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Kids who use snus before age 16 more likely to become smokers

BY SHEREEN JEGTVIG
(Reuters Health) – Norwegians who started using snus before age 16 were more likely to become cigarette smokers than those who started using snus later in life, according to a new study.
Snus is moist smokeless tobacco developed in Sweden. It’s contained in a small pouch, and unlike regular chewing tobacco, it doesn’t make the user spit.
Research suggests snus has lower levels of chemicals called nitrosamines than cigarettes and may be less harmful.
In Norway, snus has become a smoking cessation aid and most older snus users are former smokers.
But snus is also becoming increasingly popular among young Norwegian adults, many of whom have not smoked cigarettes. And although research is divided, the current thinking is that snus use reduces the likelihood of taking up smoking.
The authors of the new study wanted to know more about when people start using snus, to see if that ties into whether they also begin smoking cigarettes.
“I already knew about the research investigating associations between snus use and later smoking, but discovered that snus debut age had not been mentioned in that research,” Ingeborg Lund told Reuters Health in an email.
Lund is a researcher with the Norwegian Institute for Alcohol and Drug Research – SIRUS, in Oslo. She and her colleague Janne Scheffels published their study in Nicotine andTobacco Research.
The researchers analyzed surveys of Norwegian teenagers and adults conducted from 2005 to 2011.
Out of 8,313 people, 409 were long-term snus users who had started using snus before cigarettes or never used cigarettes. Of the snus users, 30 percent were long-term smokers.
Just over one third of the snus users started using snus before age 16. The researchers discovered those participants had two to three times the odds of becoming lifetime smokers, compared to people who began using snus after age 16.
They also found that early snus users had about the same rate of cigarette smoking as non-snus users. About 23 percent of early snus users were current smokers at the time of the survey, compared to only six percent of people who started using snus when they were older.
“Snus use seems to protect against smoking if the snus debut does not happen too early during adolescence,” Lund said.
She said it’s particularly important to keep teenagers tobacco-free until they are at least 16 years old.
“At younger ages, even if they start with a low risk product such as snus, there is a high risk that they will switch to – or add – other high-risk products, such as cigarettes,” she said. “This risk is reduced when they grow older.”
Since snus use is much less common in other countries, Lund said she doesn’t know if these results can be generalized outside of Norway and Sweden.
Lucy Popova, from the Center for Tobacco Control Research and Education at the University of California, San Francisco, told Reuters Health the new study was “interesting.” She was not involved in the research.
“Earlier initiation of snus basically makes it a gateway to tobacco use, to cigarette use in the future,” she said.
Popova explained that traditional Swedish snus is less dangerous than cigarettes.
“But it’s not harm-free, and (what) is really bad is when people start using both products because of increased rates of cardiovascular disease, pancreatic cancers and other problems,” she said.
Snus is fairly new to the U.S., and Popova said the version made in the U.S. isn’t like the traditional Swedish product.
“A research study found that it’s different from the traditional low-nitrosamine snus in Sweden – it’s not necessarily going to be as low-harm,” she said.
Popova is concerned with heavy promotion for smokeless tobacco products like snus.
“There’s been a lot of studies showing that more advertisement for tobacco products makes it more likely that children will use tobacco products,” she said, “and it’s important to keep youth tobacco-free as long as possible.”
SOURCE: bit.ly/1dP5O2Q Nicotine and Tobacco Research, online February 5, 2014.
http://www.reuters.com/article/2014/02/17/us-kids-snus-idUSBREA1G16T20140217

FDA launching $115M multimedia education campaign showing at-risk youth 'real cost' of smoking

By MICHAEL FELBERBAUM  AP Tobacco Writer
WASHINGTON — The Food and Drug Administration is using ads depicting wrinkled skin on youthful faces and teenagers paying for cigarettes with their teeth in a campaign to show the nation’s young people the costs associated with smoking.
The federal agency said Tuesday it is launching a $115 million multimedia education campaign called “The Real Cost” that’s aimed at stopping teenagers from smoking and encouraging them to quit.
Advertisements will run in more than 200 markets throughout the U.S. for at least one year beginning Feb. 11. The campaign will include ads on TV stations such as MTV and print spots in magazines like Teen Vogue. It also will use social media.
“Our kids are the replacement customers for the addicted adult smokers who die or quit each day,” said Mitch Zeller, the director of the FDA’s Center for Tobacco Products. “And that’s why we think it’s so important to reach out to them — not to lecture them, not to throw statistics at them — but to reach them in a way that will get them to rethink their relationship with tobacco use.”
Zeller, who oversaw the anti-tobacco “Truth” campaign while working at the nonprofit American Legacy Foundation in the early 2000s, called the new campaign a “compelling, provocative and somewhat graphic way” of grabbing the attention of more than 10 million young people ages 12 to 17 who are open to, or are already experimenting with, cigarettes.
According to the FDA, nearly 90 percent of adult smokers started using cigarettes by age 18 and more than 700 kids under 18 become daily smokers each day. The agency aims to reduce the number of youth cigarette smokers by at least 300,000 within three years.
“While most teens understand the serious health risks associated with tobacco use, they often don’t believe the long-term consequences will ever apply to them,” said FDA Commissioner Margaret Hamburg. “We’ll highlight some of the real costs and health consequences associated with tobacco use by focusing on some of the things that really matter to teens — their outward appearance and having control and independence over their lives.”
Two of the TV ads show teens walking into a corner store to buy cigarettes. When the cashier tells them it’s going to cost them more than they have, the teens proceed to tear off a piece of their skin and use pliers to pull out a tooth in order to pay for their cigarettes. Other ads portray cigarettes as a man dressed in a dirty white shirt and khaki pants bullying teens and another shows teeth being destroyed by a ray gun shooting cigarettes.
The FDA is evaluating the impact of the campaign by following 8,000 people between the ages of 11 and 16 for two years to assess changes in tobacco-related knowledge, attitudes and behaviors.
The campaign announced Tuesday is the first in a series of campaigns to educate the public about the dangers of tobacco use.
In 2011, the FDA said it planned to spend up to $600 million over five years on the campaigns aimed at reducing death and disease caused by tobacco, which is responsible for about 480,000 deaths a year in the U.S. Future campaigns will target minority youth, lesbian, gay, bisexual and transgender youth and youth in rural areas.
Tobacco companies are footing the bill for the campaigns through fees charged by the FDA under a 2009 law that gave the agency authority over the tobacco industry.
 http://www.therepublic.com/view/story/e2170c9ad67b4bc08ab8228b121857ea/US–FDA-Tobacco-Campaign

Surgeon General Sets Tobacco End-Game as Smoking Persists

By Anna Edney, Bloomberg News
A half century after linking smoking to lung cancer, the U.S. is confronting stalled progress in kicking the habit of 42 million Americans with new evidence that many common ailments such as diabetes, arthritis and impotence can be tied to tobacco use.
Acting Surgeon General Boris Lushniak in a report today criticized the “fraudulent campaigns” by cigarette companies, weaknesses in regulation and a rebound in smoking depicted in Hollywood films. He said he’s considering greater restrictions on sales to achieve “a society free of tobacco-related death and disease.”
While a landmark 1964 report on smoking and lung cancer helped cut cigarette use by more than half to 18 percent of U.S. adults, the decline has slowed. Smoking remains the leading preventable cause of death, killing 480,000 people each year, and the U.S. may miss a 2020 goal of limiting to 12 percent the share of smoking adults, today’s report shows.
“Enough is enough,” Lushniak said repeatedly at a press conference in Washington where he presented the more than 900-page report. “It’s astonishing that so many years later we’re still making these findings.”
The report shows the U.S. must be more aggressive in promoting tobacco control than regulators have been, he said.
“What we really need to do is say ‘Now is the time,’” Len Lichtenfeld, deputy chief medical officer at the Atlanta-based American Cancer Society, said in a telephone interview.

Further Stalling

Maintaining the status quo on tobacco control will lead to further stalling in the declining rate of smoking, said Lushniak, whose job serves as the nation’s main public-health advocate. He placed part of the blame on tobacco companies.
“The tobacco epidemic was initiated and has been sustained by the aggressive strategies of the tobacco industry, which has deliberately misled the public on the risk of smoking cigarettes,” he said in the report.
Earlier this week, Altria Group Inc. (MO:US), Reynolds American Inc. (RAI:US)and other tobacco companies agreed with the U.S. on how they will publicize admissions that they deceived the American public on the dangers of smoking. Altria is the largest tobacco company in the U.S. and its Philip Morris unit makes the popular Marlboro brand of smokes.

Overwhelming Evidence

“Philip Morris USA agrees with the overwhelming medical and scientific consensus that cigarette smoking causes lung cancer, heart disease, emphysema and other serious diseases in smokers,” David Sutton, a spokesman for parent company Altria Group Inc., said in an e-mail.“ Smokers are far more likely to develop serious diseases, like lung cancer, than non-smokers. There is no safe cigarette.”
The report lists smoking as a cause of liver cancer and colorectal cancer, which is responsible for the second-largest number of cancer deaths each year. Cigarette use may cause breast cancer and women smokers’ chances of dying from lung cancer have caught up to men, the surgeon general said. Even secondhand smoke can now be linked to a higher risk of stroke, Lushniak said.
The first surgeon general report on tobacco’s ill effects was made in January 1964, when at least half of all men in the U.S. and almost 40 percent of women smoked. Congress later adopted an act that required warning labels about the health consequences of smoking and in 1970 it prohibited cigarette advertising on television and radio.

Extend Lifespans

Measures, such as city and state bans on smoking in workplaces, restaurants and bars, also have helped to prevent 8 million early deaths and extended lifespans by two decades. About 5.3 million men and 2.7 million women live longer thanks to tobacco control, according to one of six studies on the topic published last week in the Journal of the American Medical Association.
Advertising and promotional activities entice younger smokers and nicotine addiction keeps people smoking as they grow older. Portrayals of tobacco use in U.S. films rebounded in the past two years and the use of multiple tobacco products may increase initiation rates among teens and young adults, according to the report.
While the share of teens and young adults who smoke is down, the number of them who start to smoke has increased since 2002. In addition, the prevalence of U.S. students in middle and high school who used electronic cigarettes doubled in 2012, the Centers for Disease Control and Prevention said in a September report.
“There are a substantial number of diseases, not just cancer, but certain cardiovascular disease, stroke, respiratory disease, whether it’s chronic lung disease or asthma, the list goes on and on about how tobacco impacts this country,” Lichtenfeld said.

Erectile Dysfunction

Smokers also have as much as a 40 percent higher risk of developing Type 2 diabetes and the habit is attributable to erectile dysfunction and deadly ectopic pregnancies where the embryo implants in the Fallopian tube or elsewhere outside the uterus, according to the report. People exposed to second-hand smoke are as much as 30 percent more likely to have a stroke.
Women smokers were 2.7 times more likely to develop lung cancer in 1959, a number that jumped to 25.7 percent by 2010. Male smokers were 12.2 times more likely to get lung cancer in 1959 and now smokers of both genders carry almost an equal chance of being diagnosed with the disease.
In the last 50 years almost 25 trillion cigarettes have been consumed in the U.S. costing at least $130 billion a year for direct medical care and $150 billion annually in lost productivity from premature death, according to the surgeon general.

Kicking the Habit

The surgeon general recommended helping people kick the habit with more national media campaigns like the federally funded graphic advertisements that featured former smokers with missing limbs and holes in their throats. He also advocated consideration of additional cigarette taxes and legislation to extend smoke-free indoor protections.
Banning smoking “is a bigger societal issue,” Lushniak said at the press conference. “We need to have that discussion.”
The tobacco companies and the Justice Department resolved this week that “corrective statements” will appear in the print and online editions of newspapers and on television as well as on the companies’ websites. Expanded information on the adverse health effects of smoking will appear on cigarette packages, according to the agreement filed Jan. 10 in federal court in Washington.

Altria Support

“Moving forward, we believe FDA regulation, particularly as it applies to product innovation, has the potential to substantially reduce the harm caused by smoking,” Altria’s Sutton said. “We support extending its regulatory authority over all tobacco products, including those containing tobacco-derived nicotine such as e-cigarettes.”
The FDA regulates cigarettes and is poised to extend its oversight to their electronic counterparts.
While smoking substitutes such as e-cigarettes may help reduce tobacco use, more needs to be known about their health effects and how much they may help, the report said.
“However, the promotion of electronic cigarettes and other innovative tobacco products is much more likely to be beneficial in an environment where the appeal, accessibility, promotion, and use of cigarettes are being rapidly reduced,” Lushniak said.
http://www.businessweek.com/news/2014-01-17/surgeon-general-sets-tobacco-end-game-as-smoking-decline-stalls

The 50-year war on smoking

By The Times editorial board, Los Angeles Times
The 1964 U.S. Surgeon General’s report on smoking — the first official acknowledgment by the federal government that smoking kills — was an extraordinarily progressive document for its time. It swiftly led to a federal law that restricted tobacco advertising and required the now-familiar warning label on each pack of cigarettes.
Yet there was nothing truly surprising about the conclusion of the report. Throughout the 1950s, scientists had been discovering various ways in which smoking took a toll on people’s health. Britain issued its own report, with the same findings, two years before ours. Intense lobbying by the tobacco industry slowed the U.S. attack on smoking. And even when then-Surgeon General Luther Terry convened a panel before the report was issued to make sure its findings were unimpeachable, he felt compelled to allow tobacco companies to rule out any members of whom they disapproved.
Saturday marks the report’s 50th anniversary. The intervening decades have seen remarkable progress against smoking in the United States, despite the stubborn efforts of the tobacco industry, which lobbied, obfuscated and sometimes lied outright to the public about the dangers of its products. During those years, though, independent research tied smoking and secondhand smoke to an ever-wider range of ailments. According to the U.S. Centers for Disease Control and Prevention, smoking causes cancer of the lungs, larynx, bladder, bone marrow, blood, esophagus, kidneys and several other organs. It increases the risk of stroke, heart disease and cataracts. It can damage fetuses, weaken bones and harm teeth and gums. The list goes on.
The growing body of evidence bolstered important policies to combat tobacco use and the injury to nonsmokers barraged by the damaging effects of secondhand smoke. It can be hard for young Californians today to fathom that smoking was once practically ubiquitous throughout government buildings, restaurants and workplaces. In the 1970s, during hearings on legislation to curb smoking in public buildings, some legislators puffed away even as speakers described the asthma attacks they sometimes suffered from secondhand smoke. New restrictions helped smokers as well; if they could do without a cigarette for hours at a time at their jobs, many discovered, they could do without them entirely.
Limits on cigarette advertisements, rules that prevented sales to minors and new taxes on cigarettes helped bring smoking rates down.
In 1964, 42% of Americans smoked. Half the people on the panel that produced the surgeon general’s report smoked. Today, the U.S. smoking rate is 18%. Teen smoking rates fell to below 10% after the federal tax on cigarettes was increased by 62 cents a pack in 2009.
As smoking rates have declined, lung cancer rates have fallen as well. According to a report this week from the CDC, the rate among men ages 35 to 41 dropped by 6.5% per year from 2005 to 2009. One study just published in the Journal of the American Medical Assn. estimated that 8 million premature deaths from all smoking-related causes have been prevented since the surgeon general’s report was issued in 1964.
Despite the good news, smoking is still the No. 1 cause of preventable death in this country. Smoking-related disease costs $183 billion a year in medical expenses and lost productivity.
We know what works against this: research, education, limits on secondhand smoke and higher cigarette taxes. But the tactics of tobacco companies continue to hold the nation back.
Knowing how heedless of our well-being they have been all along, we should ignore their ads and their lobbyists and take the following steps:
• Raise tobacco taxes, preferably at the federal level to avoid black-market sales across state lines. According to a 2012 report by the U.S. Surgeon General, every 10% increase in the cost of smoking leads to a 4% drop in smoking rates.
President Obama has proposed increasing the federal excise tax by 94 cents a pack, nearly doubling it from the current $1.01, and using the resulting revenue stream — an estimated $78 billion over the next decade — to fund pre-kindergarten education. The tax is a good idea, but we have concerns about using the money for preschool. If smokers are paying the tax, the revenue ideally should go toward education, research, affordable cessation programs, enforcement of existing laws and healthcare costs related to tobacco use.
• Place increased emphasis on reducing teen smoking. If there’s one thing all Americans, including staunch defenders of the right to smoke, should agree on, it’s that minors should be protected from smoking. According to the American Lung Assn., more than two-thirds of adult smokers developed the habit as teenagers. Studies have shown that many retailers don’t check identification and sell even when the ID shows the buyer to be underage.
In addition, the U.S. Food and Drug Administration should immediately impose a ban on sales and marketing of e-cigarettes to minors, including Internet sales. E-cigarettes, which allow users to inhale nicotine-laced vapor rather than tobacco smoke, may turn out to be significantly more healthful than regular cigarettes, but studies are still underway about their long-term effects, and there’s no question that they encourage nicotine addiction. They have been heavily marketed to minors, who are allowed to buy them without restriction in most states. Further research is necessary as the e-cigarette market expands dramatically.
• Push for indoor-smoking restrictions in all states. It may surprise Californians, who now face smoking bans in parks, open eating areas and beaches, to learn that some states lack smoking bans even in workplaces, bars and restaurants. Kentucky, for example, restricts smoking only in government and university buildings.
Smoking is and should remain a personal choice among adults, but the nonsmokers around them have the right not to be sickened by the choices of others.
http://www.latimes.com/opinion/editorials/la-ed-smoking-50th-anniversary-of-surgeon-general–20140110,0,3302586.story#ixzz2q27cKUYc

The war on smoking is working — and should continue

By , Washington Post

FIFTY YEARS on, the war on smoking can look back and claim a huge victory. Nearly half of the country used to smoke. Now less than a fifth of the country does. Some say that public health advocates have done enough; let those who still choose to light up, disproportionately from poor and vulnerable communities, smoke away their lives in peace. We disagree. It’s time for more taxes, more regulation and more outreach.
“Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking outweighs all other factors; and the risk of developing lung cancer increases with the duration of smoking and number of cigarettes smoked per day, and diminishes by discontinuing smoking.”
Today, we know that smoking and secondhand smoke cause so many health problems across so much of the body that the benefits from the drop in use, accumulated across so many lives, are incalculable. Millions who quit or never started smoking breathe easier, suffer fewer strokes, get fewer cases of lung cancer, pass on fewer birth defects and take fewer sick days.
A new study in the Journal of the American Medical Association attempts at least to calculate the number of premature deaths prevented since 1964 by changing the public’s view of the habit. Based on the assumption that smoking patterns would have continued without a decades-long public health push, the researchers estimated that tobacco-control programs have saved 8 million lives in the past five decades. Should the country forgo the opportunity to save millions more?
Of course not. Plenty of sensible measures that stop short of banning cigarettes but effectively discourage their use are not consistently applied in the United States. The most obvious is taxing cigarettes. Rates vary drastically by state , leading to interstate smuggling. The federal government should raise its excise tax, bringing laggard states closer to those that do the right thing, reducing the opportunity for criminals and increasing incentives not to smoke. If Congress doesn’t act, individual states with low taxes, such as Virginia, should. Similarly, states and localities without strong indoor smoking restrictions should bring them in line with others’ stronger rules.
The Food and Drug Administration, meanwhile, has a range of authorities over tobacco products that it should exercise with ambition. Perhaps the most promising is the possibility that requiring tobacco companies to reduce the amount of nicotine in their products will usefully cut their addictive quality.
Consumer choice might help, too. Electronic cigarettes appear to offer the hopelessly addicted a safer alternative to combustible tobacco products, and smokers’ increasing use of these indicates significant demand for this sort of product. If federal regulation, public education and other efforts combine smartly with smokers’ desire to stop lighting up, e-cigarettes might be a useful tool to reduce harm rather than a gateway to a life of smoking.
Editorials represent the views of The Washington Post as an institution, as determined through debate among members of the editorial board. News reporters and editors never contribute to editorial board discussions, and editorial board members don’t have any role in news coverage.
http://www.washingtonpost.com/opinions/the-war-on-smoking-is-working–and-should-continue/2014/01/10/7af7d9e4-797a-11e3-b1c5-739e63e9c9a7_story.html

Deal reached on tobacco firm corrective statements

By MICHAEL FELBERBAUM, AP Tobacco Writer
RICHMOND, Va. (AP) — The nation’s tobacco companies and the federal government have reached an agreement on publishing corrective statements that say the companies lied about the dangers of smoking and requires them to disclose smoking’s health effects, including the death on average of 1,200 people a day.
The agreement filed Friday in U.S. District Court in Washington, D.C., follows a 2012 ruling ordering the industry to pay for corrective statements in various advertisements. The judge in the case ordered the parties to meet to discuss how to implement the statements, including whether they would be put in inserts with cigarette packs and on websites, TV and newspaper ads.
The court must still approve the agreement and the parties are discussing whether retailers will be required to post large displays with the industry’s admissions.
The corrective statements are part of a case the government brought in 1999 under the Racketeer Influenced and Corrupt Organizations. U.S. District Judge Gladys Kessler ruled in that case in 2006 that the nation’s largest cigarette makers concealed the dangers of smoking for decades. The companies involved in the case include Richmond, Va.-based Altria Group Inc., owner of the biggest U.S. tobacco company, Philip Morris USA; No. 2 cigarette maker, R.J. Reynolds Tobacco Co., owned by Winston-Salem, N.C.-based Reynolds American Inc.; and No. 3 cigarette maker Lorillard Inc., based in Greensboro, N.C.
Under the agreement with the Justice Department, each of the companies must publish full-page ads in the Sunday editions of 35 newspapers and on the newspapers’ websites, as well as air prime-time TV spots on CBS, ABC or NBC five times per week for a year. The companies also must publish the statements on their websites and affix them to a certain number of cigarette packs three times per year for two years.
Each corrective ad is to be prefaced by a statement that a federal court has concluded that the defendant tobacco companies “deliberately deceived the American public.” Among the required statements are that smoking kills more people than murder, AIDS, suicide, drugs, car crashes and alcohol combined, and that “secondhand smoke kills over 38,000 Americans a year.”
Tobacco companies had urged Kessler to reject the government’s proposed corrective statements; the companies called them “forced public confessions.” They also said the statements were designed to “shame and humiliate” them. They had argued for statements that include the health effects and addictive qualities of smoking.
A federal appeals court also rejected efforts by the tobacco companies to overrule Kessler’s ruling requiring corrective statements.
Representatives for Altria, R.J. Reynolds and Lorillard each declined to comment.
Several public health groups, including the American Cancer Society, American Heart Association and American Lung Association, intervened in the case. In a statement Friday, the groups said the corrective statements are “necessary reminders that tobacco’s devastating toll over the past 50-plus years is no accident. It stems directly from the tobacco industry’s deceptive and even illegal practices.”
The corrective statements include five categories: adverse health effects of smoking; addictiveness of smoking and nicotine; lack of significant health benefit from smoking cigarettes marked as “low tar,” ”light,” etc.; manipulation of cigarette design and composition to ensure optimum nicotine delivery; and adverse health effects of exposure to secondhand smoke.
Among the statements within those categories:
“Smoking kills, on average, 1,200 Americans. Every day.”
“Philip Morris USA, R.J. Reynolds Tobacco, Lorillard, and Altria intentionally designed cigarettes to make them more addictive.”
“When you smoke, the nicotine actually changes the brain — that’s why quitting is so hard.”
“All cigarettes cause cancer, lung disease, heart attacks, and premature disease, heart attacks, and premature death — lights, low tar, ultra lights, and naturals. There is no safe cigarette.”
“Secondhand smoke causes lung cancer and coronary heart disease in adults who do not smoke.”
“Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, severe asthma, and reduced lung function.”
“There is no safe level of exposure to secondhand smoke.”
http://www.seattlepi.com/news/article/Deal-reached-on-tobacco-firm-corrective-statements-5131393.php

War on smoking, at 50, turns to teens: Our view

The Editorial Board, USATODAY

Want kids to quit? Raise cigarette taxes. It works.

The war on smoking, now five decades old and counting, is one of the nation’s greatest public health success stories — but not for everyone.
As a whole, the country has made amazing progress. In 1964, four in ten adults in the U.S. smoked; today fewer than two in ten do. But some states — Kentucky, South Dakota and Alabama, to name just a few — seem to have missed the message that smoking is deadly.
Their failure is the greatest disappointment in an effort to save lives that was kick-started on Jan. 11, 1964, by the first Surgeon General’s Report on Smoking and Health. Its finding that smoking is a cause of lung cancer and other diseases was major news then. The hazards of smoking, long hidden by a duplicitous industry, were just starting to emerge.
The report led to cigarette warning labels, a ban on TV ads and eventually an anti-smoking movement that shifted the nation’s attitude on smoking. Then, smokers were cool. Today, many are outcasts, banished from restaurants, bars, public buildings and even their own workplaces. Millions of lives have been saved.
The formula for success is no longer guesswork: Adopt tough warning labels, air public service ads, fund smoking cessation programs and impose smoke-free laws. But the surest way to prevent smoking, particularly among price-sensitive teens, is to raise taxes. If you can stop them from smoking, you’ve won the war. Few people start smoking after turning 19.
Long before health advocates discovered this, the tobacco industry knew that high taxes kill smoking as surely as cigarettes kill smokers. “Of all the concerns … taxation … alarms us the most,” says an internal Philip Morris document, turned over in a gaggle of anti-smoking lawsuits in the 1990s.
The real-life evidence of taxing power is overwhelming, too. The 10 states with the lowest adult smoking rates slap an average tax of $2.42 on every pack — three times the average tax in the states with the highest smoking rates.
New York has the highest cigarette tax in the country, at $4.35 per pack, and just 12% of teens smoke — far below the national average of 18%. Compare that with Kentucky, where taxes are low (60 cents), smoking restrictions are weak and the teen smoking rate is double New York’s. Other low-tax states have similarly dismal records.
Foes of high tobacco taxes cling to the tired argument that they fall disproportionately on the poor. True, but so do the deadly effects of smoking — far worse than a tax. The effect of the taxes is amplified further when the revenue is used to fund initiatives that help smokers quit or persuade teens not to start.
Anti-smoking forces have plenty to celebrate this week, having helped avert 8 million premature deaths in the past 50 years. But as long as 3,000 adolescents and teens take their first puff each day, the war is not won.
USA TODAY’s editorial opinions are decided by its Editorial Board, separate from the news staff. Most editorials are coupled with an opposing view — a unique USA TODAY feature.
http://www.usatoday.com/story/opinion/2014/01/08/war-on-smoking-50th-anniversary-cigarette-tax-editorials-debates/4381299/

US is marking 50th anniversary of surgeon general report that turned the tide against smoking

Article by: MIKE STOBBE , Associated Press
ATLANTA — Fifty years ago, ashtrays seemed to be on every table and desk. Athletes and even Fred Flintstone endorsed cigarettes in TV commercials. Smoke hung in the air in restaurants, offices and airplane cabins. More than 42 percent of U.S. adults smoked, and there was a good chance your doctor was among them.
The turning point came on Jan. 11, 1964. It was on that Saturday morning that U.S. Surgeon General Luther Terry released an emphatic and authoritative report that said smoking causes illness and death — and the government should do something about it.
In the decades that followed, warning labels were put on cigarette packs, cigarette commercials were banned, taxes were raised and new restrictions were placed on where people could light up.
“It was the beginning,” said Kenneth Warner, a University of Michigan public health professor who is a leading authority on smoking and health.
It was not the end. While the U.S. smoking rate has fallen by more than half to 18 percent, that still translates to more than 43 million smokers. Smoking is still far and away the leading preventable cause of death in the U.S. Some experts predict large numbers of Americans will puff away for decades to come.
Nevertheless, the Terry report has been called one of the most important documents in U.S. public health history, and on its 50th anniversary, officials are not only rolling out new anti-smoking campaigns but reflecting on what the nation did right that day.
The report’s bottom-line message was hardly revolutionary. Since 1950, head-turning studies that found higher rates of lung cancer in heavy smokers had been appearing in medical journals. A widely read article in Reader’s Digest in 1952, “Cancer by the Carton,” contributed to the largest drop in cigarette consumption since the Depression. In 1954, the American Cancer Society announced that smokers had a higher cancer risk.
But the tobacco industry fought back. Manufacturers came out with cigarettes with filters that they claimed would trap toxins before they settled into smokers’ lungs. And in 1954, they placed a full-page ad in hundreds of newspapers in which they argued that research linking their products and cancer was inconclusive.
It was a brilliant counter-offensive that left physicians and the public unsure how dangerous smoking really was. Cigarette sales rebounded.
In 1957 and 1959, Surgeon General Leroy Burney issued statements that heavy smoking causes lung cancer. But they had little impact.
Amid pressure from health advocates, President John F. Kennedy’s surgeon general, Dr. Luther Terry, announced in 1962 that he was convening an expert panel to examine all the evidence and issue a comprehensive, debate-settling report. To ensure the panel was unimpeachable, he let the tobacco industry veto any proposed members it regarded as biased.
Surveys indicated a third to a half of all physicians smoked tobacco products at the time, and the committee reflected the culture: Half its 10 members were smokers, who puffed away during committee meetings. Terry himself was a cigarette smoker.
Dr. Eugene Guthrie, an assistant surgeon general, helped persuade Terry to kick the habit a few months before the press conference releasing the report.
“I told him, ‘You gotta quit that. I think you can get away with a pipe — if you don’t do it openly.’ He said, ‘You gotta be kidding!’ I said, ‘No, I’m not. It just wouldn’t do. If you smoke any cigarettes, you better do it in a closet,'” Guthrie recalled in a recent interview with The Associated Press.
The press conference was held on a Saturday partly out of concern about its effect on the stock market. About 200 reporters attended.
The committee said cigarette smoking clearly did cause lung cancer and was responsible for the nation’s escalating male cancer death rate. It also said there was no valid evidence filters were reducing the danger. The committee also said — more vaguely — that the government should address the problem.
“This was front-page news, and every American knew it,” said Robin Koval, president of Legacy, an anti-smoking organization.
Cigarette consumption dropped a whopping 15 percent over the next three months but then began to rebound. Health officials realized it would take more than one report.
In 1965, Congress required cigarette packs to carry warning labels. Two years later, the Federal Communications Commission ordered TV and radio stations to provide free air time for anti-smoking public service announcements. Cigarette commercials were banned in 1971.
Still, progress was slow. Warner recalled teaching at the University of Michigan in 1972, when nearly half the faculty members at the school of public health were smokers. He was one of them.
“I felt like a hypocrite and an idiot,” he said. But smoking was still the norm, and it was difficult to quit, he said.
The 1970s also saw the birth of a movement to protect nonsmokers from cigarette fumes, with no-smoking sections on airplanes, in restaurants and in other places. Those eventually gave way to complete smoking bans. Cigarette machines disappeared, cigarette taxes rose, and restrictions on the sale of cigarettes to minors got tougher.
Tobacco companies also came under increasing legal attack. In the biggest case of them all, more than 40 states brought lawsuits demanding compensation for the costs of treating smoking-related illnesses. Big Tobacco settled in 1998 by agreeing to pay about $200 billion and curtail marketing of cigarettes to youths.
In 1998, while the settlement was being completed, tobacco executives appeared before Congress and publicly acknowledged for the first time that their products can cause lung cancer and be addictive.
Experts agree the Terry report clearly triggered decades of changes that whittled the smoking rate down. But it was based on data that was already out there. Why, then, did it make such a difference?
For one thing, the drumbeat about the dangers of smoking was getting louder in 1964, experts said. But the way the committee was assembled and the carefully neutral manner in which it reached its conclusion were at least as important, said Dr. Tim McAfee, director of the Office on Smoking and Health at the Centers for Disease Control and Prevention.
At the same time, he and others said any celebration of the anniversary must be tempered by the size of the problem that still exists.
Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and 8.6 million live with a serious illness caused by smoking, according to the CDC.
Donald Shopland finds that depressing.
Fifty years ago, he was a 19-year-old who smoked two packs a day while working as a clerk for the surgeon general’s committee. He quit cigarettes right after the 1964 report came out, and went on to a long and distinguished public health career in which he wrote or edited scores of books and reports on smoking’s effects.
“We should be much further along than we are,” the Georgia retiree lamented.
http://www.startribune.com/lifestyle/health/238716101.html?page=all&prepage=1&c=y#continue

Triple tobacco taxes? Researchers say yes to save 200M lives

By Cheryl K. Chumley – The Washington Times
Tripling tobacco taxes would save 200 million smokers around the world from premature deaths over the course of the next century, researchers say.
That’s because the higher costs would make it nearly impossible for many to afford the habit and at the same time serve as a deterrent to youth from taking their first puffs, scientists said, AOL Money reported.
The scientists said they reviewed 63 different studies about the causes and effects of tobacco smoking around the world — and discovered a link between lower smoking statistics and higher priced product. Raising the price of cigarettes by 50 percent lowers the rate of smoking by about a fifth, the scientists found.
So now study authors suggest that prices of tobacco should be raised significantly, by boosting taxes of the product by three times the present amount.
“The two certainties in life are death and taxes,” said study co-author Professor Sir Richard Peto, from the nonprofit Cancer Research UK, in the AOL Money report. “We want higher tobacco taxes and fewer tobacco deaths. It would help children not to start, and it would help many adults to stop while there’s still time.”
They estimate the death rate could be cut by almost half if the tax rate increase is accepted.
“Globally, about half of all young men and one in 10 of all young women become smokers and, particularly in developing countries, relatively few quit,” Mr. Peto said, in AOL Money. “If they keep smoking, about half will be killed by it. But if they stop before 40, they’ll reduce their risk of dying form tobacco by 90 percent.”
The researchers say that in the European Union alone, 100,000 lives per year of those under the age of 70 could be saved by doubling the cost of cigarettes.
http://www.washingtontimes.com/news/2014/jan/2/triple-tobacco-taxes-researchers-say-save-lives/

Trebling [tripling] tobacco tax 'could prevent 200 million early deaths'

By: Kate Kelland, Reuters
LONDON (Reuters) – Trebling [tripling] tobacco tax globally would cut smoking by a third and prevent 200 million premature deaths this century from lung cancer and other diseases, researchers said on Wednesday.
In a review in the New England Journal of Medicine, scientists from the charity Cancer Research UK (CRUK) said hiking taxes by a large amount per cigarette would encourage people to quit smoking altogether rather than switch to cheaper brands, and help stop young people from taking up the habit.
As well as causing lung cancer, which is often fatal, smoking is the largest cause of premature death from chronic conditions like heart disease, stroke and high blood pressure.
Tobacco kills around 6 million people a year now, according to the World Health Organization (WHO), and that toll is expected to rise above 8 million a year by 2030 if nothing is done to curb smoking rates.
Richard Peto, an epidemiologist at CRUK who led the study, said aggressively increasing tobacco taxes would be especially effective in poorer and middle-income countries where the cheapest cigarettes are relatively affordable.
Of the 1.3 billion people around the world who smoke, most live in poorer countries where often governments have also not yet introduced smoke-free legislation.
But increasing tobacco tax would also be effective in richer countries, Peto said, citing evidence from France, which he said halved cigarette consumption from 1990 to 2005 by raising taxes well above inflation.
“The two certainties in life are death and taxes. We want higher tobacco taxes and fewer tobacco deaths,” he said in a statement. “It would help children not to start, and it would help many adults to stop while there’s still time.”
While smokers lose at least 10 years of life, quitting before age 40 avoids more than 90 percent of the increased health risk run by people who continue smoking. Stopping before age 30 avoids more than 97 percent of the risk.
Governments around the world have agreed to prioritize reducing premature deaths from cancer and other chronic diseases in the United Nations General Assembly and in the WHO’s World Health Assembly in 2013. They also agreed to a target of reducing smoking by a third by 2025.
The CRUK analysis found that doubling the price of cigarettes in the next decade through increased taxes would cut worldwide consumption by about a third by that target, and at the same time increase annual government revenues from tobacco by a third from around $300 billion to $400 billion.
This extra income, the researchers suggested, could be spent on boosting health care budgets.
Peto noted that the international tobacco industry makes about $50 billion in profits each year, saying this equated to “approximately $10,000 per death from smoking”.
“Worldwide, around half a billion children and adults under the age of 35 are already – or soon will be – smokers, and many will be hooked on tobacco for life. So there’s an urgent need for governments to find ways to stop people starting and to help smokers give up,” said Harpal Kumar, CRUK’s chief executive.
He said the study, which examined 63 research papers on the causes and consequences of tobacco use in many different countries, showed tobacco taxes are “a hugely powerful lever”.
They are also potentially a triple win, Kumar said, cutting the number of people who smoke and die from their addiction, reducing the health care burden and costs linked to smoking and at the same time increasing government income.
(Reporting by Kate Kelland; Editing by Janet Lawrence)
http://www.grandforksherald.com/event/article/id/281348/