Experts increasingly contemplate end of smoking

Adult smoking rate expected to drop to 10 percent in next decade and to 5 percent or lower by 2050
Associated Press
Feb 10, 2014

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 federal 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 1984."

Among the things that have changed:

—Cigarette taxes have increased around the country, 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 the country. Airline flights have long been off-limits for smoking.

—Polls show that cigarette smoking is no longer considered normal behavior, and is now 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 last week. 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.

—Retailing of cigarettes is changing, too. CVS Caremark, the nation's second-largest pharmacy chain, announced last week 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 federal law gave the FDA the authority to regulate tobacco products. The law barred 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.

Many believe FDA's delay is driven by defense preparations for an anticipated battery of legal and political challenges.

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 the nation's largest tobacco companies — though not Altria — sued to stop FDA-proposed graphic warning labels on cigarette packs. A federal court blocked the ads.

"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 think.

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. Efforts to prohibit them are likely to fail, they say. (Remember Prohibition?)

"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 — 2000, say. That would be constitutional, he said. The question is: Would our 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 cigarettes.

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."

 

Comments

coasterfan

Jeez, I hope they are right. I was inside a large public venue on Saturday, and was 100' from an outer door, which opened/closed regularly, as people left the building. To my surprise, I could smell cigarette smoke, which was unexpected, since smoking was not permitted in the building. When exiting, I noticed a guy smoking right outside the door.

Having 'no smoking' venues only helps to some degree, and when a smoker who doesn't understand that their smoke gets sucked into a building when they light up right outside the entrance, it doesn't help at all. Luckily, most smokers seem to be at least moderately respectful towards the non- smoking public.

As someone with asthma, it's a continued concern. Having non-smoking zones only partially helps: they work about as well as a 'no chlorine' area would in a swimming pool, because smoke often carries far away from the smoker. Even when on the lookout, I still often unexpectedly inhale a breath or two of smoke, before I realize there is a smoker nearby. Then I either have to change my walking path, or put up with it as I hold my breath while passing through their carcinogenic haze.

Things ARE much better in Ohio since the smoking ban went into effect, and I do believe that most smokers are respectful of non-smokers.

Contango

Re: "smoking ban,"

Applauding fascism.

Until the biggest monetary winners in the sale of tobacco products: state, fed and local govt. ban them, they remain hypocritical.

How will the central planners handle the other two biggest killers: Obesity & lack of exercise?

Exercise gulags perhaps?

"O brave new world, That has such people in't!"

coasterfan

I agree that we should tackle obesity and lack of exercise, as well. I could care less if you think it's fascism. All I care about is that I/you/we all end up paying for the poor health choices other people make, through higher health care/health insurance costs.

To me, the government isn't the enemy, and to be sure, nothing in the 3 above areas would be addressed without government. Big Tobacco isn't going to fund cancer research, nor help with the health care costs of the people who die because of their products. And let's call a spade a spade: it's southern/Red states who are the biggest tobacco producers, and it's mostly conservative politicians who are the big monetary winners, and in cahoots with the tobacco lobbyists.

Only in the imaginary Fox World do people wring their hands and fret over such things as Fascism and exercise gulags. The rest of us scratch our heads and chuckle that for 20+ years, they've been telling us that "America is in danger of immediate/imminent downfall". You see, we have read "Chicken Little", and after the 2nd or 3rd false warning of doom, those of us with common sense realize that the sky is definitely NOT falling.

Contango

Re: "I could care less if you think it's (sp) fascism."

You may not "care," but that's what it is.

You undoubtedly don't smoke, I don't smoke.

But, a business owner should be allowed to decide whether his/her patrons can or cannot smoke.

You can choose to patronize the establishment or not.

Pretty simple; I believe in personal freedom & individual responsibility.

You believe in heavy-handed Statism and the tyranny of the majority.

Big money winners: Taxes.

coasterfan

Ah yes, tyranny, taxes and fascism. You can always count on a teabagger to whip those words out, regardless of whether they are applicable to the conversation. (rolls eyes).

Guess we'll have to agree to disagree. I don't think that a business owner should have the option of allowing one patron to do something harmful to another patron, simply because it's his/her establishment. Evidently Ohio lawmakers agree with me.

I believe in personal freedom, too. I think everyone should be able to go into a restaurant or bar, and be free to breathe clean air - the most basic of freedoms, one could say. If a smoker wishes to smoke, he/she can do so in his own home, where it doesn't infringe on anyone else's right to breathe. One person's habit should not be allowed to make a venue uninhabitable for anyone else.

What good is freedom, if you die 20 years prematurely due to lung cancer?

Contango

Re: "What good is freedom, (snip)"

Whether someone chooses to smoke or not is ultimately none of your business.

Little wonder that you're a statist, as the basic principles of freedom are beyond your level of understanding.

Stop It

The proprietor of any establishment should be able to deem his place non smoking or smoking as long as it is posted on the door and inside.

If you know that the establishment is a smoking environment, don't go in if you don't like it.

Every time this kinda crap happens, you just let the gov't DICTATE on how you live. Bars and eateries are PRIVATE property open to the public. No one forces you to go in.

Donegan

A liberal who wants to dictate what people do and still claim they love freedom, Typical. Stress cases more death per year than cigarettes and having a bunch of control freaks try to dictate every aspect of a persons life causes stress. So my Idea is to ban liberals who cause stress which in turn cause death. At least treat liberalism for what it is, A mental disorder.

coasterfan

Nope. I just don't think other people should be able to smoke in public places, because it affects my ability to breathe. They are welcome to smoke in their own home/car, if they wish.

Being liberal doesn't cause me any stress. I'm comforted by the fact that the more educated a person is, the more likely they are to be liberal. If the letters posted here are any indication, the more illiterate someone is, the more likely they are to be conservative or teapartiers. I get to hang around with all the smart people, while you get to hang around with the anti-education science deniers.

Quick question: can I assume that you won't be accepting any Social Security checks and Medicare when you retire?

After all, those were liberal innovations. If left to Republicans, you'd be left with the "personal freedom" and "personal responsibility" to sell pencils or apples on the street corner in your old age. Luckily, America has found ways, such as the above examples, to protect its citizens from conservative principles.

Contango

Re: "because it affects my ability to breathe."

Unless you're omnipresent, this is a fallacy.

----------------------

Re: "protect its citizens from conservative principles."

Pyramid schemes that are helping to impoverish the youth in order to enrich older generations.

Note: The modern health & welfare state concept was created by Otto Von Bismarck an autocrat.

Congratulations on your embracement of Statism.

coasterfan

You're welcome. Like I say, if the extreme wingnuts on the other side oppose me, I must be on the correct path.

Since you're not a hypocrite, I'm sure you'll send your Social Security checks back to Uncle Sam, and refuse any Medicare coverage, on principle.

Contango

Re: "You're (snip)"

Not surprising at all that a leftist authoritarian-totalitarian statist would be arguing against personal freedom and individual responsibility.

Were FORCED "contributions" made to SS and Medicare?

Absurdist argument.

Donegan

"because it affects my ability to breathe" We know its hard enough for you to breath as it is without being told to do it, But others are more adapt at survival and do not need others to dictate every single thing we do. I wonder, Do you support ridding the country of the Dope laws? Your god says we need to legalize MJ, So I assume you dont mind being high. They do say it helps with mental illnesses.

coasterfan

Donegan: Your comments are rather silly, considering it is the Republican Party who is FAR more intrusive into our personal freedoms. From trying to legislate who can marry whom, to women's reproductive rights, and vaginal probes, Puritanical conservatives can always be counted on, to continually attempt to push their beliefs into even the most private portions of our lives.

In contrast, Democratic politicians do not ever try to control what people do/don't do in their bedrooms. To me, conservatives advocate a much higher level of control/intrusiveness than anything Democrats do.

Sorry, I still think that personal freedoms are fine, UNTIL/UNLESS they infringe on someone else's right to enjoy basic freedoms such as breathing. Smokers are outnumbered 83-17 in America. Does anyone actually believe that the 83 should kowtow to the 17?

Donegan

What is silly is you believe your any better than the republicans. Just now i answered a post by you advocating for the president to murder a citizen without a trial, you have no moral standing on any issue that you are force fed through party lines. You and your belief that the government should take more of my money and spend it while tearing down my rights is offensive and Un-american. Just because your god tells you something does not mean he is all powerful. The reason we have rights guaranteed in the Constitution is so you 83%. cannot dictate behavior t the 17%. As for dictating what people do behind closed doors the party of DOMA and segregation are supposed to be civil rights leaders? Please learn some history of your party. You people feed off of control, You hate the US because there are checks that stop you from that end. Move if you do not like it.

Darwin's choice

"it affects my ability to breathe"

Then please stop breathing.

coasterfan

So, you're saying that smokers should be allowed to go everywhere, but I should either put up with the smoke, or be satisfied with only going places where smokers aren't present? Why should my rights be less important than theirs? Sorry, bud, but the Constitution covers this topic rather clearly.

Contango

Re: "Why should my rights be less important than theirs?"

Conversely, why should theirs be less than yours?

coasterfan

Interesting comment, Contango. That's exactly what we Democrats say, every time a conservative tries to discriminate against women, gays, minorities, the poor...

Contango

Re: "discriminate,"

In that context it obviously depends on the word "discriminate" doesn't it and how it should be if necessarily rectified.

You continue to conflate the subject with absurd comparisons.

mikeylikesit

constitution? you mean that old outdated thing obama uses to wipe his a$$ on?

coasterfan

I'm not doing anything that endangers their health. Smokers are, indeed, doing something that endangers my health. So, your comparison doesn't apply.

Contango

Re: "I'm not doing anything that endangers their health."

But you are arguing against their rights.

You can't be in every public establishment all the time. Your argument is fallacious.

coasterfan

So, by your same logic, someone should be able to go into a store with a gun and kill a few dozen people, and we shouldn't be able to argue that they shouldn't, because we would be denying them of their right to shoot a gun.

Rights and personal freedom are important, but they end when exercising them hurts/injures someone else.

Contango

Re: "someone should be able to go into a store with a gun and kill a few dozen people,"

Conflation of ideas. Absurd comparison.

Are there establishment that currently allow that insane behavior?

You're seriously grasping.

Stop It

Who 'made' you go into the place and breathe the smoke?

pptrsha

wow! I thought the story was by 2050 there wont be any smokers left. well I am a smoker and I don't care what ANY of you do. smoke don't smoke its up to you. I just took it as there wont be any smokers left because we will all be dead from smoking.

Contango

@ coasterfan:

You need to get out more.

Most southern states do not have publicly mandated smoking bans, but almost every restaurant I've ever been in is "Smoke Free."

Gotta trust the free-market, Comrade.

http://en.wikipedia.org/wiki/Lis...

coasterfan

Actually, I get out a lot more than you do. I'm a travel agent. :)
Our discussion was on smoking in Ohio. I'm well aware that many states do not ban smoking.

Love the comrade joke. Most teapartiers think that mainstream conservatives are RINOs, and that all Democrats are communists. This is what is known as having a very, very skewed perspective.

Contango

Re: "I'm well aware that many states do not ban smoking."

And as I pointed out: The free-market system works without the need for govt. intrusion. QED.

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Re: "Love the comrade joke."

You're not a progressive-socialist?

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