Finding the political will to curb tobacco use

Nearly one in five adults smoke cigarettes and equally disturbing, nearly one in five high school students continue to light up, indicating a slowing decline in teen smoking overall. Moreover, nonsmokers, particularly children, remain at risk. About four in 10 nonsmokers in the U.S. are exposed to secondhand smoke and more than half of children aged 3 – 11 years are exposed primarily in homes. Why do so many people, young and old, begin and continue a habit that has such grave consequences? Cigarette smoking results in a two to three fold risk of dying from coronary heart disease and doubles a person’s risk for stroke. The financial impact is similarly troubling. Direct medical costs and lost productivity costs associated with smoking total an estimated $193 billion per year.

The health and financial burdens associated with tobacco use have negatively impacted the health and vitality of many communities. Admittedly, we have made tremendous progress in erasing tobacco from a significant portion of America’s landscape with enactment of smoke-free policies, tobacco excise tax legislation and federal oversight of the manufacture, marketing and advertising of tobacco products. The tobacco industry, however, has stepped up efforts to addict a new generation of smokers with the introduction of trendy ads, packages and smokeless tobacco products that would appeal to most youngsters, and companies are waging legal challenges to stricter regulations in efforts to continue business as usual. This is not the time for anti-tobacco advocates to become complacent. Tobacco use, the most preventable cause of premature death in the U.S., remains a stubborn enemy in our fight to improve the cardiovascular health of all Americans. The American Heart Association is encouraging all Americans to follow Life’s Simple 7, http://mylifecheck.heart.org/, which includes useful information to help smokers quit. Personal responsibility is utmost but success would be unsustainable without strong regulatory measures to hold the industry accountable and adequate programs and resources to help individuals quit for good.

Under health reform, coverage for tobacco cessation programs will expand but much more needs to be done. The association encourages all states to pass legislation requiring all insurers to provide comprehensive coverage which includes both counseling and pharmacotherapies. Such programs have dramatically reduced smoking prevalence among Medicaid beneficiaries, particularly in Massachusetts where the state’s health care reform law mandated tobacco cessation coverage for the Medicaid population. Over a two-year period following the law’s enactment, the smoking rate among Massachusetts beneficiaries declined 26 percent, suggesting that comprehensive tobacco cessation benefits that include coverage for medications and behavioral treatments can yield positive outcomes.

Undoubtedly, the slow economy has left many states in precarious fiscal situations, which led to cuts in tobacco prevention and cessation programs. Yet revenue from the 1998 multi-state tobacco settlement and tobacco excise taxes continues to fill state coffers and, in many cases, has not been used as intended to address public health problems associated with tobacco use. A recent report from public health groups found that states are collecting more tobacco-generated revenue than ever before but are spending less of it on tobacco control programs. North Dakota is the only state that currently funds its tobacco prevention programs at CDC recommended levels even though states that have funded programs that follow CDC’s “Best Practices” have reduced youth tobacco use by more than 40 percent. Why such dismal results among states? Unlike North Dakota, where voters approved a ballot measure mandating the state fund tobacco prevention programs, it appears many elected officials lack the political will to improve the health of their citizens and reduce health care spending tied to tobacco illnesses. As policymakers map out their agendas moving forward, we urge state legislators to adequately fund tobacco prevention and cessation programs, increase excise taxes on all tobacco products and pass strong smoke-free air laws. In our nation’s capital, Congress must provide sufficient resources to the Food and Drug Administration to effectively implement the Family Smoking Prevention and Tobacco Control Act and fight industry attempts to challenge provisions of the law and weaken regulations. Without bold, decisive action from our elected officials, efforts to reduce tobacco use and save lives will continue to hit too many bumps in the road.

Nancy Brown is the CEO of the American Heart Association.