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Fitful Progress in the Antismoking Wars

By THE EDITORIAL BOARD, New York Times
Fifty years ago this Saturday, on Jan. 11, 1964, a myth-shattering surgeon general’s report on smoking and health brushed aside years of obfuscation by tobacco companies and asserted, based on 7,000 scientific articles, that smoking caused lung cancer and was linked to other serious diseases. Those findings expanded as more data was gathered.
Research since then has shown that tobacco can cause or exacerbate a wide range of diseases, including heart disease, stroke, multiple kinds of cancer, chronic obstructive pulmonary disease, emphysema, asthma and diabetes, and can injure nonsmokers who breathe in the toxic fumes secondhand. The death toll from tobacco remains stubbornly high but can be driven down by using a range of new and proven tactics.
By some measures, the 50-year campaign to rein in tobacco use has been an enormous success. The percentage of American adults who smoke dropped from 42 percent in 1965 to 18 percent in 2012. A study published in the Journal of the American Medical Association this week estimated that tobacco control measures adopted since 1964 have saved eight million Americans from premature death and extended their lives by an average of almost 20 years.
Experts attribute the gains to vigorous campaigns to educate people about the dangers of smoking; increases in cigarette taxes; state and local laws that protect half the nation’s population from tobacco fumes in workplaces, bars and restaurants; restrictions on advertising; prohibition of sales to minors; and various prevention and cessation programs financed by states or private insurance.
Despite these gains, nearly 44 million American adults still smoke, more than 440,000 Americans die every year from smoking, and eight million Americans live with at least one serious chronic disease from smoking. Medical costs connected to smoking are nearly $96 billion a year, with an additional $97 billion lost in productivity because of illness.
On Wednesday, several health organizations, including the American Heart Association, the American Lung Association, the American Cancer Society, the American Academy of Pediatrics, and the Campaign for Tobacco-Free Kids called for a new national commitment to drive smoking among adults down to less than 10 percent over the next decade; protect all Americans from secondhand smoke within five years by having every state enact laws against smoking in all workplaces, bars and restaurants; and ultimately eliminate death and disease caused by tobacco.
It won’t be easy. The tobacco industry spends more than $8 billion a year to market cigarettes and other tobacco products in this country, with much of its marketing slyly aimed at young people.
The industry is also invading foreign markets, often in less developed countries, in an effort to make addicts of millions more customers to replace those in industrialized nations. Although smoking rates among adults around the globe have fallen sharply since 1980, the number of smokers has increased significantly along with population growth and will continue to increase as national incomes and populations rise. The United States government must help counter the tobacco industry’s efforts to spread its noxious products around the world.
http://www.nytimes.com/2014/01/10/opinion/fitful-progress-in-the-antismoking-wars.html?_r=0

Landmark Report Marks 50th Anniversary

ND Center for Tobacco Prevention & Control Policy
January 11 is the 50th anniversary of the landmark Surgeon General’s report that first linked smoking as a cause of lung cancer. North Dakota’s Center for Tobacco Prevention and Control Policy (the Center) and other tobacco prevention groups across the country are using the anniversary to note the important progress in tobacco prevention.
According to surgeongeneral.gov, the prevalence of smoking among U.S. adults has been reduced by 50 percent since the release of the first Surgeon General’s report on smoking and health in 1964. A new study published in the “Journal of the American Medical Association” claims that approximately 8 million lives have been saved by U.S. tobacco prevention measures. The same study also concludes tobacco control efforts have extended the average American life span by 19 to 20 years.
In North Dakota, voter initiatives are responsible for the state’s successful tobacco prevention efforts. In 2008, voters chose to fund a comprehensive tobacco prevention program. Then, in 2012, voters chose to implement a comprehensive smoke-free law, which took effect a year ago in December. These initiatives improve the public’s health by protecting people from secondhand smoke in all indoor workplaces, preventing youth from starting to use tobacco and helping tobacco users quit.
The comprehensive program has shown positive results across the state. North Dakota now has 131 school districts-representing 60 percent of the state’s K-12 students-that have implemented comprehensive tobacco-free policies. And, according to the 2013 Youth Risk Behavior Survey, high school smoking rates have dropped to 19 percent from 22.4 percent in 2009.
“We’ve made a lot of progress towards reducing the devastating toll tobacco use has on our state and across the country, but we still have more work to do,” said Jeanne Prom, executive director for the Center. “Tobacco companies spend billions each year marketing their deadly products to hook our youth to a life-time addiction to nicotine.”
Smoking kills 800 North Dakotans each year, and costs the state $247 million in healthcare and $192 million in lost productivity. Across the country, those numbers jump to 440,000 annual smoking-related deaths, $96 billion in healthcare costs and $97 billion in lost productivity. Tobacco prevention measures are essential in eliminating the harmful effects caused by the epidemic of tobacco use.
According to Prom, one of the most effective ways to keep kids from using tobacco and convince people to quit is to make tobacco less affordable by increasing the tobacco tax.
“North Dakota’s current tobacco tax is one of the lowest in the country at $0.44; it hasn’t increased since 1993,” said Prom. “Raising the tax from $0.44 to $2, a $1.56 increase per pack, would go a long way in reducing tobacco use in North Dakota.”
A fact sheet produced by the Campaign for Tobacco-Free Kids and the Cancer Action Network shows the positive impact a $1.56 tobacco tax increase would have in North Dakota. The higher tax would save approximately 5,400 lives that would otherwise have been lost to smoking-related causes. The youth smoking rate would decline by 24 percent, 9,900 kids in North Dakota would be kept from becoming addicted adult smokers and 8,200 current adult smokers would quit. Over the next five years, that amounts to about $7.3 million saved in healthcare costs.
“The health benefits of a higher tobacco tax are clear because higher taxes are proven to reduce tobacco use,” Prom said. “Ultimately, it’s about saving lives and improving health for the people of North Dakota.”
http://www.breathend.com/news/detail.asp?newsID=312

Leading Health Groups Call for Bold Action to End the Tobacco Epidemic In the United States

Nation Challenged to Cut Smoking Rates to Under 10 Percent in 10 Years and Protect All Americans from Secondhand Smoke within 5 years

 
The seven groups issuing the call to action are the American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Campaign for Tobacco-Free Kids and Legacy®.
WASHINGTON, DC – As the United States marks the 50th anniversary of the first Surgeon General’s Report on Smoking and Health, seven leading public health and medical organizations today called for a new national commitment to end the tobacco epidemic for good.
At a press conference today, the organizations called for bold action by all levels of government to achieve three goals:

  • Reduce smoking rates, currently at about 18 percent, to less than 10 percent within 10 years;
  • Protect all Americans from secondhand smoke within five years; and
  • Ultimately eliminate the death and disease caused by tobacco use.

These seven organizations issued the following joint statement:  American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Campaign for Tobacco Free Kids, and Legacy for Longer Healthier Lives
The first Surgeon General’s Report on Smoking and Health, issued on January 11, 1964, was a historic turning point in the nation’s fight against tobacco use.
Our organizations celebrate the remarkable progress of the past 50 years.  The United States has cut smoking rates by more than half (from 42.4 percent in 1965 to 18 percent today) and per capita consumption of cigarettes by more than 70 percent.  While smoking was allowed almost everywhere in 1964, today nearly half the nation’s population is protected by smoke-free laws that apply to all workplaces, restaurants and bars.  Reductions in smoking have saved millions of lives and are responsible for 30 percent of the increase in the life expectancy of Americans since 1964, according to a study published today in the Journal of the American Medical Association (JAMA).  The fight against tobacco has been a tremendous public health achievement.
However, the battle is far from over.  Tobacco use is still the number one cause of preventable death in the United States.  Smoking kills more than 440,000 Americans each year, sickens millions more and costs the nation $193 billion annually in health care expenditures and lost productivity.  About 44 million adults still smoke, and more than 3,000 kids try their first cigarette each day.  It is unacceptable that tobacco still kills so many Americans, lures so many children, devastates so many families and places such a huge burden on our nation’s health care system.
On the 50th anniversary of the first Surgeon General’s report, it is time for a new national commitment to end the tobacco epidemic for good.  Today our organizations call for bold action by all levels of government to achieve three goals: 1) Reduce smoking rates, currently at about 18 percent, to less than 10 percent within 10 years; 2) protect all Americans from secondhand smoke within five years; and 3) ultimately eliminate the death and disease caused by tobacco.
Over the past 50 years, we have developed proven strategies that can achieve these goals if they are fully and effectively implemented.  These strategies include tobacco tax increases, comprehensive smoke-free workplace laws, hard-hitting mass media campaigns, health insurance coverage to ensure smokers have access to quit-smoking treatments, and well-funded, sustained programs to prevent kids from smoking and help smokers quit.  In 2009, these measures were supplemented with a powerful new tool when the Food and Drug Administration was granted authority to regulate the manufacturing, marketing and sale of tobacco products, for the first time empowering a federal agency to rein in the tobacco industry’s harmful practices.
We have the tools to end the tobacco epidemic for good.  We cannot afford to wait another 50 years.
Related materials: Downloadable charts showing progress since 1964

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/

Anti-smoking efforts have saved 8 million American lives

Liz Szabo, USA TODAY

A new analysis says smoking rates have dropped from 42% in 1964 to 18% in 2012.

Anti-tobacco efforts have saved 8 million lives in the 50 years since the publication of a landmark Surgeon General report, “Smoking and Health,” a new analysis shows.
The 1964 report, which concluded that tobacco causes lung cancer, led to a sea change in American attitudes toward smoking. Smoking rates have plunged 59% since then, falling from 42% of adults in 1964 to 18% in 2012, according to the Centers for Disease Control and Prevention.
By avoiding tobacco or quitting the habit, people have gained nearly two decades of life, according to the analysis, published Tuesday in the Journal of the American Medical Association.
An American man’s life expectancy at age 40 has increased by an average of nearly eight years, and a woman’s by nearly 5½ years, since 1964. About one-third of those gains come from decreased tobacco use, the analysis says.
“Tobacco control has been described, accurately, as one of the great public health successes of the 20th century,” CDC director Thomas Frieden writes in an accompanying editorial.
Twenty-six states and Washington, D.C., now ban smoking in indoor public places. As smoking rates have declined, so have the incidence rates of many cancers. About 40% of the decline in men’s overall cancer death rates, in fact, is due to the drop in tobacco use, according to the American Cancer Society.
Tobacco damages virtually every part of the body, Frieden says, causing one-third of heart attacks. Smoking increases the risk of 14 kinds of cancer, including acute myeloid leukemia and tumors of the mouth, esophagus, stomach and pancreas, according to the American Cancer Society. About 443,000 Americans die from smoking-related illnesses every year.
Nearly 18 million Americans have died from tobacco just since the Surgeon General report was published, according to the new analysis, led by Theodore Holford of the Yale University School of Public Health.
Tobacco killed 100 million people worldwide in the 20th century, according to the Campaign for Tobacco-Free Kids. If current trends continue, tobacco will kill an additional 1 billion in the 21st century, the group estimates.
Frieden notes that smoking remains a major health challenge. Nearly one-third of non-smokers are still exposed to secondhand smoke, either at home or at work. Images of smoking are still common on TV and in movies. Tobacco taxes are too low in many parts of the country, making cigarettes affordable for both adults and kids. And although most smokers say they want to quit, few of them receive proven treatment, such as counseling and medication, which together can double their odds of kicking the habit, he writes.
A spokesman for R.J. Reynolds Tobacco Company declined to comment.
David Sylvia, a spokesman for Altria, the parent company of tobacco giant Philip Morris USA, says his company’s goal today is simply to make current smokers aware of its brands, and it has no interest in attracting new smokers.
“Adults should have the ability to choose to purchase a legal product,” Sylvia says. “We want to make sure that when adult, current smokers are choosing their brand, they think about our brand.”
http://www.usatoday.com/story/news/nation/2014/01/07/anti-smoking-efforts-saved-lives/4355227/

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