Table 2 Key factors influencing tobacco control efforts against smokeless tobacco—USA up to 1986
Factor | Before: 1960s–1980 | During: 1981–1986 |
|---|---|---|
1) Evidence of disease | Smokeless was not judged officially to cause any disease in the USA, while smoking was judged a major cause of serious disease and disability. | Smokeless was judged “not safe”: 1) An NCI study treated as definitive on oral cancer 2) Prominent case of young man viewed as dying from oral cancer from smokeless |
2) Use of smokeless | Declining use by mostly older adults in rural areas and some occupations | Rising use in general population and by youth |
3) Public perception and industry marketing of smokeless as a safe alternative to cigarettes | Marketing of smokeless tobacco with no health warnings, but for cigarettes health warnings and several years no radio/TV marketing | Widespread radio/TV and print marketing of Skoal Bandits® with “Take a pouch instead of a puff” slogan and endorsements by athletes |
4) Evidence-based assessment that smokeless is not safe, needs a warning label, and other control measures | None | a) Petition to Federal Trade Commission b) Action by several states to require warning labels c) Legislation on rotating warnings, ban of electronic advertising, and other measures |
5) Evidence-based assessment that smokeless tobacco is not safer than cigarettes | None | None |