liberty and freedom of choice, especially in matters that affect individual health. Thus, although it has been widely understood for many years that smoking poses serious health risks, the prevailing assumption was that the weighing of the benefits and the health risks of consumer products, including tobacco products, is up to the consumer and that government efforts to force people to make healthy choices would amount to an unacceptable form of paternalism. The underlying intuition is that people are and ought to be free to make their own choices and are responsible for the consequences of their choices. This perspective was also reflected in the unbroken line of jury verdicts and judicial decisions refusing to hold tobacco companies liable for smoking-induced disease and death among informed consumers.
The first major change in tobacco policy was consistent with the antipaternalism principle and with traditional economic theory. The nonsmokers’ rights movement, which took root in California in the late 1970s, called attention to the fact that some of the costs of smoking are borne by third parties and urged lawmakers to adopt bans on smoking in public buildings and workplaces. The antismoking movement received a major boost when the U.S. Environmental Protection Agency classified environmental tobacco smoke as a carcinogen in 1992 (EPA 1992). Although the tobacco industry disputed the nature and the extent of the risks associated with exposure to sidestream smoke and continues to do so, the evidence documented suggesting the considerable health dangers of environmental tobacco smoke has been definitively summarized by the Surgeon General (DHHS 2006), and the moral legitimacy of smoking restrictions in enclosed public places is now taken for granted.
In the late 1990s, the weaknesses in the libertarian point of view began to seep into public understanding and to transform the policy debate about tobacco. This profound change in the political dynamic occurred as a result of three intertwined developments.
The first important development was a profound change in public understanding as the addictive nature of nicotine became scientifically established (DHHS 1989). The simultaneous proliferation of nicotine replacement treatments (NRTs) and other cessation tools, along with evidence of their effectiveness, helped to reinforce public understanding of the grip of nicotine addiction and the need for stronger measures to help people quit. This development also began to erode the anti-paternalism objection against efforts to reduce consumption directly on the grounds that many people who have become hooked would like to quit.
The second convergent development was a concerted focus on the problem of smoking initiation. It became clear that almost all adult smokers began smoking as teenagers and that prevention of the initiation of smoking needed to be a core aim of tobacco policy. (Although it is not the only