From higher taxes on a pack of smokes to new so-called safer cigarettes, the battle over tobacco in America is being reshaped.

"I think this a major shift in the world of tobacco marketing, and regulation, and public health," says Jack Henningfield, a behavioral biology professor at Johns Hopkins University, referring to the intensified push by state and local lawmakers to discourage smoking, and a host of new products designed to provide safer ways to smoke. "On the one hand, for the first time in history we are seeing that it's possible to meaningfully reduce the number of cigarette deaths," he says. "On the other hand we are seeing a major marketing push [by tobacco companies]." The Proof Is in the (Lack of ) Puffing The most significant change in recent years, Henningfield argues, is the increasing scientific evidence that anti-smoking campaigns are effective. In California, which has long had one of the most ambitious anti-tobacco campaigns, per capita cigarette consumption has fallen more than 50 percent since 1988. That year, voters in the state passed Proposition 99, which imposed a 25-cent-per-pack tax, and earmarked 20 percent of the revenue to anti-tobacco campaigns. Many anti-smoking advocates say the well-documented drop in cigarette sales and smoking-related deaths has proven that California's approach is effective. "They are getting declines that are not being seen elsewhere in the U.S.," says Dr. John Hughes, a specialist in addiction psychiatry at the University of Vermont, referring to California and Massachusetts, which has also mounted a vigorous smoking-control campaign. "For the first time in history, the lung cancer deaths and heart disease deaths were significantly reduced in a state — and that's California," Henningfield says. The move to hit smokers in their pocketbooks has gathered steam lately. New York City this week hiked the price of a premium pack of cigarettes to more than $7. "I think one of the things that's going on is that the effectiveness of price at deterring smoking has become increasingly clearly established," says Lloyd Johnston, a researcher at the Institute for Social Research at the University of Michigan. Tighter fiscal budgets have also prompted lawmakers to consider raising cigarette taxes, many researchers say. States such as New Jersey, Vermont, Indiana, Kansas, Ohio and Illinois have recently boosted taxes on smokes, and Pennsylvania is set to increase its tax later this month. "It's reached a critical mass where you're getting states that have never acted before starting to act," says Peter Jacobson, a professor at the University of Michigan's School of Public Health. Meanwhile, California has continued to push new anti-smoking steps. Legislators there in June introduced a bill to increase the legal smoking age from 18 to 21 — the highest in the nation. Not all anti-smoking policies have been shown to work, however. A recent study by University of California, San Francisco, researchers found that laws that prohibit selling cigarettes to minors have not reduced teenage smoking, for example. Despite widespread griping about higher cigarette prices and restrictions on where people can light up, there has been little sign of a significant smokers' backlash. "Most smokers actually support price increases even though they grumble about it, because they recognize it'll make them more likely to quit," says Dr. David Burns, a tobacco researcher at the University of California, San Diego. Some smokers' rights groups have decried the recent tax hikes and restrictions on smoking, and vow to lobby lawmakers to reverse course. "This is more of a persecution than it is a raise in revenue," says Audrey Sil of Citizens Lobbying Against Smoker Harassment, a New York smokers advocacy group. Tobacco companies have offered some support to the groups, pointing out that cigarette taxes hit especially hard because smokers tend to be lower-income. More Money, Shifting Opinions Along with increasing evidence that public anti-tobacco campaigns work, states have had more money to devote to such efforts, due in large part to the landmark 1998 "Master Settlement Agreement" the tobacco industry reached with 46 states. Under the deal, the tobacco companies agreed to funnel millions of dollars to state tobacco-control programs. When tobacco companies admitted their products were harmful, as part of that agreement, the deal also increased public pressure on lawmakers to discourage smoking, says Burns, the tobacco researcher at UC San Diego. Increased attention to smoking's dangers has also turned more people against the habit, some researchers believe. The United Nations' cancer research agency recently found that tobacco smoke is even more cancerous than previous research had indicated. "You've got the fact that the public is more aware than ever that smoking is deadly," Henningfield says. Many researchers believe more negative general attitudes toward smoking have contributed to a gradual increase in the number of jury awards to ill smokers, such as John Lukacs, a Florida man who won a $37.5 million last month. As attitudes have shifted, the percentage of Americans who smoke has gradually declined over the years. Roughly one in four American adults smokes today, according to the Centers for Disease Control and Prevention, down from slightly less than half the population in years following World War II. Smoking increased in the early 1990s, particularly among young people. But that trend had reversed itself over the last four or five years, researchers say. The Promise of a ‘Safer’ Cigarette Tobacco companies have responded in part by developing new products to suit changing consumer demand. Omni — which is advertised as "the first reduced-carcinogen cigarette" — is already on the market. Quest — described as a nicotine-free, reduced-carcinogen cigarette — is expected to hit shelves later this year. Another product — Advance Lights — claims to reduce the presence of some dangerous chemicals in cigarettes by using a different tobacco-preparation process. An Institute of Medicine expert panel issued a cautious note of support for so-called safer cigarettes, saying they were "potentially beneficial," although noting there was no proof yet that they offered lower health risks than regular cigarettes. The Food and Drug Administration on Tuesday ruled that nicotine water was a drug, preventing the product from reaching store shelves anytime soon. NicoWater's maker had hoped to market it as a way to help people quit smoking. The FDA has previously shot down nicotine-added lip balm and lollipops. Public health exerts are divided on the issue of safer cigarettes. "The hope is that cigarette makers will make truly less deadly cigarettes; the fear is that they'll market them that way" without scientific support for their claims, Henningfield says. "Harm-reduction" approaches — which seek to lessen the ill effects of smoking, rather than stamp them out altogether — are likely to generate more controversy as new products appear. Experts say anti-tobacco advocates are bound to disagree on what compromises to make on issues of tobacco regulation and attempts to formulate less deadly ways to smoke. A Smokeless Future? Some researchers predict smoking will be virtually eliminated in America over the next several decades. "I think it is likely that it will not be a mainstream behavior" in as little as two decades, Burns predicts. He believes that the social impetus to smoke will drop sharply as fewer people engage in the habit, and that the marketing and distribution of tobacco products will also decline with lessening demand. "Scientists think smoking is partly a social phenomenon. As smoking drops to a smaller percentage of the population, you lose that," Burns argues. Other public health experts, such as Jacobson at the University of Michigan's School of Public Health, have more modest expectations. He believes smoking levels will eventually drop to perhaps 15 percent of the population. "You'll always have kids lighting up," he says.

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