Reading the CDC’s latest report on cigarette smoking, I saw little evidence of progress towards a healthier future. The rate of cigarette use among adults over the last five years has remained constant. Cigarette smoking is still the leading cause of preventable morbidity and morality in the US, and tobacco use is still highest among vulnerable populations: particular racial/ethnic minorities, persons with histories of mental health and substance abuse, and persons with lower socioeconomic status.
A 1984 internal tobacco company report famously warned that young smokers were vital to the tobacco industry because they served as a source of “replacement smokers”—replacing, presumably, those who died from their habit. That still holds true today. The CDC report notes that the majority of established adult smokers begin smoking during their adolescence, with dropping out of high school a major risk factor.
So we’ve made little headway over the last few years. What does the future hold? One of President Obama’s earliest legislative acts was the Family Smoking Prevention and Tobacco Control Act, a federal law that gives the FDA to the authority to regulate the tobacco industry. The law requires tobacco companies to reveal product ingredients, limits advertising targeting young smokers, makes cigarette warning labels more noticeable, among other provisions. In addition, the 2009 extension of CHIP—the Children’s Health Insurance Program—was funded by a hike in the federal cigarette tax.
These federal initiatives, combined with increased access to preventive health resources as mandated by the Affordable Care Act, will hopefully build momentum toward fewer young people deciding to begin smoking. At the same time, however, with many states struggling with close budget gaps, funding for smoking prevention and cessation has declined in many areas of the country.
As a medical student at Washington University in St Louis, I’m proud to say that my entire university went tobacco-free on July 1st, 2010. While there are obvious health benefits, to me the major point of such a ban is to signal an institutional stand for prevention and to help reshape the social meaning of cigarette use among a campus of young people. College campuses, by virtue of being both a place of living and learning, provide a unique opportunity to create a comprehensive environment geared towards prevention.
A similar environment needs to be cultured in our communities and school districts. Without comprehensive efforts preventing cigarette and other tobacco use among high-risk groups, this time next year the CDC will release yet another report with the same statistics—that cigarette smoking has cost Americans another $193 billion in health care costs and productivity losses and resulted in 443,000 preventable, premature deaths.