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Summer 2007 Vol. 7 No. 2

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©Marianna Day Massey/ZUMA/Corbis No Butts About It

A Plan to End the Tobacco Problem


Actors portraying doctors once touted tobacco's virtues in primetime TV spots. Smokers could light up in planes and trains as well as their own automobiles. Today, however, cigarette ads in most media have disappeared, and air travelers must put away their packs of smokes even before entering the airport. In fact, smoking rates have plummeted by 50 percent since 1965. To borrow from one cigarette maker's tagline: You've come a long way, America.

B ut continuing the present course of control and prevention efforts likely will not end the tobacco problem, says a new report from the Institute of Medicine. Some 45 million adults in America -- one out of every five -- still smoke, and just under 10 million use other tobacco products. The rate at which kids take up tobacco use has hovered around 20 percent for most of the past two decades, although it is down at the moment. All this puffing claims 440,000 lives every year, including 50,000 deaths from secondhand smoke.

To really reduce this annual death toll and help individuals avoid or escape the grip of addiction, the nation -- and the federal government in particular -- needs to take additional, aggressive steps, the report says. It offers a two-pronged strategy that involves strengthening current tobacco control measures and at the same time fundamentally transforming the regulatory environment, including giving the U.S. Food and Drug Administration oversight of tobacco production, sale, and marketing. "The dangerous properties of tobacco and its impact on public health are now beyond dispute and, as our report shows, aggressive measures to reduce smoking rest on a solid scientific and ethical foundation," said Richard J. Bonnie, chair of the committee that wrote the report.

The committee urged public and private groups to keep up and intensify their efforts to control and prevent tobacco use through such strategies as excise tax increases, media-based prevention campaigns, indoor smoking bans, licensing of tobacco retailers, and support for cessation therapies and services. Evidence shows that these strategies do work. If fully supported, current control and prevention strategies could help bring smoking rates down to 10 percent by 2025, which would equate to about 11 million fewer smokers.

However, without greater regulatory oversight, tobacco prevention efforts will always struggle to maintain the upper hand against marketing efforts that seek to downplay the products' risks, the report notes. Moreover, smoking rates need to be brought down well below 10 percent before the health care costs and deaths from tobacco no longer present a significant public health burden.

The report therefore calls on Congress to empower FDA to regulate the manufacture, marketing, and distribution of tobacco products. And it says the states should not be pre-empted from enacting their own tougher intervention efforts. Key elements of the committee's vision for expanded regulatory oversight include requiring graphic warnings on product packages; limiting advertising to a text-only, black-and-white format; banning any activities by tobacco companies that target youths; and regulating retail outlets more aggressively, including supporting state experiments to reduce the number of retail outlets. As a long-term stratagem, FDA also should explore the feasibility of gradually reducing the nicotine content of cigarettes, the committee urged.

This bilateral approach would not only reduce demand for tobacco products, but also address the addictive aspects of tobacco and curb manufacturers' incentives to attract more smokers. A principal goal is to further limit young people's access to these products given that the vast majority of smokers pick up the habit during adolescence when they overestimate their ability to escape addiction and fail to appreciate fully the later health consequences.   -- Christine Stencel

Ending the Tobacco Problem: A Blueprint for the Nation.Committee on Reducing Tobacco Use: Strategies, Barriers, and Consequences, Board on Population Health and Public Health Practice, Institute of Medicine (2007, approx. 400 pp.; ISBN 0-309-10382-7; available from the National Academies Press, tel. 1-800-624-6242; $64.95 plus $4.50 shipping for single copies).

The committee was chaired by Richard J. Bonnie, John S. Battle Professor of Law and director, Institute of Law, Psychiatry, and Public Policy, University of Virginia School of Law, Charlottesville. The study was funded by the American Legacy Foundation.

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Copyright 2007 by the National Academy of Sciences