Online Extra: Smart Moves for Stopping Smoking
The core issues surrounding the tobacco industry haven't changed in the past decade: Its history of dishonesty about addiction, smoking's health effects, the way cigarettes are marketed, including techniques critics see as aimed at children, and how culpable the industry should be for the health of the 45 million current U.S. smokers.
But progress has been made on the public health front. Antismoking programs begun in California, Massachusetts, and elsewhere during the early 1990s have borne fruit, including hard evidence that some initiatives aimed at reducing smoking work very well and others just don't.
"We actually have a tremendous amount of knowledge now," says Stanton A. Glantz, a professor of medicine and director of the Center for Tobacco Control Research & Education at the University of California San Francicso.
EFFECTIVE TAX HIKES.
Glantz and other scientists have written volumes about the California experience. Key findings include the great success of California's aggressive media campaign, focused on the general market, with the core message that the tobacco industry lies, nicotine is addictive, and second-hand smoke kills.
The fact that marketing is aimed at adults as well as kids is important, says Glantz. It will be harder for the industry to get a political voice if adults are skeptical about the industry's claims. The message that second-hand smoke kills makes people embarrassed to light up in public. Combined with a workplace smoking ban, the advertising campaign triggered a 29% drop in California's cigarette consumption.
Another simple, effective move is hiking taxes. As the price per pack rises, people cut back. Look at New York City, where a single pack can cost north of $8 -- more than double the national average -- thanks to increases in both local and state levies. A study published by New York's State Health Dept. found that smoking has declined across the state due to the higher tax rates.
DISINTERESTED YOUNG CHILDREN.
Even factoring in that more people bought their smokes on Indian land and found other ways to avoid paying higher prices, the department found that cigarette consumption would have been 52% higher in 2003 had the higher city and state taxes not been in place. The prevalence of smoking adults was 1.3% lower in 2002 than it would have been without the excise tax, they calculated, or 188,000 fewer smokers.
A New York ban on smoking in the workplace has also helped reduce tobacco consumption in the nation's stress capital. In fact, on a per-capita basis, workplace smoking bans are a much more cost-effective method of reducing consumption than formal cessation programs in which individuals are counseled on quitting, according to recent research.
Surprisingly, school-based programs and other initiatives aimed at young children aren't particularly successful and are quite expensive. Most preteens say they aren't interested in smoking, and these programs are often diluted by other "life skills training" that has nothing to do with smoking, Glantz notes.
CAMPAIGN CONTRIBUTIONS, FEDERAL FAILURES.
So why isn't this knowledge being more widely applied? In the Justice Dept. suit against the largest tobacco companies, in which oral arguments concluded last week, the government is seeking things that public health experts endorse, including money for cessation programs and broad media campaigns. But they're also looking for something that research has shown to be much less effective -- funding for youth-focused antismoking advertising.
On the federal level, attempts at tobacco controls have repeatedly failed. Patrick Reynolds, president of Tobaccofree.org, a Los Angeles-based antitobacco advocacy group (and a grandson to R.J. Reynolds, who founded the company that makes Camel cigarettes, among others) cites a long list of federal failures, starting with the federal government's 32-cent per pack cigarette tax.
Reynolds argues that a tax hike to $1 a pack could cause a sharp reduction in smoking. Congress hasn't acted on recent attempts to institute tobacco oversight by the Food & Drug Administration, and the global treaty on tobacco control, which 55 countries have ratified, hasn't been moved to Congress by President Bush.
Campaign contributions are to blame, Reynolds believes. "In the 2003- 2004 election cycle, tobacco companies gave more than $2 million [to federal candidates]," he says. "No industry gives away that much money without getting something in return."
LITTLE SPENT ON PREVENTION.
For public health advocates, the biggest problem is a lack of funding for antismoking programs. In Massachusetts, a successful program that reduced adult smoking in the state by 25% and saved 200,000 lives has seen its budget cut back, says Gregory Connolly, longtime director of the Massachusetts Tobacco Control Program and now a professor at the Harvard School of Public Health.
The Master Settlement Agreement between the states attorneys general and the largest cigarette makers has brought billions to state coffers since it was signed in 1998, but precious little of that has gone to tobacco control. Indeed only three states -- Maine, Delaware, and Mississippi -- are even spending the minimum on tobacco-prevention programs recommended by the Centers for Disease Controls.
The good news is that those states that spend money effectively have seen big drops in smoking. The bad news is that hard evidence has not been enough to get the 47others to put their money into the right programs.
By Nanette Byrnes in New York