Category Archives: Tobacco Control
A tobacco history timeline published today by the Robert Wood Johnson Foundation showcases a decrease in smoking among adults, from 42.2 percent in 1965, shortly after the release of the first Surgeon General’s Report on Smoking and Health in 1964, to about 18 percent today. More than just a repository of changes in smoking rates over the years, 50 Years of Tobacco Control is an interactive look at the events and actions that have prevented more than eight million premature deaths in the ongoing fight to keep communities safe from the dangers of tobacco.
The timeline offers interviews with today’s tobacco control leaders—people such as John Sefrin, the Chief Executive Officer of the American Cancer Society, and Matthew L. Myers, President of the Campaign for Tobacco-Free Kids—who have made enormous strides in tobacco control and have a bold vision for tobacco reduction in the future. While scrolling through the major tobacco control milestones of the last 50 years, viewers can examine historical cigarette advertisements, reports and photos.
The Tobacco Timeline is an excellent resource for understanding the last 50 years of tobacco control, as well as the ambitious goals that health advocates have set for the future. While eight million premature tobacco-related deaths have been prevented by tobacco control efforts, up to 20 million have been lost in the same time frame.
Although smoking rates have dramatically declined, there is much more to the story. At a White House event to release the new Surgeon General’s report, U.S. Secretary of Health and Human Services Kathleen Sebelius shared some urgent facts from the report, including the projection that “approximately 5.6 million American children alive today—or one out of every 13 children under age 18—will die prematurely from smoking-related diseases unless current smoking rates drop.”
The new report ticks off new hazards of smoking in the last fifteen years, including new findings that show more diseases linked to smoking than previously reported including diabetes, colorectal cancer, liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration and strokes caused by secondhand smoke. Additionally, according to the report, cigarettes themselves are more lethal than they were fifty years ago.
U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius led off an event at the White House today to mark the 50th anniversary of the inaugural Surgeon General’s Report on Smoking and Health and to release a new progress report on smoking and health by telling the crowd of tobacco advocacy experts that “we’re still a country very much addicted to tobacco.” The new report finds that while the number of U.S. smokers is down from half of the adult population five decades ago to about 18 percent today, if the current smoking trends continue, 5.6 million children alive today will die of tobacco-related diseases in the years ahead.
The report also shows that although many diseases other than lung cancer have been linked to tobacco in the last fifty years, even more illnesses are now known to be linked to tobacco, including:
- Strokes from secondhand smoke
- Rheumatoid arthritis
- Ectopic pregnancies
- Erectile dysfunction
- Colorectal and liver cancer
“Fifty years later, tobacco remains a public health catastrophe and the tobacco fight still rages on every corner of our country,” said HHS Assistant Secretary for Health Howard Koh, MD, MPH at today’s event.
Tom Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention, added that most current smokers want to quit. What is keeping smoking rates high, said Frieden, includes advertising and promotional activities by tobacco companies, especially to children and adolescents, as well as disparities in smoking among certain ethnic groups, low-income populations and many people who are mentally ill.
Effective evidence-based measures cited in the report that can reduce smoking include media campaigns, increased tobacco taxes and new smoking cessation benefits made available to people with health insurance coverage under the Affordable Care Act.
Additionally, actions to reduce smoking that are expected in the coming year include the likely confirmation of a new Surgeon General, a U.S. Food and Drug Administration media campaign aimed at showcasing the dangers of smoking to young people and a new Tips from Former Smokers campaign that will include a video public service announcement (PSA) filmed at the bedside of Terrie Hill, whose previous PSA has been viewed 2 million times and who died of smoking-related illness last year at the age of 53.
>>Bonus Fact: The 1964 Surgeon General Report was released by then-Surgeon General Luther Terry. Among the members of his family attending the White House event today was Dr. Terry’s granddaughter, a graduate of the Harvard School of Public Health.
To mark the 50th anniversary of the 1964 first Surgeon General’s Report on Smoking and Health, JAMA, the Journal of the American Medical Association, released a theme issue this week on fifty years of tobacco control. The study getting the most attention is one by researchers at several medical centers and schools of public health, who estimate that tobacco control efforts in the United States since 1964 have added decades to the lives of eight million American.
Other tobacco topics in the issue include:
- Adults with mental illness have a harder time quitting tobacco than do other smokers
- Smoking rates among most health care providers have dropped sharply in recent years, with the exception being licensed practical nurses
The issue also has several opinion pieces on tobacco-related issues, including one co-written by JAMA Editor Helene Cole, MD, and Michael Fiore, MD, MPH, director of the University of Wisconsin Center for Tobacco Research and Intervention, who call for key tobacco policy changes such as:
- Increasing tobacco taxes
- Stronger application of U.S. Food and Drug Administration (FDA) regulation of tobacco products, including cigars and e-cigarettes
- Massive public health campaigns
In fact, the FDA has announced it will spend $300 million in 2014 on ads urging teens to be tobacco free, and the U.S. Centers for Disease Control and Prevention plans to continue its “Tips from Former Smokers” campaign.
>>Bonus Link: Read a NewPublicHealth post on the press conference yesterday by the major tobacco control advocacy groups to mark the 50th anniversary of the 1964 Surgeon General Report on Smoking and Health.
Fifty Years after First Surgeon General’s Report on Smoking and Health, Tobacco Advocacy Groups Pledge to 'End the Tobacco Epidemic for Good'
National tobacco control advocacy groups including the Campaign for Tobacco Free Kids, Americans for Non Smokers Rights, the American Cancer Society Cancer Action Network, and the American Lung and Heart Associations observed the 50th anniversary of the Surgeon General’s Report on Smoking and Health by calling for “bold actions” to “end the tobacco epidemic for good.”
The historic 1964 Surgeons General’s report, the first of many since then that have documented specific health dangers from tobacco, was the first major report to link smoking to lung cancer. It was also a critical first step toward reducing smoking rates from close to 50 percent in 1964 to about 18 percent today, according to the advocacy groups. Significantly, a study published yesterday in JAMA, shows that from 1964 to 2012, at least 8 million premature, smoking-related deaths were prevented, and each of those eight million people gained, on average, 20 years of life. Even more significant, the study authors estimate that reductions in smoking contributed 30 percent of the increase in U.S. life expectancy in from 1964 to 2012.
However, the groups quickly turned their attention to the 440,000 Americans who still die of tobacco-related illnesses each year and resolved collectively to achieve new tobacco control landmarks including:
- Reduce smoking rates to fewer than 10 percent within ten years
- Protect all Americans from secondhand smoke within five years
- Ultimately eliminate the death and disease caused by tobacco smoke
At a question and answer period following the press conference additional proposed strategies were discussed by the groups’ top representatives, including:
- Expanded regulation by the Food and Drug Administration (FDA) of all tobacco products—regulations on some products, such as menthol and electronic cigarettes, are still pending.
- Guidance from the U.S. Department of Health and Human Services on a common smoking cessation benefit Americans can access through the health insurance they receive under the Affordable Care Act.
- Greater inroads on reducing smoking rates among people with mental illness. According to research from the U.S. Centers for Disease Control and Prevention, Americans with mental illnesses have a 70 percent greater likelihood of smoking than the general population.
- Greater efforts to reduce marketing and other tactics by tobacco companies in third world countries where smoking rates remain high.
“We can end the tobacco epidemic by fully and effectively implementing proven strategies,” said Tobacco-Free Kids president Matthew Myers, “including higher tobacco taxes, comprehensive smoke-free workplace laws, hard-hitting mass media campaigns, well-funded tobacco prevention and cessation programs, and effective Food and Drug Administration regulation of the manufacturing, marketing and sale of tobacco products. By doing what we know works, we can accelerate declines in tobacco use and ultimately eliminate the death and disease it causes.”
- Read a NewPublicHealth interview with Mitch Zeller, director of the FDA’s Center for Tobacco Products, on the Center’s goals for ending tobacco use in the United States.
- Read a NewPublicHealth interview on “tobacco end game strategies” with Professor Kenneth Warner, of the University of Michigan School of Public Health and a co-author of the new JAMA study on the lives saved through tobacco-control efforts.
Fifteen Years after Tobacco Settlement, States Falling Short in Funding Tobacco Prevention: Q&A with Danny McGoldrick
On November 23, 1998, 46 states settled their lawsuits against the nation’s major tobacco companies to recover tobacco-related health care costs, joining four states—Mississippi, Texas, Florida and Minnesota—that had reached earlier, individual settlements.
These settlements require the tobacco companies to make annual payments to the states in perpetuity, with total payments estimated at $246 billion over the first 25 years.
Yesterday a coalition of health advocacy groups released the latest edition of A Broken Promise to Our Kids, an annual report on state use of tobacco funds for tobacco prevention and cessation efforts. As in years past, the report finds that most states fall short in the amount of money they allocate to prevent kids from smoking and to help current smokers quit.
The groups that jointly issued the report include the Campaign for Tobacco-Free Kids, the American Heart Association, American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights.
Key findings of the 2013 report include:
- Over the past 15 years, states have spent just 2.3 percent of their total tobacco-generated revenue on tobacco prevention and cessation programs.
- The states this year will collect $25 billion from the tobacco settlement and tobacco taxes, but will spend just 1.9 percent of it—$481.2 million—on tobacco prevention programs. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use.
- States are falling short of the U.S. Centers for Disease Control and Prevention’s (CDC) recommended funding levels for tobacco prevention programs. Altogether, the states have budgeted just 13 percent of the $3.7 billion the CDC recommends.
- Only two states—Alaska and North Dakota—currently fund tobacco prevention programs at the CDC-recommended level.
To discuss the ramifications of the latest edition of the Broken Promises report, NewPublicHealth recently spoke with Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.
NewPublicHealth: Can you give us some background on the Tobacco Master Settlement Agreement?
Danny McGoldrick: This is the 15th anniversary of the Tobacco Master Settlement Agreement, when 46 states and the District of Columbia settled their lawsuits against the tobacco companies mostly to recover the costs that they’d incurred treating smoking-caused disease in their states. Four other states had settled individually with the tobacco companies prior to the Master Settlement Agreement, and so this provided for some restrictions on tobacco company marketing; they promised never to market to kids again, which is ironic, but it also resulted in the tobacco companies sending about $250 billion over just the first 25 years of the settlement for the states to spend as they saw fit. They left that to the province of the state legislators and governors to decide how those funds should be spent.
As smartphone technology becomes ever more ubiquitous and the dangers of tobacco become ever more apparent, it's not surprising that there are 414 quit-smoking apps available between iPhones and Androids, with Androids alone seeing about 700,000 downloads of these apps each month.
There's no question that these apps are in demand in the United States, where an estimated 11 million smokers own a smartphone and more than half of smokers in 2010 tried to quit.
The question is: Are they effective?
According to a new study in the American Journal of Preventive Medicine, the answer is too often "no," with many of the most popular apps failing to employ and advocate known and successful anti-tobacco strategies.
"Quit-smoking apps are an increasingly available tool for smokers," said lead author Lorien Abroms, ScD, an associate professor of Prevention and Community Health at the George Washington University School of Public Health and Health Services (SPHHS), according to Health Canal. "Yet our study suggests these apps have a long way to go to comply with practices that we know can help people stub out that last cigarette."
The study looked at the 50 top anti-smoking apps for both iPhones and Androids, analyzing their tactics on a number of fronts, including how well they aligned with guidelines from the U.S. Public Health Service on treating tobacco use. The review found serious issues with the apps' advice, especially concerning clinical practices. It found that:
- Most lacked basic advice on how to quit smoking and did not help people establish a "quit plan"
- None recommend calling a quit-line, which can more than double the chances of successfully quitting tobacco
- Fewer than one in 20 of the apps recommended medications, even though studies show how nicotine replacement therapy can help curb cravings
Taken together these, last two findings are especially troubling, as their pairing has been found to more than triple the chances of a person successfully breaking their nicotine addiction. One of the biggest takeaways from the study, according to Abroms, is that while quit-smoking apps can be important components of a larger plan to quit smoking, there might also be a simpler way to use those fancy smartphones.
"They should simply pick up their smartphone and call a quit-line now to get proven help on how to beat a tobacco addiction."
And the lack of adequate advice and guidance isn't limited to quit-smoking apps. A study by the IMS Institute for Healthcare Informatics found that while apps remain popular, they also remain limited.
"It clearly demonstrated that, to date, most efforts in app development have been in the overall wellness category with diet and exercise apps accounting for the majority available. An assessment finds that healthcare apps available today have both limited and simple functionality--the majority do little more than provide information.
Read the full story at Health Canal.
>>Bonus content: Read the previous NewPublicHealth post, "Public Health: There's An App For That"
>>Bonus link: Mobile Health and FDA Guidance
>>Bonus links: Here's a quick look at a few of the newest apps designed to improve public health in a variety of ways:
- My Health Apps offers a vast array of apps, sorted by categories such as "Mental Health," "Me and My Doctor" and "Staying Healthy"
- Hula, which helps people find STD testing, get the results on their phone and even share verified results
- My Fitness Pal, which combines guidance and community to help people lose weight
- Planned Parenthood offers a series of teen-focused apps on important issues such as birth control, condoms and even substance abuse
Tobacco featured prominently as a public health issue at the American Public Health Association (APHA) meeting this week, including a regulatory update from Mitch Zeller, JD, who became director of the U.S. Food and Drug Administration’s (FDA) Center for Tobacco Products earlier this year. Zeller previously worked on tobacco issues in government as associate commissioner and director of FDA’s first Office of Tobacco Programs, and also as a U.S. delegate to the World Health Organization (WHO) Working Group for the Framework Convention on Tobacco Control.
NewPublicHealth spoke with Zeller ahead of the APHA meeting.
Mitch Zeller: I think most broadly my goals are to help give the center and the agency the greatest chance of fulfilling the public health mission behind the law passed in 2009 giving the Food and Drug Administration authority over tobacco. This really is an important piece of legislation. It’s really stunning that in 2013—with everything that we know about the harms associated with tobacco use—that it remains the leading cause of preventable death and disease both in this country and globally.
There are some very powerful tools that Congress has given FDA to use wisely and supported by evidence. That’s where I think, the greatest opportunity lies: to use the tools relying on regulatory science to try to protect consumers and reduce the death and disease toll from tobacco.
There are two areas where I think these tools can make a profound positive impact on public health. The first is something called product standards, which is basically the power to ban, restrict or limit the allowable levels of ingredients in tobacco or tobacco smoke. We are exploring potential product standards in three areas: toxicity, addiction and appeal. And we are funding research in all three areas and working very hard behind the scenes to find out what our options are for potential product standards in those three areas.
GUEST POST by Lisa Junker, CAE, Director of Communications at the Association of State and Territorial Health Officials (ASTHO).
The United States is facing a “perfect storm of vulnerability,” said U.S. Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, MPH, yesterday at the 2013 Annual Meeting of the Association of State and Territorial Health Officials (ASTHO)—and state and local public health officials are on the front line of defense.
Frieden began his remarks by encouraging his listeners to “go back to first principles” and keep in mind the first priority of government, which is to keep people safe.
“If the government can’t keep people safe, whether it’s the police or us in public health, we are failing at our number-one responsibility to the public,” Frieden said.
And to keep the U.S. population safe today, public health officials have to keep their eyes open for threats arriving from outside our borders. Infectious diseases, drug resistance, new pathogens, intentional engineering of microbes, and globalization of travel, food and medicines: “If there’s a blind spot anywhere, we’re at risk everywhere,” Frieden emphasized.
He also focused on CDC’s partnership with state and local public health, even during the current tight fiscal atmosphere.
“Overall, our approach has been to double down on support for the front lines [state and local health agencies],” he said. “We all are in this together…We have lots of problems and lots of opportunities, and the more effectively we are connected, the more effectively we can address these opportunities.”
A study published in The Lancet yesterday by researchers from the U.S. Centers for Disease Control and Prevention (CDC) found that the CDC’s 2012 first-ever tobacco cessation ad campaign, Tips From Former Smokers, can take credit for more than 200,000 U.S. smokers quitting immediately during a three-month ad blitz—with an estimated 100,000 of those former smokers predicted to quit permanently.
The study was done using a web survey with thousands of smokers and non smokers, most of whom had seen or heard the ads that were broadcast on radio, television and the Internet, as well as posted on billboards and in publications. The ads, which included quit-line phone numbers and quit-line web links, featured former smokers, many permanently disabled from the effects of years of smoking. Brandon, 31, one of the former smokers in the campaign, began smoking at 15. At 18, doctors diagnosed Buerger’s disease, a vascular condition that was linked to his tobacco use and resulted in the amputation of both legs and several fingertips.
Terrie, 52, whose video ad has been viewed more than any other CDC video, had her larynx removed after years of smoking caused both oral and throat cancer. Terrie speaks through an artificial voice box. Her “tip” to smokers is to record lullabies and stories for their children now, before they lose their voices to cancer and can no longer read a children’s book with their own voice.
In a conference call with reporters yesterday, Lisha Hancock, 38, said that she started smoking when she was 21 years old and was soon up to as many as two packs a day.
“I tried to quit many times. But it wasn't until I saw Terrie's ad on the Tips for Former Smokers campaign that I was really able to quit for good,” she said. “It broke my heart to see what Terrie was going through, but because of her, I will never smoke again. My son…had a lot to do with it. He was actually very interested in the ads himself. I'm not sure if it was because of her voice or because it was something different than what we normally see on television. But his question for me was why does she sound like that? And then when I replied because she smoked, he asked if mommy would sound like that…I could see myself in her shoes had I continued to smoke.”
Public Health Summer Fellowship Gives College Student a Close-Up Look at Public Health Campaigns and Messaging
Mina Radman was one of seven college students who spent their summer in Washington, D.C. as part of the Frank Karel Fellowship Program in Public Interest Communications. The program, coordinated by the Nonprofit Roundtable, an alliance of 300 nonprofits and community partners, places high-potential undergraduate students in hands-on summer fellowships with leading nonprofit organizations that promote the public interest.
The Karel Fellowship honors and advances the legacy of Frank Karel, who established, led and nurtured the field of strategic communications during his 30 years as chief communications officer for the Robert Wood Johnson Foundation and the Rockefeller Foundation. Among Karel’s strong beliefs was that racial and ethnic minorities were underrepresented in the public interest communications field, and so foundations and public interest organizations must be proactive in recruiting and nurturing broader participation and leadership in public interest communications and advocacy.
NewPublicHealth spoke with Mina Radman, a 2013 Karel fellow, about her summer spent working and learning at the Campaign for Tobacco-Free Kids.
NewPublicHealth: Did you learn about Frank Karel’s professional history and legacy as part of the fellowship?
Mina Radman: Yes, we did. People who had known Mr. Karel, such as Andy Burness of Burness Communications, spoke about him at the opening dinner for the fellowship program, and his name came up many times during the summer whenever we would speak with people who knew Mr. Karel and his work. We also have sessions as a group at the conference room at Burness in Bethesda, Maryland, and that room is named for Frank Karel. And Mr. Karel’s wife, Betsy, came by to say hello at a recent fellowship session.
NPH: You’re journalism major. What do you hope to do once you graduate?
Radman: That's the “million dollar” question. I’m still figuring that out and that was part of my reason for applying for and accepting the Karel fellowship—in order to explore potential fields of interest. I definitely want to work in communication, but what avenue I’ll take is something I’m still discovering.