Tobacco Epidemic 50 Years Surgeon General Report
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Tobacco Epidemic 50 Years Surgeon General Report
- 1. The Tobacco Epidemic in the 21st Century Terry F. Pechacek , Ph.D. Professor of Health Management & Policy November 20, 2014
- 2. The Health Consequences of Smoking: 50 Years of Progress A Report of the Surgeon General 1964 2014
- 4. 50 years of Death 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
- 5. 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.
- 6. Industry’s Role “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.” Hon. Gladys Kessler MAJOR CONCLUSION #2
- 7. “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
- 8. 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
- 9. ENDS Potential for Benefit Complete long-term substitution by established smokers Assist in rapid transition to a society with little or no use of burned products Short-term use if shown to produce successful and permanent cessation of burned products
- 10. 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
- 11. 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
- 12. 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
Notas del editor
- Fifty years ago Dr. Luther Terry shocked the nation when he released the first Surgeon General’s report that linked smoking to lung cancer and heart disease. In January, the 32nd Surgeon General’s Report on smoking and health was released. The new report provides more evidence of the serious damage smoking does to the human body. It also commemorates the anniversary of that first report that laid the foundation for today’s programs to reduce the disease and death caused by smoking.
- Even though prevalence continues to decrease, the 2014 SGR’s first major conclusion is that “The century-long epidemic of cigarette smoking has caused an enormous avoidable public health tragedy. Since the first Surgeon General’s report in 1964 more than 20 million premature deaths can be attributed to cigarette smoking.” 20 million American died over the past 50 years and 2.5 million of those deaths were nonsmokers who died from heart disease or lung cancer caused by SHS exposure And over 100,000 were babies who died of SIDS or complications from prematurity, low birth weight, or other conditions caused by parental smoking.
- Any time we talk about e-cigarettes must remember the fact that burden tobacco is still a problem. According to the SGR, “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 2014 report also concludes that the tobacco industry intentionally mislead the public about the dangers of smoking. This was verified with U.S. District Judge Gladys Kessler’s final opinion and order from August 17, 2006. “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”
- So, how do we end the epidemic? This is a critically important conclusion. This SGR is the first ever government document to formally explore end game scenarios to end combustible tobacco use completely. Chapter 15 of the report explores a variety of end game scenarios discussed in the scientific literature. Some are “out there” like selling tobacco through a non-profit entity whose objective would be to reduce consumption. But some could be undertaken today. Of the many scenarios explored, the SGR concludes that two rise to the top as being more feasible in the U.S.: The first is using FDA authority to change the characteristics of tobacoc products so that they are less addictive (through nicotine content reductions), less harmful and toxic (e.g. through product standards to set maximum allowable levels of chemicals in cigarettes), and less appealing The second is additional restrictions on sales. The Tobacco Control Act prohibits FDA from national bans on certain products such as cigarettes, but every state and municipality in the U.S. has the power to ban cigarette sales. There may be other factors such as state constitutions that could preempt local measures
- Not approved as a cessation device There has also been a lot of talk of whether e-cigarettes help people quit. E-cigarettes will cause harm if they delay smokers from quitting, lead to relapse of smoking among former smokers, encourage young people to start smoking or become addicted to nicotine, or lead to use of e-cigarettes and burned cigarettes at the same time. Any significant benefit of using an e-cigarette likely requires completely switching from burned tobacco or quitting tobacco use altogether. E-cigarettes are more likely to benefit public health when appeal, accessibility, promotion, and use of cigarettes and other burned tobacco products are being rapidly reduced Bottom Line: Smokers should talk to their doctors for help in quitting and used proven cessation medication and support services.
- We know that tobacco smoke is deadly We know that the cigarette is “A defective and unreasonably dangerous product”1 However, we see only three ways for these new ENDS and e-cigarette products to have benefit, READ THREE CIRCUMSTANCES Complete long-term substitution by established smokers Assist in rapid transition to a society with little or no use of burned products Short-term use if shown to produce successful and permanent cessation of burned products 1Proctor RN. Why ban the sale of cigarettes? The case for abolition. Tobacco Control 2013;22:i27-i30
- As we discuss e-cigarette use, we must accelerate efforts to eliminate smoking. Today cigarettes and other combustible tobacco products—which kill half of long-term users—remain ubiquitous, affordable in most states, highly addictive, and attractive to young people. About 1 in 5 adults and 1 in 5 high school students regularly smoke some form of combustible tobacco, and 5.6 million children alive today are projected to die early from smoking if current smoking rates persist. We don’t need e-cigarette and tobacco companies to sell their products to children in order to “protect” them from cigarettes. We have plenty of proven, highly effective public health strategies to discourage youth smoking, including higher prices, smoke-free policies, mass media campaigns, and restricting youth access. Youth use of cigarettes decreases dramatically when these policies are applied aggressively.