Category Archives: Tobacco control
Cynthia Hallett, executive director of Americans for Nonsmokers’ Rights, will speak today about tobacco policies at a Public Health Law Conference session on innovative community policy. The other presenters include Aaron Wernham of the Health Impact Project and Marion Standish, director of community health at the California Endowment. NewPublicHealth caught up with Ms. Hallett before the session.
NewPublicHealth: What is the focus of the panel discussion you’re a part of?
Cynthia Hallett: We will be sharing some of our collective experiences on successful health policy efforts and some of the resources that would be available for others as they’re thinking about what kind of health policies they want to try to pursue at the community level.
NPH: What will you be presenting about tobacco?
Last month at the Association of State and Territorial Health Officials Annual Meeting (ASTHO), attendees focused during one session on the progress made in reducing tobacco death and disease—and the significant room for improvement, as tobacco remains the leading cause of preventable death in the United States.
We caught up with Lawrence Deyton, MSPH, MD, director of the Food and Drug Administration’s (FDA) Center for Tobacco Products at the ASTHO meeting to get his take on the value of tobacco control as a prevention strategy, as well as the role of state and local public health officials.
NewPublicHealth: What did you go to ASTHO to learn, and what did you share?
Dr. Deyton: State health officers are on the front lines of tobacco control. They see the impact in their communities. I went to the ASTHO meeting to both hear from them, and to explain where we are in tobacco regulation at the FDA and to invite the public health community to get more involved in the regulatory process by commenting.
The depth and breadth of my respect for the work state health officers do—and the budgets they have to do it with—is great. We’ll want to see comments from all stakeholders, including folks from ASTHO, on our proposed regulations, because public health officials all have a very important view we’ll want to hear about. They may have the data that could be important to support their recommendations.
NPH: What is the FDA Center for Tobacco Products doing to help prevent tobacco-related death in the U.S., and what do you want public health leaders to know about this work?
Public health experts hope high school juniors and seniors will add another question to their list as they begin to visit colleges this year: is the campus smoke free?
According to the Tobacco-Free College Campus Initiative—launched last month at the University of Michigan by the Department of Health and Human Services along with private, public and education partners—about 17 percent of colleges and universities in the United States already have tobacco-free (no form of tobacco allowed) or smoke-free (no cigarettes allowed) policies, and more schools are moving toward such policies.
Cynthia Hallett, executive director of Americans for Nonsmokers’ Rights in Berkeley, Calif., says the trend toward eliminating smoking on college campuses began in the early 2000s. Before then, says Hallett, skepticism over student and faculty interest may have kept the schools from initiating policies against smoking. “With so many campuses now [outlawing smoking] and the growing number of resources available, such as model policies and guidelines for implementation and enforcement, it is becoming much easier for colleges and universities to initiate smoke- and tobacco-free policies,” Hallett says.
Hallett says effective arguments to push colleges toward tobacco-free campuses include:
- Tobacco use initiation peaks from 18 to 25 years of age. College attendance could be a turning point in choosing not to use tobacco.
- According to a recent report from the U.S. Surgeon General, about 25 percent of full-time college students aged 18 to 22 years old were current smokers in 2010.
- The number of smokers who initiated smoking after age 18 increased from 600,000 in 2002 to 1 million in 2010.
- Progression from occasional to daily smoking almost always occurs by age 26, and curbing tobacco influence on campuses could prevent a new cohort of lifetime smokers.
Recent campus initiatives to help students stop or never start smoking include:
- The University of Kentucky has an aggressive tobacco-free policy, which was implemented in 2009. Current efforts focus on educating new students about the policy each year and using innovative approaches to smoking cessation including mobile apps. The university also has faculty and students who are part of the Tobacco-Free Take Action volunteer group, who approach smokers and request they put out their cigarette, and also offer resources to help the smoker quit.
- Harrisburg University of Science and Technology in Pennsylvania, only seven years old, has always been smoke free and its age gives it an edge over many other universities in that respect, according to a university spokesman.
- City Colleges of Chicago, which has 120,000 students, implemented a 100-percent tobacco-free policy across its seven campuses last month. The policy includes offering students a smoking cessation program called “Courage to Quit.” The college system conducted a survey that found that 85 percent of students, faculty and staff respondents believe a tobacco-free policy would improve health for staff and students. The policy is the first component in City Colleges’ overall Healthy Campus initiative, which will also include healthy and affordable food choices, green initiatives and healthy activities.
- In January 2012, University of California President Mark Yudof announced that all 10 University of California campuses would become smoke-free as of January 2014. University Student Health Services offers an individual tobacco cessation program that helps students identify triggers, reasons for quitting, and barriers to quitting as well as a variety of quitting techniques.
>>Bonus Link: Americans for Nonsmokers’ Rights maintains a list of colleges and universities with smoke-free policies.
New York’s high cigarette tax—the highest in the country, at $4.35 per pack—has helped the state cut smoking levels dramatically for both adults and high school students, according to a new study in PLoS One.
The state’s rate of adult smoking dropped by 28 percent from 2003 to 2010, while the national rate for the same period dropped only 11 percent. The rate for New York high school students dropped 38 percent from 2003 to 2011, compared to a national drop of 17 percent. There are approximately 664,000 adult smokers in New York.
While a clear contributor, a high cigarette tax is just one of the tactics that’s helped improve the state’s health, according to the Campaign for Tobacco-Free Kids. New York also has a comprehensive smoke-free air law, as well as prevention and cessation programs. Overall, these public health strategies have helped prevent more than 300,000 kids from smoking and saved approximately $11.6 billion in health care costs.
Despite the clear public health successes, Tobacco-Free Kids says more still needs to be done to help low-income New Yorkers quit smoking. While the study determined their smoking rate is also well below the national rate, 24.3 percent of New Yorkers earning less than $30,000 annually are smokers.
>> Read more on the study from the Campaign for Tobacco-Free Kids.
>> Read more on how tobacco taxes can help cut health care costs.
The U.S. Food and Drug Administration has announced that it will require tobacco companies to report on a range of toxic chemical ingredients, as well as back up any claims for "safer" tobacco products.
Both actions will have a public comment period, ending June 4, 2012, before the rules become final.
Under the proposed regulations, tobacco companies will be required to report quantities of 20 different ingredients associated with cancer, lung disease and other health problems on consumer-friendly packaging by the end of the year, and the agency plans to make the information available to the public in a consumer-friendly format by April 2013.
Tobacco manufacturers will also have to substantiate claims if they want to market a tobacco product as "less risky" to health.
>>Read a statement from the Campaign for Tobacco-Free Kids on the new rules.
>>Read more about modified risk tobacco products.
>>Read more about potentially harmful chemicals in tobacco products.
Can fear of the ill effects of smoking push people to break their cigarette addiction? That’s what the Centers for Disease Control and Prevention (CDC) is banking on with its first ever national paid media campaign, “Tips From Former Smokers,” which shows smokers who quit, but not before losing a great deal, including legs, fingers, a larynx and the opportunity to shoot hoops with their kids.
>>Read an UPDATE on the impact of the Tips From Former Smokers campaign in a dramatic uptick in calls to 1-800-QUIT-NOW.
The idea behind the new campaign is that the danger of smoking is usually talked about in terms of deaths of thousands or more. The new ads, according to the CDC, provide a perspective on real people who used to smoke and became ill as a result. Most of the people in the ads—none are actors—were diagnosed with smoking-related illnesses in their 30s and 40s; one was only 18.
The CDC is also counting on the campaign to counter promotion efforts by cigarette companies. “The tobacco industry spends $10.5 million a year—more than one million dollars every hour—to entice kids, keep smokers hooked and glamorize their deadly and addictive products,” says Matthew L. Myers, president of the Campaign for Tobacco-Free Kids. “The CDC’s campaign will tell the harsh truth about how devastating and unglamorous cigarette smoking truly is.”
What if kids and teens never started smoking? They’d likely never start as adults and be extraordinarily less likely to die of lung cancer, heart disease, stroke and other conditions associated with smoking. That’s the gist of a report released today by the Surgeon General, Preventing Tobacco Use Among Youth and Young Adults. It’s the 31st such report by a U.S. Surgeon General, and the first since 1994 to give detailed information on smoking—and the related health consequences—by children and young adults ages 12 to 25.
“We have made progress in reducing tobacco use among youth; however, far too many young people are still using tobacco,” says Surgeon General Regina Benjamin, MD. “Today, more than 600,000 middle school students and 3 million high school students smoke cigarettes. Rates of decline for cigarette smoking have slowed in the last decade and rates of decline for smokeless tobacco use have stalled completely.”
The key driver for increases, according to the report, is ubiquitous marketing by tobacco companies, specifically targeted at children and young adults. “Messages and images that make tobacco use appealing to [young adults] are everywhere,” says Dr. Benjamin.
A new report, Preventing Tobacco Use Among Youth and Young Adults, released this morning, is the 31st report from the Office of the Surgeon General focused on tobacco use in the U.S. NewPublichHealth talked about the new report with Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids.
>>NewPublicHealth was on the ground as the report was released. Read more on the new Surgeon General's report on youth tobacco use.
NewPublicHealth: What does the Surgeon General’s report tell us about progress in the fight to reduce youth smoking?
Danny McGoldrick: Well, unfortunately, it tells us that we’re not making nearly the progress that we need to. While smoking rates declined dramatically between 1997 and 2003—by almost 40 percent—between 2003 and 2009 they declined by just over 10 percent, and we still have almost 4,000 kids trying their first cigarette every day. So while we’ve made some progress, we’re not making nearly as much as we need to.
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?