By Mary Ellen Shepard, PhD

The Newest Statistics about smoking from the Centers for Disease Control and Prevention (CDC) are staggering:

• Tobacco remains the No. 1 cause of premature death in the United States.
  
  
• Tobacco now kills more than 442‚000 people each year.
  
  
• Direct costs attributed to smoking have risen since the early 1990’s and now total more than $75 billion a year.
  
  
• Each pack of cigarettes sold in the United States costs the nation an estimated $7.18 in medical care costs and lost productivity.
  
  
• If current trends continue‚ 6.4 million of our children will not live full lives because of tobacco.

The highest price of all is paid by the families of smokers‚ who must watch loved ones suffer from any number of deadly tobacco-related diseases‚” says John Seffrin‚ PhD‚ CEO of the American Cancer Society (ACS) in response to the CDC report.

The War Against Smoking
In the United States‚ an estimated 25 million men and 22.6 million women smoke. More compelling are statistics showing that 6‚000 people under the age of 18 try a cigarette every day‚ a fact made even more powerful by a study that shows that some children can become addicted in a matter of days—after only smoking a handful of cigarettes. So the “experimental” smoking of some teens may lead to a lifetime addiction that can be as strong as an addiction to heroin.
As one researcher states‚ “After the glamour of starting smoking subsides‚ that addiction can be strong enough to propel people into a lifetime habit of smoking.”

Anti–Smoking Approaches
Aggressive public health initiatives to reduce smoking include implementation of tobacco control programs‚ tax increases on tobacco products‚ adoption of policies restricting smoking in public facilities‚ creative media campaigns‚ and increases in medical insurance coverage for tobacco dependency treatments.

Many organizations collaborate to accomplish these goals including local health departments; heart‚ lung‚ and cancer organizations; the medical community; schools; and parent-teacher organizations. Often‚ it is the tobacco companies themselves that are funding these initiatives indirectly through settlement funds to the states.In 1997‚ Florida became the first state to sue the tobacco industry. In a landmark decision‚ Florida won the lawsuit and received a $11.3 billion settlement. In 1998‚ tobacco companies agreed to pay the 50 states $246 billion as a settlement for lawsuits filed by states to recover money spent to treat tobacco–related illness. Inside and outside of the courtroom‚ battles between the tobacco industry and state governments continue.
 
Although the tobacco companies have paid large sums of money to states and portions of this settlement have funded tobacco control programs‚ it is still not enough.
 
“When you consider the magnitude and cost of the disease and the number of lives lost due to the use of tobacco products‚ tobacco control programs are woefully underfunded. One of our priorities is to encourage state legislatures to fund comprehensive tobacco control programs at levels recommended by the Centers for Disease Control‚” explains Ron Todd‚ MSEd‚ director of tobacco control for the national ACS in Atlanta‚ Georgia.

Many of the states looking for an anti–smoking campaign that works are looking west.

Success Story
Proposition 99‚ the Tobacco Tax and Health Protection Act of 1988 (www.dhs.ca.gov/tobacco)‚ in California is the most successful anti-smoking campaign. Since the program’s inception‚ California has invested over $1 billion implementing tobacco control programs. Since then cigarette consumption and smoking prevalence have dropped faster than anywhere else in the nation. Consumption rates are 60% lower than in 1988. The death rate in women decreased 14% while elsewhere it is rising.  And the incidence of lung cancer is decreasing.
 
“Our goal is to change the social norm in California from smoking to nonsmoking‚” explains Dileep G. Bal‚ MD‚ chief of the cancer control branch of the California Department of Health Services in Sacramento‚ California. Smoking is now banned in California bars‚ restaurants‚ and workplaces. Running juvenile stings‚ reporting illegal tobacco sales through a toll-free number‚ and adding a $0.25 tax has limited youth access to cigarettes.
 
“Our success has not relied on a single method of campaigning but rather a synergism between all of our efforts‚” says Dr. Bal. “Our very first television commercial in 1990 is an example of the aggressive nature of our campaign.” The commercial was designed to target African Americans and said‚ “You brought us here to pick it and now you want us to smoke it?”

“We work with over 60 health departments and over 100 public and private tobacco control programs. These collective efforts help us to have a direct impact on people‚” states Dr. Bal.

Focusing on young people and encouraging them not to start is only a part of the problem. Another focus is on smokers‚ many of whom have tried in vain to quit smoking multiple times.