Cut Nicotine in Cigarettes, Say Health Officials

[Thomas3.20.2010]

WASHINGTON -- Cutting the nicotine content of tobacco products and greater restrictions on sales, "including bans on entire categories of tobacco products" are just two of the strategies for an "endgame" to stop all tobacco use suggested in a federal report released Friday.

It's time for more aggressive tobacco control in a drive toward eradication of tobacco use, the Surgeon General and other public health officials urged Friday, noting further health effects that can be causally linked to smoking.

The report, marking the 50th anniversary of the Surgeon General's first report on the health effects of tobacco smoke, added diabetes, rheumatoid arthritis, colorectal cancer, and other ailments to the already long list of the ill effects of tobacco use.

"It is time to commit to ending the tobacco epidemic once and for all, and it shouldn't take another 50 years," Howard Koh, MD, MPH, assistant secretary for health of the Department of Health and Human Services, said at a press conference at the White House.

Banning tobacco entirely should be discussed on a societal level, acting Surgeon General Boris D. Lushniak, MD, MPH, suggested at the press conference.

"We need to have that discussion," he told reporters. "But until we do ... the reality of the situation is we need to use the tobacco control tools we have available and ramp up, because at the end of the day if we are shooting for that tobacco-free generation, it is attainable using the tools we have."

The report also called for raising excise taxes on cigarettes, extending indoor smoking bans to 100% of the population, and extending smoking cessation as a standard of care to all smokers in primary or specialty care.

Raising the cost of tobacco products is another suggested strategy. "We know that increasing the cost of cigarettes is one of the most powerful interventions we can make to prevent smoking and reduce prevalence," Kathleen Sebelius, Secretary of Health and Human Services, noted in a foreword to the report.

The federal excise tax should nearly double this year, rising an additional 94 cents from the current $1.01 per pack of cigarettes. Those extra funds would largely go toward early childhood education and health, she explained at the press conference.

Other actions recommended in the report while endgame strategies remain under development included:

  
• National media campaigns at a high frequency level, with exposure for 12 months a year for a decade or more to counteract industry marketing
  
• Barrier-free access to proven tobacco cessation treatment for all smokers, especially those with significant mental and physical comorbidities
  
• Expanding smoking cessation for all smokers in primary and specialty care settings by having healthcare providers and systems examine how they can establish a strong standard of care for these effective treatments
  
• Fully funding comprehensive statewide tobacco control programs at CDC-recommended levels

States and localities collect roughly $80 per person per year in Master Settlement funds and tobacco taxes, but spend less than $1.50 per person per year of that money on tobacco control compared with the $12 per person per year or more recommended by the CDC, noted the director of that agency, Thomas Frieden, MD, MPH.

That $12 level of expenditure is far less than what the tobacco industry spends on marketing and is "not a lot to ask for what is the leading preventable cause of death in this country," he said at the press conference.

Physician and health advocacy organizations cheered the report.

The American Cancer Society called the tobacco endgame it lays out "both possible and necessary."

The report "reinforces that the detrimental effects of smoking are severe and continue to prove more harmful than we originally thought," American College of Cardiology presidentJohn G. Harold, MD, noted in a release from that organization.

The American Lung Association argued for strong action based on the additional health effects outlined in the report. "The White House must empower the FDA to aggressively implement the Tobacco Control Act to regulate all tobacco products, including e-cigarettes and cigars," its president, Harold P. Wimmer, said in a prepared statement. "FDA also must move forward with product standards that will reduce death and disease caused by smoking, such as prohibiting menthol cigarettes."

The report stopped short of making any actionable recommendations on electronic cigarettes and "flavored little cigars" that have yet to be brought under FDA jurisdictio....

"Of all the accomplishments of the 20th century, historians rank the 1964 Surgeon General's report as one of the seminal public health achievements of our time," Lushniak concluded in his introduction to the report. "Armed with both science and resolve, we can continue to honor the legacy of the report by completing the work it began in the last century."