July 22, 2015

Tobacco Control – Much Progress Made, Much Work Ahead

National Tobacco Control Expert Stephen Schroeder, M D, M P H

Stephen Schroeder, M.D., MPH

National tobacco control expert Stephen Schroeder, M.D., MPH, in June visited the Arkansas Department of Health and spoke at ADH Grand Rounds about policies and programs that have helped bring down the smoking rates since US Surgeon General Luther Terry issued his report in 1964 on the damaging health effects of smoking. At the time, smoking was widely accepted – 43% of American adults smoked. Today, the adult smoking rate nationally is 18% (in Arkansas, it’s 25%).

The human and economic costs of smoking are still astronomical. According to the 2015 Campaign for Tobacco Free Kids reports, about 500,000 people die in the US each year from smoking or secondhand smoking. Even in Arkansas, one of the less populous states 5,800 smoking-related deaths occur each year, and smoking costs the state more than $1.2 billion annually in health care costs (including $85.3 million in state Medicaid and $36.5 million in other state government smoking-related costs) and an additional $1.7 billion in lost productivity.

Support for effective tobacco control policies, such as indoor smoking bans, has grown as the public became aware of the harms of tobacco and the tobacco industry’s deceptions.

The scientific evidence on the health consequences of smoking now implicates injury to nearly every organ in the body.

“We continue to find diseases for which smoking increases the odds of getting and dying from the disease,” Dr. Schroeder said, as he showed a slide on the diseases causally linked to smoking.

According to the 2014 report from the US Surgeon General, “The Health Consequences of Smoking—50 Years of Progress,” the health risks are much more than a chance of developing lung cancer and heart disease. Smoking also increases one’s risk for hip fractures, diabetes, tuberculosis; blindness, cataracts and macular degeneration; lowered fertility, bearing a child with a cleft palate, cancers of the blood, pancreas, bladder, kidneys, cervix, liver, and colon; male erectile dysfunction, rheumatoid arthritis and poor immune function.

Declines in smoking rates, most significantly in the past three decades, are attributed to litigations against the tobacco industry, bans on TV ads, mass media campaigns, increases on cigarette prices and taxes, stiff penalties for sales to minors, smokefree indoor air policies, prevention and cessation programs, increased focus on provider intervention with patients, hospital measures of tobacco intervention linked to payment, and comprehensive state tobacco control programs.

“Further gains can be made with full, forceful, and sustained use of these measures,” states the 2014 US Surgeon General’s report.

Smoking rates remain high among disadvantaged and marginalized groups – those who are poor or without any college education, the LGBT population and individuals with poor mental health, all of which are more vulnerable to the lure of tobacco or less able to quit.

“Tobacco control is increasingly becoming a social justice issue,” Dr. Schroeder said.

Intensifying tobacco control efforts will require more funding, and that requires strong advocacy. Effective advocacy most often spotlights persons most affected, but with lung cancer, most victims don’t live long after their diagnosis to tell their story, and the stigma around smoking dampens advocacy on their behalf. As Dr. Schroeder explained, when someone dies from breast cancer, it is not their fault; when a smoker dies from lung cancer, “they brought it on themselves.” But it is a fact that most smokers started as teenagers, the hapless victims of tobacco industry manipulation. On average it takes 12 tries before a smoker successfully kicks the habit.

Tobacco industry outspends anti-smoking public health efforts nationally 23 to 1. That ratio is much better – about 14 to 1 – in Arkansas, where, the tobacco industry has spent about $107 million on marketing each year, compared to the $17.6 million in total spent on tobacco prevention and cessation. Unfortunately, in the 2015 legislative session, that figure was reduced by approximately 2 million.

The Arkansas Department of Health’s Tobacco Prevention and Cessation Program (TPCP) five-year, comprehensive strategic plan was updated in 2014. It covers all the bases: prevention of initiation of tobacco product use by youth; elimination of exposure to secondhand and third-hand smoke; promotion of quitting among adults and youth; and evaluation of programs so that there is solid evidence guiding those efforts.

There is a strong economic argument to be made for why Arkansas would benefit from a larger state investment in tobacco control, Dr. Schroeder said. Think Medicaid savings, for one thing the millions of dollars in state Medicaid money spent each year on care for smoking-related illnesses.

The financial references from CFTA are at https://www.tobaccofreekids.org/research/factsheets/pdf/0178.pdf