Tobacco: History, Government and Control Policies

Introduction

Tobacco has been in use for over 10,000 years around worldwide for over 500 years, but its use was limited by the intensity of time and labor involved in producing, preparing, and using it. From the 1800s, developments in mechanization, transport, and technology helped the wide spread of tobacco in the world. Tobacco is a plant that grows natively in North and South America. It is in the same family as the potato, pepper, and the poisonous nightshade or very deadly plant. It was believed that tobacco began growing in the Americans about 6000 B.C as early as American Indians began using it in many different ways, as religious and medicinal practices. In October 15 1942 Christopher Columbus was offered dried tobacco as a gift by American Indians.

Soon after, sailors brought tobacco back to Europe, and the plant was being grown all over Europe. The major reason for tobacco's growing popularity in Europe was its supposed healing properties. In 1571, A Spanish doctor named Nicolas Monardes wrote a book about the history of medicinal plants of the new world. In this, he claimed that tobacco could cure 36 health problems. Europeans believed that tobacco could cure almost anything, from bad breath to cancer. They used tobacco in dressing wounds, pain killers and they chewed as toothache relievers.

Effectiveness of Government Policies on Tobacco

Over the past decade, the Australian population has been exposed to changes in several tobacco control policies, including changes in taxes on tobacco products resulting in increases in the real price of cigarettes, increasing availability of pharmaceutical smoking cessation products such as nicotine replacement therapies (NRT) and bupropion, and the introduction of smoke-free restaurant laws. In addition, there has been considerable variation in exposure to public health–sponsored mass media campaigns and pharmaceutical advertising for NRT. We have assessed the independent effect of each tobacco control policy and type of media campaign with a data series in which self-reported smoking prevalence was measured every month over a period of 11 years. This method has the advantage over annual population surveys of more closely matching the timing and extent of policy implementation and media exposure to the smoking prevalence and it has the ability to examine the pattern of change in prevalence, such as the lag time to a measurable impact and the duration of influence.

Tobacco Control Policies

Population-wide interventions that can reduce adult smoking prevalence are important for curbing the pandemic of tobacco-related disease.1–3 However, evaluating the effects of tobacco control policies and mass media interventions on populations is difficult.4,5 Generally, there are few comparable control populations to which policy or media interventions are not delivered. Tobacco policies and media campaigns often co-occur, complicating the assessment of the relative contribution of each. In addition, most studies in which smoking prevalence is the outcome measure rely on annual population surveys to track change over time, despite policy and media interventions being generally implemented throughout the year, and at differing strengths relative to the time of survey administration. Small or transient impacts on smoking prevalence are difficult to detect and may be underestimated.

Population Survey Data

Smoking prevalence from June 1995 to December 2006 was estimated from a Roy Morgan Research (Melbourne, Australia) weekly omnibus survey6 with a consistent methodology of a random sample of Australian residents 14 years or older. Federal electorate districts of approximately equal populations served as the strata for sampling. Each electoral area was divided into 4 sampling points of roughly equal population size, which were used in rotation, 1 per week, with starting addresses selected at random from the electoral roll. (In Australia, the voting age is 18 years, and enrollment on the electoral roll is compulsory for those who are eligible.) All 148 electorate districts were used in each weekly wave of interviews. One person per household was interviewed; interviewers were instructed to ask to speak to the youngest male 14 years or older and, if unavailable, to then ask to speak to the youngest female 14 years or older. The survey sample was weighted according to the Australian Bureau of Statistics quarterly population estimates between June 1995 and June 1998, and for monthly population estimates from July 1998 to December 2006. Refusal rates varied over time, with a trend for higher refusal rates in more recent years.

We used survey data from the 5 largest Australian capital cities (Adelaide, Brisbane, Melbourne, Perth, and Sydney), where 61% of the adult population resides.7 These regions corresponded with the 5 media markets for which data on antitobacco advertising exposure were available. We cumulated weekly data to yield monthly estimates of smoking prevalence for respondents 18 years and older. Overall, there were 343 835 completed interviews and an average of 2474 participants each month in the survey (minimum = 1697, maximum = 3310).

We defined smokers as those who responded “yes” to the question, “Do you now smoke factory-made cigarettes?” or “yes” to the question, “In the last month, have you smoked any roll-your-own cigarettes (of tobacco)?” Smoking prevalence for any given month was the proportion of people who responded affirmatively to either of these questions out of all respondents surveyed in that month. Information was collected on the month and year of interview and geographic location of respondents so that survey data could be matched to records of changes in policy and advertising.