ATLANTA (AP) — U.S. 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 slowly-declining adult smoking rate
dropping to 10 percent in the next decade and to 5 percent or lower by 2050.
Acting U.S. Surgeon General Boris Lushniak last month
released a 980-page report on smoking that pushed for stepped-up tobacco-control
measures. His news conference was an unusually animated showing of anti-smoking
bravado, with Lushniak nearly yelling, repeatedly, “Enough is enough!”
“I can’t accept that we’re just allowing these numbers to
trickle down,” he said, in a recent interview with the AP. “We believe we have
the public health tools to get us to the zero level.”
This is not the first time a U.S. health official has spoken
so boldly. In 1984, Surgeon General C. Everett Koop called for a “smoke-free
society” by the year 2000. However, Koop — a bold talker on many issues — didn’t
offer specifics on how to achieve such a goal.
“What’s different today is that we have policies and
programs that have been proven to drive down tobacco use,” said Matthew Myers,
president of the Campaign for Tobacco-Free Kids. “We couldn’t say that in
Factors Favoring Change
Among the things that have changed:
* Cigarette taxes have increased, making smokes more expensive. Though
prices vary from state to state, on average a pack of cigarettes that would have
sold for about $1.75 20 years ago would cost more than triple that now;
* Laws banning smoking in restaurants, bars and workplaces have popped up
all over America. Airline flights have long been off-limits for smoking;
* Polls show that cigarette smoking no longer is considered normal behavior
and now is less popular among teens than marijuana;
* Federal officials are increasingly aggressive about anti-smoking
advertising. The Food and Drug Administration launched a new youth tobacco
prevention campaign recently. At about the same time, the Centers for Disease
Control and Prevention debuted a third, $60-million round of its successful
anti-tobacco ad campaign — this one featuring poignant, deathbed images of a
woman featured in earlier ads;
* 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
and curtail marketing of cigarettes to youths; and
* Retailing of cigarettes is changing, too. CVS Caremark, the second-largest
U.S. pharmacy chain, announced recently it will stop selling tobacco products at
its more than 7,600 drugstores. The company said it made the decision in a bid
to focus more on providing health care, but medical and public health leaders
predicted pressure will increase on companies like Walgreen Co. and Wal-Mart
Stores Inc. to follow suit.
“I do think, in another few years, that pharmacies selling
cigarettes will look as anachronistic” as old cigarette ads featuring physician
endorsements look today, said CDC Director Dr. Tom Frieden.
These developments have made many in public health dream
bigger. It’s caused Myers’ organization and others to recently tout the goal of
bringing the adult smoking rate down to 10 percent by 2024, from the current 18
percent. That would mean dropping it at twice the speed it declined over the
last 10 years.
The bigger goal is to reduce U.S. smoking-related deaths to
fewer than 10,000, from the current level of 480,000. But even if smoking rates
dropped to zero immediately, it would take decades to see that benefit, since
smoking-triggered cancers can take decades to develop.
But while some experts and advocates are swinging for the
fences, others are more pessimistic. They say the key to reaching such goals is
not simply more taxes and more local smoking bans, but action by the U.S. Food
and Drug Administration to regulate smoking.
A 2009 U.S. law gave the FDA the authority to regulate
tobacco products. The law barred the FDA from outright blocking the sale of
cigarettes, but the agency was free to take such pivotal steps as prohibiting
the use of appealing menthol flavoring in cigarettes and requiring cigarette
makers to ratchet down the amount of addictive nicotine in each smoke.
But nearly five years after gaining power over cigarettes,
FDA has yet to even propose such regulations. Agency officials say they’re
working on it.
A spokesman for Altria Group Inc., the maker of Marlboro,
said the company supports FDA exercising its regulatory authority over tobacco
products. But as a whole, the industry has tended to fight regulation. Some of
America’s largest tobacco companies — though not Altria — sued to stop
FDA-proposed graphic warning labels on cigarette packs. A federal court blocked
“The industry makes money as long as they can delay
regulation,” said Kenneth Warner, a University of Michigan public health
professor who is a leading authority on smoking and health.
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 percent only to about 12 percent by 2050. If health
officials do make huge strides, the rate could drop as low as 6 percent, they
But Lushniak said zero. Will that ever happen?
Some experts doubt it. As long as cigarettes and other
combustible tobacco products are legal, it’s likely some people will smoke them.
“It’s hard to do a ban on cigarettes because you’re taking
something away from people they have and are using. Once you have something, you
hold tight,” said Richard Daynard, a Northeastern University law professor who
focuses on tobacco issues.
Better, he said, 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 —
That would be constitutional, he said. The question is:
Would American culture accept it?
Probably not, said Ruth Malone, editor-in-chief of the
scientific journal Tobacco Control.
“In our culture, we tend to think we have a right to things
even if they’re terrible for us,” she said.
A growing number of experts believe the most promising
option is to get people to switch voluntarily to something else, like electronic
Electronic cigarettes are battery-powered devices that
provide users with aerosol puffs that typically contain nicotine, and sometimes
flavorings like fruit, mint or chocolate. They’ve often been described as a less
dangerous alternative to regular cigarettes.
But there are few studies exploring exactly what chemicals
are in them, and in what concentrations, and whether those levels are harmful.
They’re controversial: Some experts believe that at a time
when cigarette smoking has finally become passe in popular culture, e-cigarettes
may re-glamorize puffing away in public places. Cigarette sales could surge.
“It could go in either direction,” said John Seffrin, the
American Cancer Society’s chief executive officer.
But if the FDA can ratchet down nicotine in conventional
cigarettes to levels below what’s in e-cigarettes, perhaps everyone who clings
to smoking will switch to the higher-nicotine new products. That could achieve
the end of smoking, at least of combustible, carcinogen-filled cigarettes — or
so the thinking goes.
In the past, “the country really wasn’t ready” to walk away
from cigarettes,” Daynard said. “I think the country’s ready now.”
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