It’s been 50 years since the 1964 Surgeon General’s report that stated that smoking was harmful to our health. The Smoking and Health Report (what it was formally called) was based on a review of an estimated 7000 documents. It concluded that “cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking outweighs all the factors; and the risk of developing lung cancer increases with the duration of smoking and number of cigarettes smoked per day, and diminishes by discontinuing smoking.” Just so we women don’t feel left out, subsequent studies and reports stated that it was just as harmful and perhaps even more addictive for women, but I digress…
The January 8 issue of JAMA was dedicated to the last 50 years of tobacco control. In an editorial, some fascinating statistics were presented that I would like to share:
Half a century after the release of the 1964 report, tobacco dependency continues to devastate US society. Nearly 42 million smokers still struggle with this addiction. Unfortunately, even though 70% want to quit only 3 to 5% annually can do so on their own. New estimates of annual tobacco related deaths now approaches half a million in the United States and more than 5 million worldwide. Children and adolescents are especially affected by tobacco dependency through secondary smoke an onset of smoking. Other vulnerable populations include the poor, those with mental illness or substance-abuse disorders, lesbian, gay, bisexual and transgender population as well as the homeless and those who are incarcerated. The tobacco industry spends more than $8 billion a year in the United States to advertise and market cigarettes and smokeless tobacco, while also promoting cigars, pipe-tobacco and newer products which include dissolvable tablets and electronic cigarettes.
But before you grasp your head and begin to shake it and moan oy! there are some encouraging statistics. Although there have been 17.6 million smoking attributable deaths in the last 50 years, it’s estimated that 8 million premature deaths have been prevented because of tobacco control measures. It’s estimated that one-third of the gains in life expectancy for men (30%) and 29% of the gains for women during these past 50 years were due to declines in smoking. Moreover six nations, including the United States, have had reductions in smoking prevalence of greater than 50% during the past 25 years.
Another article in JAMA points out the factors that have helped smoking cessation in the U.S. Firstly, documentation of the danger of environmental tobacco smoke which has led to a flurry of clean indoor air legislation. Currently, 26 states and the District of Columbia ban smoking in enclosed public spaces. Secondly, the 1988 Surgeon General’s report documenting tobacco use as an addiction changed public perception of tobacco use from habit to “of free choice” to true drug dependency similar to that of heroin and cocaine.Thirdly, cigarette tax increases, clean indoor air laws and efforts to prevent adolescents from purchasing tobacco or starting to smoke have proved effective. Fourthly, there has been some very public litigation by private individuals, the States and the US Department of Justice against the tobacco industry. Indeed, there was a settlement in 1998 mandating that the tobacco industry pay the States $246 billion over 25 years. (The tobacco companies are bad… to add to their list if immoral and death producing offenses, in 2006 they were found guilty of racketeering.) But let’s get back to “the making a difference” factors… There are current evidence-based smoking cessation treatments – both counseling and FDA approved medications – that can markedly increase cessation rates among smokers trying to quit. And these will now be paid for by the Affordable Care Act