creation of smoke-free spaces, and increasingly activists began to initiate other antismoking programs at the state and local levels. New antitobacco coalitions in the states began to effect important policy changes.

The burst of state action began in 1988, when the people of California passed Proposition 99, a referendum that increased the excise tax on tobacco from 10 to 35 cents per pack and earmarked 20 percent of the new revenues for a statewide antismoking campaign. California designed and put in place a comprehensive program that included mass media counter marketing campaigns, school-based programs, community-based interventions, and a research component. Massachusetts, Arizona, and a succession of other states followed with citizen referenda or legislation increasing tobacco excise taxes to various degrees and designating some of the money for antitobacco activities.

Historically, federal, state, and local governments have taxed cigarettes primarily to generate revenues, especially in response to budget crises. In