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Accelerating the National Progress to Reduce Tobacco Use
The document discusses the slow progress in tobacco control and the ongoing challenges posed by the tobacco industry, which targets youth to maintain sales. It emphasizes the potential benefits and risks of electronic nicotine delivery systems (ENDS), suggesting they could either aid in public health or exacerbate tobacco use among young people. Recommendations for effective tobacco control strategies include sustained media campaigns, tax increases, smokefree policies, and comprehensive cessation programs.
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Accelerating the National Progress to Reduce Tobacco Use
- 1. Accelerating the National Progressto Reduce Tobacco Use Terry F. Pechacek , Ph.D. Professor of Health Management & Policy Georgia State University School of Public Health Retooling and Recommitting: Policy, Systems, and Environmental Approaches in Tobacco Control August 19th, 2015 ● Atlanta, Georgia
- 2. • The currentrate of progress in tobacco control is too slow. • The tobacco industry continues to position itself to sustain its sales by: • recruiting youth and young adults • Maintaining current smokers as consumers of all their nicotine-containing products including cigarettes Accelerating the National Progress to Reduce Tobacco Use
- 3. Tobacco Product Useby Education Level NSDUH 2013 Adults aged 18 and older 0 5 10 15 20 25 30 35 40 <HS HS Grad Some College College Grad Percent Using in Past Month Any Tobacco Cigarettes Cigars SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013
- 4. 5.6 Million ProjectedDeaths Key Assumptions • Initiation rates of smoking among adolescents and young adults remain high • Peak birth cohort smoking prevalence in young adulthood remains high • Adult cessation rates in young adulthood remain low • Tobacco products most commonly used remain highly lethal
- 5. Past Year CigaretteInitiates among Persons Aged 12 or Older, byAge at First Use: NSDUH 2002-2013 Numbers in Millions Initiated at Age 18 or Older Initiated Prior to Age 18 SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013
- 6. Past Month CigaretteUse among PersonsAged 12 or Older, by Age: NSDUH 2013 Age in Years Percent Using in Past Month SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013
- 7. Will ENDS bea panacea or peril? From a clinical perspective Using Electronic Nicotine Delivery Systems could help: • Smoking combusted cigarettes is the single greatest cause of death in the world. • Current tobacco control methods will not achieve public health objectives. • Properly regulated, ENDS have the potential of providing nicotine at a much lower level of harm. From a population perspective Electronic Nicotine Delivery Systems could: • Increase youth initiation • Promote dual use • Delay cessation • Entice former smokers back to nicotine • Re-normalize smoking • Continue addiction • Set back progress from establishing health promoting social norms
- 8. Potential Health Impactsof ENDS • Could have negative and positive individual and population health impact Source: 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 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. 2014 SGR Recommendations Sustain high-impact media campaigns such as CDC Tips and FDA youth prevention for 12 months a year for 10+ years Raise excise taxes – Average Retail Price of at least $10 per pack most effective Protect 100% of U.S. Population by comprehensive smokefree indoor air policies Fully fund comprehensive statewide tobacco control programs at CDC-recommended levels Expand Smoking Cessation for All Smokers Provide access to barrier-free proven tobacco use cessation treatments Promote proven tobacco use cessation treatment as a standard of care in primary and specialty care settings
- 10. Can novel nicotineproducts serve as a disruptive technology and advance public health?
- 11. Tobacco Industry inTransition Industry wants broader nicotine product market Cigarette Target = slow decline in market Slow down regulations ENDS Market = Keeping Smokers & Recruiting Youth Cautious adoption of less-profitable ENDS Industry favors tight regulations of innovative “vaping” Seek to reverse non-smoking norms Defending public health benefits of dual-use Non-combustibles & Heat-not-Burn = Growth Seek FDA MRTP approvals (e.g., SNUS, then H-n-B) Rapidly grow markets (e.g., Marlboro iQOS)
- 12. Tobacco Industry inTransition Seeking Public Health Endorsement Remember: “When you are dancing with the BEAR, it is hard to stay in the lead, and when the lights get low, he will eat you alive!” Companies want to manage transition Cigarettes have very high profit margins (≈ $1 per pack) Disruptive technologies favor innovation NOT established products Regulations can create barriers for innovation Financial Analysts Predict Strong Future Tobacco Sales Volumes (US and Globally)
- 13. “A defective and unreasonablydangerous 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
- 14. End Game Strategiesat State/Local Level • Raise the age of sale to 21 • Decrease access to and visibility of tobacco products in the community • decrease density of retail outlets, • proximity of retail outlets to schools, • Sales of tobacco products in pharmacies • Establish Minimum Prices/Prohibit discounting • Local and state product category bans
- 15.
- 16. Thank You! Questions? tpechacek@gsu.edu TheGeorgia State University Tobacco Center Of Regulatory Science
Editor's Notes
- #6 NSDUH Data Annual total initiates of CIGARETTES have declined prior to age 18 from 1.5 million in 2009 to 1.0 million in 2013. HOWEVER, annual total initiates of CIGARETTES among aged 18 and older has NOT DECLINED from 2009 to 2013, and remains at about 1.1 million per year, and significantly have INCREASED since 2002.
- #9 THUS, the expanding use of these new ENDS and e-cigarettes could have either negative and/or positive individual and population-based impact “The promotion of electronic cigarettes and other innovative tobacco products is much more likely to be beneficial in an environment where the appeal, accessibility, promotion, and use of cigarettes are being rapidly reduced” 2014 SGR “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
- #10 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.