Plan Aims to Reduce Tobacco Use, Save Lives

by Eileen A. Ellig

Each year, an estimated 434,000 Americans die of tobacco-related illnesses. In fact, the leafy substance -- whether smoked or chewed -- causes more deaths annually than alcohol, heroin, cocaine, suicide, homicide, automobile accidents, fire and AIDS combined.

 

Although there have been sharp declines in smoking among adults and adolescents from 1964 through 1990, the current number of older smokers has leveled off at 25 percent. The rate among teenagers, however, has increased by approximately nine percent since 1991.

 

 

"For more than two decades, we have made significant progress in reducing smoking prevalence, but this upward trend in young people starting to smoke is of great concern," says Dr. Ellen R. Gritz, chair of the Department of Behavioral Science at M. D. Anderson and holder of the Annie Laurie Howard Research Professorship.

 

What action can be taken to reduce tobacco use in the United States and world?

 

"I think we are past the point of saying there is a one-shot solution," Dr. Gritz says. "We realize that only a comprehensive national policy effort will lead to a substantial and sustained decrease in users. We have to make tobacco less available to children, protect non-smokers, regulate tobacco advertising, empower state and local governments, and consider the implications for global consumption."

 

Dr. Ellen R. Gritz contributed to an extensive tobacco report that aims to halt youth initiation and encourage smoking cessation.

 

As a member of the National Cancer Policy Board of the Institute of Medicine and Commission on Life Sciences, National Research Council, Dr. Gritz and others contributed to an extensive report by the board that outlines a plan to halt youth initiation and turn the stable path of smoking among adults into a decline.

 

Recommendations, along with Dr. Gritz' observations, are:

 

· Raise Prices to Reduce Tobacco Use. "The price versus consumption relationship is strong among children. The higher the cost, the less likely they will start to smoke. The effect on adults is not as powerful, but they may see this increase as a motivation to quit."

 

· Strengthen Federal Regulation. "We feel strongly that Congress must reinforce and clarify the Food and Drug Administration's rule that nicotine should be regulated as a drug."

 

· Support State and Local Tobacco Control Efforts. "Community-wide education programs can significantly impact smoking prevalence. Federal officials must provide city and state governments the resources necessary to be effective tobacco control monitors -- implementors of prevention and cessation programs."

 

· Monitor Performance in Relation to Public Health Goals. "While existing performance monitoring systems have provided important data on prevalence and trends, they need to be refined, more detailed and done frequently so we can assess whether our education and cessation campaigns are having a positive effect on smoking rates."

 

· Help Current Users Quit. "To help people become non-smokers, several steps must be taken: 1.) We need to make the Agency for Health Care Policy and Research's Smoking Cessation Clinical Practice Guideline a standard of care, and disseminate it to physicians and other health professionals. 2.) Medical care coverage for nicotine-dependence treatment programs must be guaranteed. 3.) Via Report Cards, we have to ensure that health care systems offer smoking cessation services and hold them accountable if they do not. 4.) Societal norms and programs outside the health care arena have to back prevention and cessation efforts. 5.) We need to research the potential benefits of long-term nicotine replacement therapy for individuals heavily addicted to smoking to reduce the harmful effects of tobacco toxins."

 

· Support Research. "Federal agencies haven't made a big commitment on smoking-related research as they have with other public health issues, with only about $100 million spent each year compared to $600 million allocated for breast cancer. We need to invest more money into smoking cessation and initiation studies if we are to develop more successful interventions."

 

· Facilitate International Tobacco Control. "We know the major U.S. tobacco companies are shifting their efforts globally. Unfortunately, there are fewer marketing and promotion restrictions abroad than there are in America. Disturbingly, the cigarettes exported are more dangerous because they are higher in tar and nicotine. To have an impact overseas, we must refrain from implementing trade policies that undermine foreign tobacco control efforts."

The execution and success of these initiatives will depend upon the cooperation of not only public health officials, researchers and clinicians, but also legislators, economists, regulators and policymakers, according to Dr. Gritz.

 

"Only then will we see the next wave of decline in smoking initiation and prevalence," she says.