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Is US ready to end smoking?

A confluence of changes in policy and public mindset makes officials hopeful of smoking dropping to 5 per cent or lower by 2050.

February 15, 2014 11:44:01 pm
Retailing of cigarettes is fast changing, with the second-largest US pharmacy chain recently saying it will stop stocking them. (Photo: AP) Retailing of cigarettes is fast changing, with the second-largest US pharmacy chain recently saying it will stop stocking them. (Photo: AP)

US health officials have begun to predict the end of cigarette smoking in America.

They have long wished for a cigarette-free America, but shied away from calling for smoking rates to fall to zero or near zero by any particular year. The power of tobacco companies and popularity of their products made such a goal seem like a pipe dream.

But a confluence of changes has recently prompted public health leaders to start throwing around phrases like “endgame” and “tobacco-free generation”. Now, they talk about the adult smoking rate dropping to 10 per cent in the next decade and to 5 per cent or lower by 2050.

Acting US Surgeon General Boris Lushniak last month released a 980-page report on smoking that pushed for stepped-up tobacco-control measures. “We believe we have the public health tools to get us to the zero level,” he told AP.

This is not the first time a US health official has spoken so boldly. In 1984, Surgeon General C Everett Koop called for a “smoke-free society” by 2000. However, Koop didn’t offer specifics.

“What’s different today is that we have policies and programmes that have been proven to drive down tobacco use,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

Among the things that have changed:
n Cigarette taxes have increased. A pack of cigarettes that would have sold for about $1.75 20 years ago would cost more than triple that now.
n Laws banning smoking in restaurants, bars and workplaces have popped up.

n Polls show that cigarette smoking is no longer considered normal behaviour, and is less popular among teens than marijuana.

n Federal officials are increasingly aggressive about anti-smoking advertising. The Food and Drug Administration has launched a new youth tobacco prevention campaign, while the Centers for Disease Control and Prevention has debuted a third, $60-million round of its successful anti-tobacco ad campaign.

n Tobacco companies, once considered impervious to legal attack, have suffered some huge defeats in court. Perhaps the biggest was the 1998 settlement of a case brought by more than 40 states demanding compensation for the costs of treating smoking-related illnesses. Big Tobacco agreed to pay about $200 billion.

n Retailing of cigarettes is changing. CVS Caremark, the second-largest US pharmacy chain, has announced that it will stop selling tobacco products at its more than 7,600 drugstores. Public health leaders predict pressure will increase on companies like Walgreen Co and Wal-Mart Stores Inc to follow suit.

These developments have caused Myers’s organisation and others to recently tout the goal of bringing adult smoking rate down to 10 per cent by 2024, from the current 18 per cent. The bigger goal is to reduce US smoking-related deaths to fewer than 10,000, from the current 4,80,000.

But while some experts and advocates are swinging for the fences, others are more pessimistic. They say the key is not simply more taxes and more local smoking bans, but action to regulate smoking.

A 2009 US law gave the FDA the authority to regulate tobacco products. It barred the FDA from blocking the sale of cigarettes, but the agency was free to take such steps as prohibiting the use of menthol flavouring and requiring cigarette makers to ratchet down the amount of nicotine.

But nearly five years later, the FDA has yet to even propose such regulations.

“The industry makes money as long as they  delay regulation,” said Kenneth Warner, a University of Michigan public health professor.

Warner and Michigan colleague David Mendez estimate that, barring any major new tobacco control victories, the adult smoking rate will drop from its current 18 per cent only to about 12 per cent by 2050. If health officials do make huge strides, the rate could drop as low as 6 per cent, they think.

But Lushniak said zero. Will that ever happen?
Some experts doubt it. Richard Daynard, a Northeastern University law professor who focuses on tobacco issues, said it’s hard to take away something from the people.

Better, he said, is to bar people from having a product in the first place. He is intrigued by legal efforts in Singapore and a handful of other countries to ban sales of tobacco to anyone born after a certain year — 2000, say. That would be constitutional, he said. The question is: Would American culture accept it?

A growing number of experts believe the most promising option is to get people to switch voluntarily to something else, like electronic cigarettes.
In the past, “the country really wasn’t ready to walk away from cigarettes”, Daynard said. “I think the country’s ready now.”    AP

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