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Article |

A Retreat in the Tobacco War

John Slade, MD
JAMA. 1992;268(4):524-525. doi:10.1001/jama.1992.03490040100034.
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On March 30, 1992, Surgeon General Antonia Novello declared war on the tobacco industry. Speaking at the Eighth World Conference on Tobacco OR Health in Buenos Aires, Argentina, she spoke passionately about the need for waging war against this cynical, deceitful industry to protect the next generation from becoming addicted to nicotine and to help those currently addicted free themselves of the nation's leading killer. As she spoke, however, the nation's leading tobacco-control program, run by the California Department of Health Services (DHS), was in retreat.

The California program, funded by a spending formula contained in a 1989, voter-initiated increase in the cigarette tax (Proposition 99),1 has been credited with substantially accelerating the reduction in tobacco use there.2 The smoking rate in California declined by 17% between 1987 and 1990, a decrease substantially greater than that seen elsewhere in the country. This singular achievement translates into an important


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