Category Archives: Tobacco control
A new film, Addiction Incorporated, gives viewers a look at the tobacco industry and nicotine addiction from the perspective of Victor DeNoble, a former industry scientist turned whistle-blower. DeNoble testified before Congress in 1994 that his research proved nicotine was addictive, contradicting the sworn testimony otherwise of the industry’s chief executives. His testimony helped fuel lawsuits against the industry and contributed to eventual enactment of the Family Smoking Prevention and Tobacco Control Act. This 2009 law gave the Food and Drug Administration the power to regulate tobacco products and marketing.
Watch the trailer for Addiction Incorporated:
NewPublicHealth spoke with DeNoble and the documentary’s filmmaker, Charles Evans, Jr., about their story.
NewPublicHealth: Charles, how long was the film in development and what prompted you to do the story in this way?
Charles Evans: I saw Victor on C-SPAN and was greatly interested in his cloak and dagger life at Philip Morris and I wanted to know more. I’m a film producer and thought it would make a good movie and actively sought him out, got to know more about him and about the work that he went on to do afterwards. In the late ‘90s he essentially just started talking to kids and to me that became the story. The story became a man who was determined to do good with science and the tobacco industry.
NPH: Victor, can you summarize the findings of your research at Philip Morris?
Victor DeNoble: When I went to work at Philip Morris, my job was to find a substitute drug for nicotine because nicotine causes cardiovascular problems. They wanted to find a drug that was equally addictive but something that wouldn’t cause heart problems, but in order to do that we had to determine how addictive nicotine was. So we used classical rat models that determined drug addictions because rat brains are very similar to people brains, and we determined that nicotine was an addictive drug and that rats would work for it and it was not much different than other drugs of abuse like morphine, cocaine and heroin.
And then in a very surprising finding, around 1982 we discovered that there was a second drug in tobacco smoke that also was addictive and interactive with nicotine—and that drug is called acetaldehyde. What was interesting was that when you mixed acetaldehyde with nicotine, nicotine became more addictive.
NPH: Cigarettes have been called a finely tuned drug delivery device. Can you talk about what that means and how cigarettes are manufactured to maximize the delivery and impact of nicotine?
Evidence is mounting to support the idea that proven prevention programs, especially those that help keep kids from smoking and help smokers quit, pay big returns by reducing health care costs:
- A newly published study shows that Massachusetts saved more than $3 for every $1 it spent on services to help beneficiaries in the state’s Medicaid program quit smoking. (Also: read a related editorial.)
- Tobacco prevention programs could save an astonishing 14 to 20 times the cost of implementing them, according to a recent study in the journal Contemporary Economic Policy.
- A recent study published in the American Journal of Public Health (AJPH) found that from 2000 to 2009, Washington State’s tobacco prevention and cessation program saved more than $5 for every $1 spent by reducing hospitalizations for heart disease, stroke, respiratory disease and cancer caused by tobacco use. Over the 10-year period, the program prevented nearly 36,000 hospitalizations, saving $1.5 billion compared to $260 million spent on the program.
“These studies send a powerful message to the nation's elected officials that disease prevention initiatives, including programs that prevent kids from smoking and help smokers quit, are essential to improving health and reducing health care costs in the United States," says Matthew L. Myers, president of the Campaign for Tobacco-Free Kids.
NewPublicHealth spoke recently with Julia Dilley, PhD, and officer with the Program Design and Evaluation Services Department in the Multnomah County (Oregon) Health Department and the lead author of the study published in AJPH about the findings.
NewPublicHealth: What were the key findings of the Washington State study?
Julia Dilley: The main thing we learned is that within a pretty short period of time the state [tobacco prevention] programs saved money.
NPH: Who should be looking at these studies?
Julia Dilley: Legislators and people who make state budgets. In Washington, for example, policymakers are making tough budget decisions, and they are not easy decisions to make. And I see them saying, well, we can do smoke-free policies and taxes, which are positive things to do, but programs cost us money. What we’re showing is that you need all three to be effective. The investment will be a benefit in the short- and long-term. In Washington State, policymakers defunded the tobacco control programs for the coming year, but may be reconsidering them for the coming fiscal year, in part because of the study and because some state leaders did not want to cut the funding. Right now Washington is the only state without a state-wide quit line.
NPH: Given the economic realities of the moment, what is the best way to leverage tobacco control program funds?
Julia Dilley: There is always good work to be done in leveraging funds. One example is that the graphic warning labels for cigarette packs designed by the Food and Drug Administration have a referral number for the national quit line. That’s a good example of a state not having to put as much of its resources in promoting state quit lines, if the authority of the FDA to require the graphic warning is upheld.
Weigh In: Has your state cut or added tobacco control programs recently?
A new report, “A Broken Promise to Our Children: The 1998 State Tobacco Settlement 13 Years Later,”on annual state use of tobacco company settlement funds shows another plummet in spending on tobacco control. This year’s report, released by a coalition of groups including the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society, Cancer Action Network, American Lung Association, Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights, shows that states have slashed funding for programs to reduce tobacco use by 12 percent in the past year and by 36 percent over the past four years.
“Those cuts threaten the nation’s progress against tobacco," says Danny McGoldrick, Vice President for Research at the Campaign for Tobacco-Free Kids.
According to the report, in fiscal year 2012, states will collect a near-record $25.6 billion in revenue from the 1998 state tobacco settlement and tobacco taxes, but will spend only 1.8 percent of it—$456.7 million—on programs to prevent kids from smoking and help smokers quit. Both the total amounts states are spending on tobacco prevention programs and the percentage of tobacco revenue spent on these programs are the lowest since 1999, when the states first received significant tobacco settlement funds.
>>Read more on the value of investing in prevention.
NewPublicHealth spoke with Danny McGoldrick about the new report.
NewPublicHealth: What are the major findings in the new report?
Danny McGoldrick: Our annual report on how states are doing funding tobacco prevention with their tobacco settlement dollars doesn’t paint a very pretty picture this year. At a time when states are bringing in as much revenue as ever from their tobacco settlement payments and tobacco taxes, they’re spending less than ever on proven programs that we know prevent kids from starting to smoke and help smokers quit. And when we don’t fund these programs or when we cut funding as we have over the past several years, what that means is that we are going to have more kids starting to smoke and fewer adults quitting, which obviously leads to more disease and deaths from tobacco and more health care costs, which we’re all going to pay for.
NPH: What specific impact does reduced state spending on tobacco control have on smoking cessation efforts in the U.S.?
Passing smoke-free measures is almost always harder than you might think, according to a new blog post from the Public Health Law Network. The post describes the recent efforts in Bullitt County, Kentucky, where a regulation drafted by the board of health requiring all public places and worksites to be smoke-free has been challenged repeatedly in the courts. The challenges are based on grounds that the regulation exceeds the authority of the board of health. The post offers important information on the variability of the legal and regulatory authority of boards of health across the country and opportunities for those boards to prevail.
Read the post here.
Bonus: Weigh in on what your community is doing to promote smoke-free air, and read comments on what others are doing in their communities. For example, Minnesota is working on smoke-free public housing and tobacco-free college campuses.
The CDC has identified reducing tobacco use as a winnable battle, given that it is a major cause of preventable death and we know what works to prevent it. Giving everyone the opportunity to breathe smoke-free air – through smoke-free workplaces, bars and restaurants – is a key strategy. If some of the 52 percent of Americans currently living in areas with no smoke-free indoor air laws or partial smoke-free laws find themselves with more places to breathe freely this year, they may want to thank the 150 advocates, researchers and funders meeting this week at “Clearing the Air: An Institute for Policy Advocacy VII,” a tobacco control policy advocacy retreat held by Americans for Nonsmokers’ Rights Foundation.
Smoke-free air advocates are critical to moving evidence into action around policy, influencing policy-makers and community leaders, and driving toward better community health. The Clearing the Air retreat brings together seasoned and new advocates, funders, researchers and other experts to create a movement for smoke-free air. Cynthia Hallett, M.P.H., executive director of Americans for Nonsmokers’ Rights, says the institute is designed to bring these individuals together to “share, learn, float new ideas and talk about challenges that people face in a safe space on how we can move forward.” For example, recent studies on the cardiovascular impacts of smoking came out of talks between researchers and local advocates, who knew that emergency room doctors had such data, and were able to link researchers with potential data sources.
Hallett commented on the benefits of the exchanges that happen at these meetings. “Often researchers and national advocates don’t hear what’s happening at the local level,” said Hallett. “Electronic cigarettes is another topic a previous institute focused on, and by giving local advocates help on crafting language to include in ordinances, the devices were included in legislation on restricting tobacco in some locales following the meeting.”
The graphic cigarette health warnings released by the Food and Drug Administration yesterday represent a milestone in the fight against tobacco use in the United States. According to the Campaign For Tobacco-Free Kids, “the stark new warnings will provide a much-needed boost to efforts to prevent kids from smoking, encourage smokers to quit and make sure all Americans fully understand the deadly consequences of cigarette smoking.” NewPublicHealth spoke with Danny McGoldrick, Vice President of Research at the Campaign, about the new labels.
NewPublicHealth: How important are the new graphic warnings to the goal of reducing cigarette smoking in the U.S.?
McGoldrick: Well, the new graphic warning labels are a huge step forward for the U.S. We are joining forty countries around the world in finally putting graphic warning labels on our cigarette packs. We haven’t changed the warning labels in over 20 years, so this is a dramatic step that will in fact both discourage kids from starting to smoke and educate everybody about the harmful effects of second hand smoke and encourage smokers to try to quit.
But it’s not going to solve the problem by itself. There are many other interventions that are evidence-based that we know if we put in place will help reduce smoking, which includes increasing tobacco taxes, passing comprehensive smoke-free laws, and funding for prevention and cessation programs, that not only protect everybody’s right to breathe clean air but also encourage smokers to try to quit and help them stay quit--as well as funding for prevention and cessation programs. We have a solid evidence base for all these interventions--they work wherever we do them. The warning labels are a wonderful complement to the other activities, but we can’t just think that this is going to solve the problem. But it’s a wonderful step forward.
NPH: What kind of an impact do you think the graphic warning labels will have on smokers?
McGoldrick: Well, the warning labels that are on the packs now are hardly noticed anymore. First of all, they are on the side of the pack, the color is not a great contrast to the color of the packs, often times, so I don’t think anyone really notices them anyway. They were news when this happened years and years and years ago, but this new effort is going to be dramatic. The warning labels are going to cover the top half of both the front and the back of cigarette packs with graphic images along with the text warnings, and help for smokers with the 1800 QUIT NOW number. So this is going to change dramatically what smokers see--every time they pick up a pack of cigarettes and what kids and others see when they see a pack of cigarettes. We hope kids don’t have them in their hands, but inevitably they see them from their parents or friends or others, so this is a dramatic change. And the evidence is very clear from studies around the world that the graphic warning labels increase knowledge about the health risks of smoking and motivate people to try to quit. Smokers report in a number of studies that the warning labels were instrumental in helping them stay quit.
NPH: What other measures do we need besides the warnings to get people to quit?
Danny McGoldrick: We need to continue to educate people about the dangers of smoking and we know that these graphic and emotional messages help them do that. But we can’t just do it on cigarette packs. You know the tobacco companies don’t just market through their packs--they spend 12 billion dollars a year promoting their products. They outspend our states 25 to 1, so we need a media campaign--we haven’t had a national anti-tobacco or smoking cessation media campaign in years, except for the Truth campaign, which is directed exclusively at kids by the Legacy Foundation, and that is also underfunded. So we need media campaigns to educate people and encourage them not to start smoking and to encourage them to try to quit. We need every smoker to have access to evidence-based smoking cessation therapies including counseling and medications that we know greatly enhance one’s chances of quitting. And we can raise tobacco taxes. Price is a huge factor in whether people smoke, particularly young people. And our smoke-free laws also help in creating an environment that is less conducive to starting to smoke and more conducive to trying to quit.
NPH: Some states facing budget cuts have slashed anti-smoking programs. What should be done to beef up programs in the face of less money to spend?
Danny McGoldrick: Yeah--our states are doing a terrible job of funding tobacco prevention cessation programs. They haven’t done a good job from the get-go, and now they are doing even worse in these tough budget situations. And they really have no excuse. They take in over 25 billion dollars a year in their settlement payments and their tobacco taxes, and devote only a tiny percentage of it to improving prevention and cessation programs. So even in tough budget times, just a small part of that money would fund tobacco prevention and cessation programs at the levels recommended by the CDC. Only one or two states funds programs at that level.
We know these programs work. So even in these tough budget times, there are a number of steps that our leaders can take, such as increasing taxes and having the double measure of the price hike and more money to spend on cessation and prevention programs. And the public supports them. The public is so far out in front of our legislative decision makers on doing something about the tobacco problem. If our elected officials did what the science shows works and what the voters tell them they want them to do, we would make great progress in reducing tobacco use.
NPH: Cigarette companies have until September 2012 to add the graphic warnings to the packages. Could there be bumps on the roads until then?
Danny McGoldrick: The companies already sued to stop the warning labels. They’ve sued over the entire FDA law that was passed two years ago and challenged a number of provisions in it. In Federal District Court, the warning labels were upheld and so we are confident that they will be upheld. Tobacco companies will probably find other reasons to litigate around this, but you know it’s been over twenty years since the last time we changed the warning labels, and we need to do everything we can to stop the tobacco companies from slowing us down again. Their opposition is just more evidence that these things work. If they are against it, it’s usually a good thing to do. So we are hopeful that if they do decide to file even more law suits than they already have to stop these warning labels, then the courts will dismiss them quickly. Every minute we wait, it’s more lives that are going to be lost and more we spend in healthcare costs.
NPH: You mentioned that smokers had gotten used to the warning messages on cigarette packs. If people become used to the new graphic warnings, what’s next?
McGoldrick: Well, the great thing about the FDA legislation is that it not only dictated these new warning statements and labels, but it also gave the FDA the authority to change them moving forward. So, it won’t take an act of Congress next time to change the warning labels. And the FDA will begin immediately to evaluate the impact of the new graphic warning labels, and they have the authority to issue a new rule to change the text of the warning labels if there is new science about the harms of tobacco or new science about what messages work best to motivate smokers to quit or to prevent kids from starting.
And the FDA can change the graphics as well. They have to go through the rule making process like they do with anything, but this flexible authority the FDA has to react to what the industry does or to new science is incredibly important. When the warning labels were announced yesterday, Dr. Deyton, [director of the FDA Office of Tobacco Products] said, “We are going to be looking at keeping these [labels] fresh and making sure that we always have the warning labels that the science tells us will have the biggest impact on public health.”
Read previous NewPublicHealth.org Q&As with newsmakers and difference makers in public health.
Today’s release of the final nine tobacco warning labels marks a historic change for public health.
After 25 years featuring just text warnings, tobacco manufacturers will now need to blanket 50 percent of tobacco packaging and 20 percent of tobacco advertising with images and language graphically depicting the health impact of tobacco use.
Today and tomorrow, two live Twitter Q&A events will help put these changes in context and dig deeper into the negative effect of tobacco use on individual and community health.
At 2:30 p.m. ET today, @FDATobacco will host a live Twitter Q&A featuring Dr. Howard Koh, Assistant Secretary for Health at the U.S. Department of Health and Human Services, and Dr. Lawrence Deyton, Director of the Center for Tobacco Products at the U.S. Food and Drug Administration. They will take questions from the audience about the new warning labels. You can participate by using the hashtag #cigwarnings.
At 2:00 p.m. ET tomorrow, @RWJF_PubHealth is proud to host Livestrong CEO Doug Ulman in a live Twitter Q&A about the fight to reduce tobacco use and Livestrong’s recent $500,000 grant to the Campaign for Tobacco-Free Kids. You can use the hashtag #AskDoug to weigh in on Wednesday. NewPublicHealth.org will also feature a live feed tomorrow allowing readers without a Twitter account to follow along.
>> U.S. Surgeon General Regina M. Benjamin writes about today’s release of the new tobacco labels
>> Interactive store counter photo showing how store displays will change with new warning labels.
>> In-depth Q&A with Doug Ulman of Livestrong
>> Interactive tobacco map shows latest data on state smoking laws
>> Idea Gallery piece from Matthew Myers of the Campaign for Tobacco-Free Kids and Cheryl Healton of Legacy calling on Major League Baseball to ban the use of smokeless tobacco
>> Full tobacco coverage from NewPublicHealth.org
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, the Surgeon General, Regina M. Benjamin, M.D., M.B.A. writes about the new FDA cigarette health warnings.
It’s simple: Smoking kills.
Sending this message to smokers — or to those who are thinking of starting smoking — just got a lot easier. Earlier today, the federal government released nine new graphic health warnings that will appear on everything from cigarette packs to in-store tobacco displays.
Stark images and bold messaging will now graphically illustrate — on every ad and every pack of cigarettes — the painful and deadly reality of tobacco use: A diseased lung. A baby surrounded by secondhand smoke. A man who needs an oxygen mask to breathe.
Beginning September 2012, each pack of cigarettes will serve as a vivid reminder of the real public health effects of smoking.
Smoking is the leading cause of premature and preventable death in the United States, killing 443,000 people each year. The next cigarette could be the one that triggers a heart attack, a stroke or cancer. And it is not just smokers who are affected: There is no safe level of exposure to tobacco smoke. Any exposure to tobacco — even if secondhand — is harmful.
The new U.S. Food and Drug Administration warnings are a major component of the Department of Health and Human Services’ new comprehensive strategy to prevent children from starting to use tobacco and to help current tobacco users quit. In fact, each new warning label carries the government-funded 1-800-QUIT-NOW cessation resource phone number.
The new labels illustrate the message — that tobacco use is harmful. The graphic warning labels will bring us one step closer to ending this completely preventable epidemic.
For more information and to see the final images, visit www.fda.gov/cigarettewarnings.
Residents in 25 states and the District of Columbia are breathing a little easier these days.
Since 2000, their governments have enacted smoke-free laws that apply to all workplaces, restaurants and bars, according to a report released last week by the Centers for Disease Control and Prevention.
“The new report underscores the strong momentum across the country to pass smoke-free workplace laws that protect all workers and the public from the serious health hazards of secondhand smoke,” says Matthew Myers, president of the Campaign for Tobacco-Free Kids.
The report projects that, at the current rate of progress, the entire nation could have laws banning smoking in all indoor areas of private sector worksites, restaurants and bars by 2020. These places are major sources of secondhand smoke exposure.
“As the U.S. Surgeon General and numerous scientific studies have found, smoke-free laws protect health without harming business,” said Myers.
In addition, polls and ballot initiatives repeatedly have shown that the public strongly supports smoke-free laws that apply to all workplaces and public places and protect everyone’s right to breathe clean air. (RELATED: See our interactive tobacco control map.)
“Every state should enact such a law,” Myers said.
For additional perspective on the CDC report, NewPublicHealth spoke with Maggie Mahoney, Deputy Director of the Tobacco Control Legal Consortium. The Consortium is a partner of the Public Health Law Network and is funded by the Robert Wood Johnson Foundation.
NewPublicHealth: Are all the laws that have been enacted the best they can be, or could some be strengthened?
Maggie Mahoney: As the CDC's report notes, the U.S. Surgeon General found in 2006 that no level of exposure to secondhand smoke is safe. It is for this reason that the public health community strives to pass smoke-free laws that — at a minimum — prohibit smoking in enclosed public places and in enclosed places of employment. A number of jurisdictions have gone beyond this minimum level of protection and have passed laws that prohibit smoking in certain outdoor areas where people gather or work, due to evidence that secondhand smoke does not necessarily dissipate quickly in outdoor areas where people are smoking.
A number of the existing laws were passed before the 2006 Surgeon General's Report [on secondhand smoke] was released, and could be strengthened to reflect the current science on this issue.
NPH: How hopeful are you that states that have not yet passed smoke-free laws will do so, and soon?
Mahoney: The public health community is dedicated to reducing tobacco use — the single most preventable cause of disease, disability and death in the United States — as well as reducing exposure to secondhand smoke, which causes 3,000 nonsmoking Americans to die of lung cancer and 46,000 to die of heart disease each year. Those facts alone should compel all — and have caused many — lawmakers to pass strong smoke-free laws. Other lawmakers have been persuaded by data showing that tobacco use results in medical costs of $96 billion per year and lost productivity costs of $97 billion per year; that smoke-free laws do not negatively impact business revenues; and that courts have found that passing smoke-free laws is an appropriate use of the government's police power. In some jurisdictions where lawmakers have hesitated to act, the public has gone to the ballot to demand to be free of exposure to secondhand smoke. There has been tremendous progress in passing smoke-free laws, especially in recent years. This turning of the tide shows that it is only a matter of time before the remainder of the United States population is protected from exposure to secondhand smoke.
NPH: And are there any concerns that states with smoke-free laws could weaken or repeal them?
Mahoney: Any law that is passed has the threat of being repealed. Additionally, weak laws are still being passed in some jurisdictions — and some strong laws currently are facing the threat of being watered down — due to misperceptions by legislative bodies about the dangers of secondhand smoke; the desire of their constituents to breathe smoke-free air in their workplaces and in places they visit; or the potential effects on business revenues.
We've seen a couple of instances at the local level where smoke-free ordinances were repealed before they went into effect, and a few attempts at the state level to put repeal measures on the ballot. For example, in Campbell County, Ky., the ordinance was passed shortly after an election, but before the new county officials took office. The new county officials repealed the ordinance before it went into effect. And in South Dakota a smoke-free law was scheduled to go into effect in 2009, but implementation was put on hold after opponents put a repeal measure on the ballot. In November 2010, the citizens of South Dakota voted against the repeal attempt and decided to keep the smoke-free law. These situations are rare. It is more typical to see attempts to reopen smoke-free laws to add language allowing smoking in certain types of venues.
NPH: What are the sorts of questions you’ve been fielding on smoke-free laws recently?
Mahoney: Just in the last two weeks, we've reviewed draft amendment language that is being considered by a state legislature and discussed the ramifications of those possible amendments with public health advocates; researched penalty provisions in a draft local ordinance, to see whether they are consistent with state law; and conducted research to help a governmental attorney prepare her brief in a court case where a bar owner is arguing that a smoke-free law should be overturned.
Earlier today, in our inaugural Idea Gallery Post, Matthew Myers, President of the Campaign for Tobacco-Free Kids, and Cheryl Healton, President & Chief Executive Officer of Legacy, shared their perspective on why Major League Baseball should ban smokeless tobacco. But they're not the only ones talking about this issue. Read on for other takes:
Bobby Valentine, a former major league player and manager of the New York Mets, wrote an op-ed in the New York Times entitled "Take the Dip Out of the Ball Game."
Everyone in baseball knows someone who chews — it’s estimated that a third of players use some form of smokeless tobacco. Even I chewed during games when I was really bored. For many of us, it is simply part of the sport. It wasn’t until I had chewed for years that I realized what a bad example I was setting and quit.
Sports writer Rob Neyer took a stance as well in this SBNation.com post.
I can't for the life of me understand why ballplayers aren't allowed to smoke tobacco in the ballpark, but are allowed to chew it.
And late today in a report from the Boston Globe, MLB Commissioner Bud Selig has indicated he personally believes that "smokeless tobacco should be banned at the Major League level, but that is a subject that we are required to bargain over with the Major League Players Association."
WEIGH IN: What are your thoughts on smokeless tobacco in MLB? Should professional athletes be held to a higher standard as role models?