The Tobacco Epidemic in the 21st Century

Terry F. Pechacek , Ph.D.Professor of Health Management & Policy

November 20, 2014

The Health Consequences of Smoking: 50 Years of ProgressA Report of the Surgeon General

1964 2014

ENOUGH IS ENOUGH!

Between 1964 and 2014:

Over 20 million Americans died because of smoking, including

2.5 million nonsmokers 6.58 million from cancers

108,000 babies 7.8 million from CVD & metabolic diseases

86,000 residential fires 3.8 million from pulmonary diseases

50 years of Death

Tobacco Smoke is Deadly

“The burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products; rapid elimination of their use will dramatically reduce this burden.”The health consequences of smoking – 50 years of progress: a report of the Surgeon General. – Atlanta, GA. : U.S. Department

of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

“The tobacco epidemic was initiated and has been sustained by the aggressive strategies of the tobacco industry, which has deliberately misled the public on the risks of smoking cigarettes.”

Industry’s Role

Hon. Gladys Kessler

MAJOR CONCLUSION #2

“A defective and unreasonably dangerous product”1

End Game scenarios for the U.S. include: FDA regulation to:

• Reduce nicotine content to make cigarettes non-addictive

• Make some or all tobacco products less appealing• Establish standards for toxicant levels in tobacco

products Sales restrictions

• including local and state product category bans

1Proctor RN. Why ban the sale of cigarettes? The case for abolition. Tobacco Control 2013;22:i27-i30

Electronic Nicotine Delivery Systems

(ENDS)

Could have negative and/or positive individual and population-based impact

“The impact of the noncombustible aerosolized forms of nicotine delivery on population health is much more likely to be beneficial in an environment where the appeal, accessibility, promotion, and use of cigarettes and other combusted tobacco products are being rapidly reduced, especially among youth and young adults.” 2014 SGR, Page 859

Complete long-term substitution by established smokers

Assist in rapid transition to a society with little or no use of burned products

ENDS Potential for Benefit

Short-term use if shown to produce successful and permanent cessation of burned products

ENDS Policy Approaches

Not tolerated: Marketing or sales that result in youth use

Prohibited: In all places where smoking is Eliminate: Use of combusted tobacco

FDA regulation is fundamental to minimizing harms

States and communities can also take action

2014 SGR Recommendations

Fully fund comprehensive statewide tobacco control programs at CDC-recommended levels

Sustain high-impact media campaigns such as CDC Tips for 12 months a year for 10+ years

Raise excise taxes -- at least $10 per pack most effective

Make proven tobacco use cessation treatment a standard of care in primary and specialty care settings

Do What Works Now!• In Fiscal Year 2014, states are spending less than

two cents of every dollar in tobacco revenue to fight tobacco use.

GEORGIA• Tobacco-Generated Revenue = $346.8 Million

• CDC Recommended Spending = $106 Million

• Spending on Tobacco Prevention = $2.2 Million

Thank You!

Questions?