US health officials have begun to predict the end of cigarette smoking in the US.
They have long wished for a cigarette-free US, 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.
A confluence of changes has recently prompted public health leaders to start tossing 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 US 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. “We believe we have the public health tools to get us to the zero level.”
This is not the first time a US health official has spoken so boldly. In 1984, then-surgeon-general C. Everett Koop called for a “smoke-free society” by the year 2000. However, Koop — a bold talker on many issues — did not 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, making smokes more expensive and laws banning smoking in restaurants, bars and workplaces have popped up all over the US.
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 US Food and Drug Administration (FDA) launched a new youth tobacco prevention campaign last week. At about the same time, the US Centers for Disease Control and Prevention (CDC) debuted a third, US$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 US$200 billion and curtail marketing of cigarettes to youths.
Cigarette retailing is changing. CVS Caremark, the second-largest US 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 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, CDC Director Tom Frieden said.
These developments have made many in public health dream bigger. It has 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 smoking-related deaths from the current 480,000 to under 10,000. However, 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.
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 FDA to regulate smoking.
A 2009 US 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.
However, nearly five years after gaining power over cigarettes, FDA has yet to even propose such regulations. Agency officials say they are working on it.
“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.
Lushniak said zero. Will that ever happen?
Some experts doubt it. As long as cigarettes and other tobacco products are legal, is likely some people will smoke them.