How could we, America’s health-care providers and knowledge experts, not do everything possible to protect our fellow citizens from a life ravaged by smoking?— Ronald A. DePinho, MD
One billion lives. That is the estimated human death toll of tobacco use in the 21st century.1 Tobacco use is the leading cause of preventable death worldwide—20% of all deaths and 30% of cancer deaths in the United States are linked to tobacco use.2,3 Impacting this preventable public health menace requires policy, education, and cessation services.
We all know the figures: 480,000 American lives are claimed each year by smoking-related illnesses.4 Data show that the vast majority of smokers—88%—started before age 18, and, each day, more than 3,200 people under age 18 smoke their first cigarette, and an estimated 2,100 young adults become daily smokers. Combine those data with the costs associated with smoking—approximately $170 billion spent annually on public and private health-care expenditures and $151 billion in productivity loss4—and we are left with an unacceptable travesty occurring in our country.
Ensuring a Healthier Nation
Based on past results, we know that instituting public health–care policies is one of the most effective strategies to influence the health of our citizens. Take seat belts as an example. When they were originally introduced in 1964,5 people refused to wear them, thinking it made cars less safe. It took federal legislation passed in 1968 requiring the usage of seat belts along with public education efforts to turn the tide on this now hard-to-believe situation (Since 1975, it is estimated that seat-belt use has saved about 255,000 lives.6)
The same could be said for the current limitations placed on the purchase and use of tobacco products. Over time, we’ve seen a cultural shift—based on sound scientific evidence and education—in support of public policy efforts designed to reduce tobacco-related cancer deaths. Although it’s not quite time to pat ourselves on the back for a job well done, we can celebrate little wins that will grow into cultural norms, much like the acceptance of wearing a seat belt.
Just this past month, we had the opportunity to applaud California lawmakers on their decision to increase the age to purchase tobacco from 18 to 21. That state follows in the footsteps of the extremely bold Hawaiian policymakers who led the approach, passing a similar law in 2015. We’re also seeing heroic efforts at the local level, with more than 150 cities and counties across the United States passing Tobacco 21 laws, which raise the tobacco sale age to 21.
Other states are trying different approaches to reduce tobacco use. Since 2000, 47 states and the District of Columbia have passed more than 130 state cigarette sales tax increases.7 Tobacco sales taxes are a proven strategy to reduce smoking, particularly among teenagers and people with low income. Studies show that every 10% increase in the price of a pack of cigarettes results in a 4% reduction in overall cigarette consumption and a 6.5% reduction in youth smoking rates.
An additional effort that has made a difference in reducing tobacco-related deaths is the ban on smoking in workplaces and public spaces. This is especially important since it also reduces the impact of secondhand smoke, which increases a person’s risk of developing heart disease and lung cancer. Here again, we’ve made progress, but more work must be done, as 25 states still lack smoke-free protection in workplaces, restaurants, bars, and casinos.
We at MD Anderson Cancer Center, as an institution of healing and science, applaud any and all instances where sound data inform public policy, and evidence suggests these are all wise steps in the right direction to address this major health problem.
Through our EndTobacco initiative, established by the Cancer Prevention and Control Platform of The University of Texas MD Anderson’s Cancer Moon Shots Program, our researchers are focused on developing and implementing evidence-based interventions in cancer prevention, screening, early detection, and survivorship, to achieve long-lasting and measurable results. Areas of focus include policy, education, and clinical services.
MD Anderson’s governmental relations and cancer control experts have served as educational resources, along with many of our partners, for Texas’ tobacco-related policy measures and further support additional policies that will protect future generations from a habit that continues to take so many lives. On the clinical side, our Tobacco Treatment Program offers tobacco-cessation services that include in-person and over-the-telephone behavioral counseling and several tobacco cessation medication treatments—at no cost to patients and employees. Quit rates for smokers enrolled in the program average 45%, whereas the self-quit rate is just 5%.
Progress is being made, but all health-care providers need to join the effort and do their part to end tobacco use. Why does it matter that we all participate in the education of policymakers and the implementation of tobacco-treatment programs? Let’s consider some predictions from the Institute of Medicine’s report entitled Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products8 that are specific to the health benefits of increasing the national age requirement to purchase tobacco products to 21:
The smoking rate will be reduced by 12% by the time today’s teenagers are adults.
There would be 249,000 fewer premature deaths due to tobacco.
Smoking-related deaths would be reduced by 10% and result in 50,000 fewer deaths from lung cancer.
This simple change would lead to 4.2 million fewer years of life lost for those born between 2000 and 2019.
With predictions like these, how could we, America’s health-care providers and knowledge experts, not do everything possible to protect our fellow citizens from a life ravaged by smoking? Much good work has been done during the past several decades to lower the rates of tobacco use in our country. Now, we must commit to accelerating this trend toward a tobacco-free generation in the future. It is not just the fiscally responsible thing to do, it is the socially responsible thing to do as well. ■
Disclosure: Dr. DePinho reported no potential conflicts of interest.
1. Eriksen M, Mackay J, Schluger N: The Tobacco Atlas, Fifth Edition, November 2015. American Cancer Society and the World Lung Foundation.
2. Centers for Disease Control and Prevention: Health Effects of Cigarette Smoking. Available at www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking. Accessed June 9, 2016.
3. American Cancer Society: Tobacco-Related Cancer Fact Sheet. Available at www.cancer.org/cancer/cancercauses/tobaccocancer/tobacco-related-cancer-fact-sheet. Accessed June 9, 2016.
4. Centers for Disease Control and Prevention: Fast Facts: Smoking and Tobacco Use. Available at www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts. Accessed June 9, 2016.
5. Centers for Disease Control and Prevention: Intervention Fact Sheets. Available at www.cdc.gov/motorvehiclesafety/calculator/factsheet/seatbelt.html. Accessed June 9, 2016.
6. Centers for Disease Control and Prevention: Policy Impact: Seat Belts. Available at www.cdc.gov/motorvehiclesafety/seatbeltbrief. Accessed June 9, 2016.
7. Campaign for Tobacco-Free Kids: Cigarette Tax Increases by State Per Year 2000-2016. Available at www.tobaccofreekids.org/research/factsheets/pdf/0275.pdf. Accessed June 9, 2016.
8. The National Academies of Sciences, Engineering, Medicine: Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products. March 12, 2015. Available at www.nationalacademies.org/hmd/Reports/2015/TobaccoMinimumAgeReport.aspx. Accessed June 9, 2016.