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Cigarette smoking costs weigh heavily on the healthcare system

Reuters via Fox News

Of every $10 spent on healthcare in the U.S., almost 90 cents is due to smoking, a new analysis says.

Using recent health and medical spending surveys, researchers calculated that 8.7 percent of all healthcare spending, or $170 billion a year, is for illness caused by tobacco smoke, and public programs like Medicare and Medicaid paid for most of these costs.

“Fifty years after the first Surgeon General’s report, tobacco use remains the nation’s leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence,” said Xin Xu from the Centers for Disease Control and Prevention (CDC), who led the study.

Over 18 percent of U.S. adults smoke cigarettes and about one in five deaths are caused by smoking, according to the CDC.

Xu and colleagues linked data on healthcare use and costs from the 2006-2010 Medical Expenditure Panel Survey to the 2004-2009 National Health Interview Survey for a nationally-representative picture of smoking behavior and costs.

Out of more than 40,000 adults, 21.5 percent were current smokers, 22.6 percent were former smokers and 56 percent had never smoked. The researchers used prior data on smoking-related disease and deaths to calculate the proportion of healthcare spending by each person that could be attributed to smoking.

They also adjusted their figures for factors like excess drinking, obesity and socioeconomic status, and calculated the proportion of spending by payer.

In that analysis, 9.6 percent of Medicare spending, 15.2 percent of Medicaid spending and 32.8 percent of other government healthcare spending by sources such as the Veterans Affairs department, Tricare and the Indian Health Service, were attributable to smoking.

Of the $170 billion spent on smoking-related healthcare, more than 60 percent was paid by government sources, they wrote in the American Journal of Preventive Medicine.

Smoking-related healthcare costs affect most types of medical care, said Kenneth Warner at the University of Michigan School of Public Health. “Smoking infiltrates the entire body, through the blood stream, and causes disease in many of the body’s organs,” he told Reuters Health in an email.

Along with lung and heart problems, smoking can cause eye disease, skin problems and many cancers including pancreatic and bladder cancer, noted Warner, who was not involved in the new analysis.

“This study shows that, in addition to the human misery it inflicts, (smoking) imposes a substantial burden on the nation’s health care institutions, especially those funded by the public’s tax dollars,” he said.

The true cost of tobacco use may be even higher, Xu said. His study didn’t include medical costs linked to other tobacco products like cigars and chewing tobacco.

In 1964, the Surgeon General gave the first report on smoking and health. Since then, there have been many anti-tobacco efforts, ranging from banning tobacco in workplaces to quit-smoking help lines.

Mass media campaigns can be effective in reducing cigarette use, Xu said. In particular, the CDC’s current “Tips from Former Smokers” campaign is credited with an estimated 100,000 smokers quitting permanently.

The combination of research, publicity, policy and treatment has prevented eight million premature deaths in the U.S. since 1964, according to a 2014 Surgeon General’s report. Based on research published this year by Warner and his colleagues, he said, “Almost a third of the increase in adult life expectancy since 1964 is attributable to tobacco control.”

“Smoking kills about 480,000 Americans each year and remains the leading cause of preventable death and disease in the United States. No matter what age, it is never too late to quit,” Xu said.

http://www.foxnews.com/health/2014/12/22/cigarette-smoking-costs-weigh-heavily-on-healthcare-system/

USA Today – Our View: E-cigarettes cloud progress on teen smoking

USA Today Editorial Board

E-cigarettes, once seen as a harmless alternative to tobacco smoking, are beginning to look more like a new gateway to addiction.

This year, for the first time, more teens used electronic cigarettes than traditional ones: 17% of high school seniors used the devices, vs. 14% who smoked cigarettes. Kids in eighth and 10th grades favored them 2-to-1 over traditional smokes, according to an eye-opening University of Michigan survey released Tuesday.

In one sense, there is good news. Teen smoking hit a record low last year after a steady decline since the late 1990s, leaving fewer teens vulnerable to the risk of cancer, heart disease and emphysema that comes with tobacco use. But e-cigarettes are a troubling alternative.

Just as scientists didn’t grasp the danger of tobacco when the nation was becoming addicted, they don’t fully understand the risks posed by e-cigarettes now.

One is obvious: addiction.

E-cigs, battery-powered nicotine inhalers that produce a vapor cloud, could be every bit as addictive as tobacco. With sales skyrocketing to $754 million, 30 times five-year-ago levels, and tobacco giants Altria and Reynolds entering the business, millions of people are getting hooked.

This is particularly a problem during the teen years because that is when nearly all smokers pick up their habit.

For manufacturers, the logic is inescapable: Addict a teenager and you could have a customer for life; miss the moment and you have no customer at all. So in ways subtle and not so subtle, e-cigarette makers have applied Big Tobacco’s advertising and marketing practices.

One prominent tactic is their use of celebrities — including former Playboy centerfold Jenny McCarthy, singer Courtney Love, actor Stephen Dorff and teen heartthrob Robert Pattinson of Twilight fame — to make “vaping” look sexy and rebellious.

No one knows how dangerous this is because with federal oversight missing, no one knows exactly what’s in the devices, some made in China. A Japanese study found hazardous substances in the vapor at higher levels than in cigarette smoke.

There are obvious ways to address the problem, starting with attention from the newly confirmed surgeon general, Vivek Murthy, and analysis by the Food and Drug Administration of e-cigarette content. Both worked with tobacco but could be thwarted by a Congress rigidly opposed to regulation.

Alternatively, states could fill the breach. Nearly a dozen still allow e-cigarette sales to minors when they plainly should not. They could also use the 1998 tobacco settlement negotiated with the industry long before e-cigarettes existed. The accord defines covered products in a way that includes e-cigarettes, because nicotine is derived from tobacco.

By invoking the settlement, state attorneys general would be able to clamp down on marketing that’s targeted at youth, including certain celebrity promotions, concert sponsorships and access to free samples.

After a decades-long battle against youth smoking, it would be tragic to see a new generation of teens hooked on a different but potentially dangerous substitute.

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/2014/12/16/e-cigarettes-teen-smoking-university-of-michigan-editorials-debates/20485297/

Taxes on cigarettes help reduce number of smokers

By Matthew L. Myers, president of the Campaign for Tobacco-Free Kids
The Hill
Science and experience have demonstrated conclusively that cigarette tax increases are highly effective at reducing smoking, especially among kids. Thus, the conclusions in a Gallup poll The Hill recently wrote about (“High cigarette prices aren’t stopping smokers,” July 18) are inconsistent with what happens in the real world every time cigarette taxes are increased.

The most recent surgeon general’s report on tobacco concludes that “raising prices on cigarettes is one of the most effective tobacco control interventions.” The report called for additional cigarette tax increases “to prevent youth from starting smoking and encouraging smokers to quit.” The Congressional Budget Office has also reviewed the evidence and concluded that an increase in the federal cigarette tax would significantly reduce the number of adult smokers.

In the year after a 62-cent increase in the federal cigarette tax in 2009, cigarette sales declined by a historic 11.1 percent. Adult and youth smoking rates also declined. “This single legislative act — increasing the price of cigarettes — is projected to have reduced the number of middle and high school students who smoke by over 220,000 and the number using smokeless tobacco products by over 135,000,” the surgeon general’s report noted.

Even the poll The Hill wrote about reported that more than a quarter of adult smokers surveyed said they smoked less due to tax increases. As there are 42 million smokers in the United States, this translates into millions of smokers whose behavior is affected by cigarette tax increases. And this survey of current smokers would not have included former smokers who have already quit due to increased tobacco taxes.
Tobacco tax increases don’t have to cause every smoker or even a majority of smokers to quit or cut back in order to have a big impact on public health. As the scientific evidence and even the new Gallup poll show, such tax increases will impact the behavior of large numbers of smokers, saving many from a premature death.
From Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, Washington, D.C.

Read more: http://thehill.com/opinion/letters/213571-taxes-on-cigarettes-help-reduce-number-of-smokers#ixzz38sdK91IE
Follow us: @thehill on Twitter | TheHill on Facebook

CTFK: President's Plan to Expand Early Education with a Tobacco Tax Will Protect Kids and Save Lives

Statement of Susan M. Liss, Executive Director, Campaign for Tobacco-Free Kids
WASHINGTON, DC – President Obama today again called for bold action to protect our children from tobacco addiction and save lives, urging Congress to increase the federal cigarette tax by 94 cents per pack and similarly increase taxes on other tobacco products. The evidence is clear that increasing the tobacco tax is one of the most effective ways to reduce smoking and other tobacco use, especially among kids, as this year’s Surgeon General’s Report on Smoking and Health just reaffirmed.
This proposal, part of the President’s FY 2015 budget, would do more to reduce tobacco use among kids than any other single action the federal government can take. The tobacco tax increase would also raise $78 billion over 10 years to fund early childhood education initiatives proposed by the President, according to the Office of Management and Budget. Congress should embrace this proposal enthusiastically – it would provide millions of kids with a strong start in life, while helping them live longer, healthier lives free of tobacco addiction.
The need for Congress to increase the tobacco tax is more urgent than ever.  While our nation has cut smoking rates by more than half since the first Surgeon General’s report was issued 50 years ago in 1964, the latest Surgeon General’s report found that smoking is even more hazardous and takes an even greater toll on our nation’s health than previously thought.  The report found that smoking annually kills 480,000 Americans – causing one in every five deaths – and costs the nation more than $289 billion in health care bills and other economic losses.  Tobacco use remains the number one cause of preventable death in our country.
The report also underscored that tobacco use is a pediatric epidemic – 90 percent of adult smokers began at or before age 18, and 5.6 million kids alive today will die prematurely from smoking-caused disease unless current trends are reversed.  The President’s proposal represents exactly the kind of action needed to accelerate progress against tobacco and ultimately end the tobacco epidemic for good.
Among its key action steps, the new Surgeon General’s report calls for “raising the average excise cigarette taxes to prevent youth from starting smoking and encouraging smokers to quit.”
“Raising prices on cigarettes is one of the most effective tobacco control interventions,” the report concludes. “The evidence is sufficient to conclude that increases in the prices of tobacco products, including those resulting from excise tax increases, prevent initiation of tobacco use, promote cessation, and reduce the prevalence and intensity of tobacco use among youth and adults.”
Even tobacco companies admit in their own documents that tobacco tax increases reduce youth smoking.  Economic research has found that every 10 percent increase in the price of cigarettes reduces youth smoking by about seven percent and overall cigarette consumption by three to five percent.
The health and economic benefits of a federal tobacco tax increase were confirmed in a 2012 report by the highly respected Congressional Budget Office. The CBO found that a 50-cent increase in the federal tobacco tax would raise substantial new revenue while prompting nearly 1.4 million adult smokers to quit by 2021, saving tens of thousands of lives and reducing health care costs, including for the Medicaid program. Based on the CBO’s statement that a $1 tax increase would roughly double those benefits, we estimate that a 94-cent cigarette tax increase would prompt 2.6 million adult smokers to quit and save 18,000 lives over 10 years.
We estimate that a 94-cent increase in the federal cigarette tax would also:
·       Prevent 1.3 million kids from becoming addicted adult smokers;
·       Prevent 493,400 premature deaths from these reductions in youth smoking alone, and
·       Save $55 billion in future health care costs from reductions in youth and adult smoking.
The increased taxes on other tobacco products would have additional health benefits, preventing kids from using harmful and addictive products such as cheap, sweet cigars and smokeless tobacco.
Furthermore, national and state polls consistently show strong public support for substantial increases in tobacco taxes, with most polls showing voters favoring tobacco tax increases by more than a two-to-one margin. Polls consistently have found that large majorities of Democrats, Republicans and Independents and voters from a broad range of demographic and ethnic groups all support tobacco tax increases – as do significant numbers of smokers.
In short, a significant tobacco tax increase is a win-win-win for the country – a health win that will reduce tobacco use and save lives, a financial win that will raise revenue to fund an important initiative and reduce tobacco-related health care costs, and a political win that is popular with voters.

E-Cigarette Makers Give Public the Finger

Rob Waters, Contributor, Forbes
With Sarah Mittermaier and Lily Swartz
In 1964, smoking was everywhere: on television, on airplanes, in workplaces and movie theatres, college campuses, doctors’ offices, restaurants and bars. In the 50 years since the first Surgeon General’s report on smoking and health was released, smoking has gradually faded to the margins of public life. TheMarlboro man was bounced from the airwaves, comprehensive smoking bans were passed in hundreds of cities and 28 states, and smoking rates were cut almost in half. The struggle to protect the public’s health is far from over—and shocking disparities in tobacco use and exposure to tobacco marketing remain—but we’re now reaping some rewards, with eight million lives saved over the past half-century.
But now a new threat is emerging. The use of e-cigarettes is rising rapidly, with teenagers a key target of marketing efforts. “Vaping” is making smoking acceptable—even cool—once again as the tobacco industry returns to its old ways, putting e-cigarette commercials back on the airwaves for the first time since the 1970s.

Right now, e-cigarettes exist in what tobacco control researcher Stanton Glanz calls a regulatory “Wild West,” with no federal regulation of the manufacturing, marketing and sales of these products. This regulatory vacuum threatens to undo the hard-won victories of the past 50 years in tobacco control.
E-cigarette companies are taking a page right out of Big Tobacco’s old-school playbook: marketing their products with sex appeal, celebrity endorsements, even cartoons. The companies argue that “vaping” is safer than traditional smoking and that may or may not be true—there are far too few studies to back up that claim or refute it. But it’s also a smokescreen.
The tobacco industry is out to hook kids, and it’s working. E-cigarettes come in an array of kid-friendly flavors, from“Cherry Crush” to “Coca Cola.” And unlike conventional cigarettes, e-cigarettes can legally be sold to kids in most US states. Data released last year by the Centers for Disease Control and Prevention showed that e-cigarette use more than doubled among middle and high school students in the previous year. For 20 percent of the middle schoolers, e-cigarettes were their first experience with smoking, raising concerns that e-cigarettes may act as a gateway to the use of other tobacco products.
E-cigarettes also threaten to reintroduce smoking to workplaces, restaurants, bars and other public spaces where hard-fought public health campaigns have succeeded in banning cigarettes. These policies have changed our communities from the ground up, creating new expectations and norms around smoking. The science is still out on whether e-cigarettes threaten non-smokers with toxic exposure, but their use in public legitimizes their use, making them seem acceptable, even Golden Globes-glamorous. We can’t let e-cigarettes undo the hard work tobacco control advocates have achieved over the past 50 years.
Some cities and states are pushing back against e-cigarettes, taking steps to regulate the sale and public use of e-cigarettes. Over the past few months, New York and Chicago city councils voted to regulate e-cigarettes as tobacco products, extending existing smoking bans to cover vaping. The Los Angeles City Council voted unanimously to regulate the sales of e-cigarettes. Boston has banned e-cigarette smoking in workplaces. States such as Utah, New Jersey, and North Dakota ban the use of e-cigarettes in indoor public spaces.
These local and state efforts should be followed—and strengthened—by federal action. Attorneys general from 40 states have called on the Food and Drug Administration to regulate e-cigarettes as tobacco products, a move that would give the FDA the power to impose age restrictions and limit marketing of e-cigarettes. Proposed rules drafted by the agency have not yet been released publicly.
We can’t wait years for scientists to conduct new studies on the health risks of vaping before we take action. We know better than to trust the tobacco industry’s health claims about their products—or to trust the industry with our children’s future. The time for action is now. To paraphrase one anti-cigarette commercial in California: “Some people will say anything to sell (e-) cigarettes.”
http://www.forbes.com/sites/robwaters/2014/01/27/e-cigarette-makers-give-public-the-finger/

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

Cigarette ads from the 20th century

Fifty years ago, on January 11, 1964, U.S. Surgeon General Luther Terry issued a landmark report on the negative health risks caused by smoking tobacco.
To view cigarette ads from the 20th century, click on the link below:
http://www.cnn.com/2014/01/10/health/gallery/historic-cigarette-ads/

Tobacco companies will say they lied, via advertising

Liz Szabo, USA TODAY

The nation’s tobacco companies and the Justice Department have reached an agreement on publishing corrective statements that say the companies lied about the dangers of smoking.

Tobacco companies are a step closer today to putting out “corrective statements” about their history of defrauding the American public by hiding the dangers of smoking, according to an agreement reached Friday with the Department of Justice.
The agreement was reached the day before the 50th anniversary of the Surgeon General warning on tobacco and lung cancer, released Jan. 11, 1964.
The long-awaited advertising campaign was ordered in 2006 by U.S. District Court Judge Gladys Kessler, who found tobacco companies guilty of violating civil racketeering laws and lying to the public about the dangers of smoking and their marketing to children. Kessler must approve the agreement.
That verdict was the culmination of a lawsuit brought by the Department of Justice in 1999, when it sued tobacco companies under the Racketeer Influenced and Corrupt Organizations Act (RICO).
Kessler made five key “findings of fact,” detailing how tobacco makers defrauded the public, including lying about the health damage caused by smoking; the addictive nature of nicotine; their marketing and promotion of “low tar” and “light” cigarettes as healthier when there are no clear health benefits; designing tobacco products to be as addictive as possible; and engaging in a massive effort to hide the dangers of secondhand smoke. The corrective statements must address each of these five areas.
Kessler found that the RICO statute did not allow for monetary damages. But she did order tobacco companies to make “corrective statements” about their history of fraud.
According to the agreement, the campaign will include online and full-page print ads in the Sunday editions of the top 35 newspapers in the country, including USA TODAY, as well as prime-time TV spots on the three major networks for one year. The corrective statements also must be attached to packages of cigarettes in what marketers call an “outsert.”
Spokesmen for the leading tobacco companies — Philip Morris USA and RJ Reynolds Tobacco — declined to comment.
The U.S. Court of Appeals for the D.C. Circuit has rejected two industry appeals. Tobacco companies are still suing over Kessler’s order to include the corrective statements in “point of sale” displays at retail stores.
In a statement, leading anti-smoking groups said, “Tobacco companies have filed time-consuming appeals at every stage . . . We urge them to end their delay tactics and finally tell the truth.” The statement was signed by the Tobacco-Free Kids Action Fund, the American Cancer Society, the American Heart Association, the American Lung Association, Americans for Nonsmokers’ Rights and the National African-American Tobacco Prevention Network. The groups joined the case as intervenors in 2005.
The corrective statements “are necessary reminders that tobacco’s devastating toll over the past 50-plus years is no accident,” the group statement says. “It stems directly from the tobacco industry’s deceptive and even illegal practices.”
In her 2006 verdict, Kessler described the tobacco industry as one that “survives, and profits, from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year, an immeasurable amount of human suffering and economic loss, and a profound burden on our national health care system. . . (Tobacco companies) have consistently, repeatedly and with enormous skill and sophistication, denied these facts to the public.”
http://www.usatoday.com/story/news/nation/2014/01/10/tobacco-corrective-statements/4409501/

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.
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http://www.washingtonpost.com/opinions/the-war-on-smoking-is-working–and-should-continue/2014/01/10/7af7d9e4-797a-11e3-b1c5-739e63e9c9a7_story.html