[Vision2020] Tobacco: Targeting the Nation’s Leading Killer: Centers for Disease Control

[Ted Moffett]

Tobacco (nicotine) is a physically addictive drug.  Once addicted, "choice"
becomes a problematic concept.  And many people become addicted while
underage, encouraged to continue their addiction in bars, where cigarettes
are often shared between customers.

The fact tobacco is physically addictive is absent from the comments of many
opposing the smoking ordinance, as are the facts regarding the magnitude of
the damage.  Comparisons to other harmful behaviors are drawn (fatty food,
etc.), suggesting that a slippery slope of regulation will lead to
government control over too many aspects of life, but many of these
behaviors do not involve a drug addiction.  Of course alcohol has dramatic
negative impacts.  But workers in bars are not forced to drink the drinks
the customers order, as they breathe the smoke of the customers.

I find it incredible that the health of workers exposed to an addictive drug
when they breathe in the workplace is approached so callously.  They can
work elsewhere, it's announced with smug authority, as if in this economy
workers have the luxury of choosing whatever job suits their fancy, rather
than an urgency to take whatever work they can find.  If it was cocaine or
heroin or methamphetamine that workers were exposed to, the attitude might
be different.

Profits from exposing workers to addictive drugs in the workplace should be
protected based on free market, free choice, adult responsibility?  If this
is the logic, where are the protests against laws imposed on those selling
cocaine, heroin or methamphetamine, et. al., to consenting adults, which can
result in long prison sentences?  Let the free market decide!  Why stand in
the way of profits and the free choice of adults?

If those opposing the smoking ordinance were consistent in their outrage
against limits on the free market, their ideology might have more
intellectual credibility.  Instead, the libertarianism proposed is
inconsistent and conformist.  Or perhaps those opposed to the smoking
ordinance will now protest that bars do not allow legal cocaine, heroin or
methamphetamine use?  Think of the profits to be made!  And remember,
tobacco prematurely kills more people than those three drugs combined...

If attempts were made to criminalize tobacco like cannabis is, resulting in
prison sentences, home invasions, for sale or use, I would oppose this
vehemently.  But an ordinance regulating smoking in bars does not stop any
adult from legally using tobacco products in settings where they do not
expose workers.

If worker freedom of choice was a valid argument to justify the exposure of
workers to tobacco smoke in bars, than OSHA could be mostly eliminated.
After all, if workers exposed to hazards monitored or banned by OSHA don't
want to work with those risks, they can work elsewhere, as long as signs
posted in the workplace inform them of the risks.  A "Big Brother"
government bureaucracy gone.
--------------------------
http://www.cdc.gov/NCCDPHP/publications/aag/osh.htm
 The Burden of Tobacco Use

Tobacco use is the single most preventable cause of disease, disability, and
death in the United States. Each year, an estimated 443,000 people die
prematurely from smoking or exposure to secondhand smoke, and another 8.6
million have a serious illness caused by smoking. For every person who dies
from smoking, 20 more people suffer from at least one serious
tobacco-related illness. Despite these risks, approximately 43.4 million
U.S. adults smoke cigarettes. Smokeless tobacco, cigars, and pipes also have
deadly consequences, including lung, larynx, esophageal, and oral cancers.

The harmful effects of smoking do not end with the smoker. More than 126
million nonsmoking Americans, including children and adults, are regularly
exposed to secondhand smoke. Even brief exposure can be dangerous because
nonsmokers inhale many of the same carcinogens and toxins in cigarette smoke
as smokers. Secondhand smoke exposure causes serious disease and death,
including heart disease and lung cancer in nonsmoking adults and sudden
infant death syndrome, acute respiratory infections, ear problems, and more
frequent and severe asthma attacks in children. Each year, primarily because
of exposure to secondhand smoke, an estimated 3,000 nonsmoking Americans die
of lung cancer, more than 46,000 (range: 22,700–69,600) die of heart
disease, and about 150,000–300,000 children younger than 18 months have
lower respiratory tract infections.

Coupled with this enormous health toll is the significant economic burden of
tobacco use—more than $96 billion per year in medical expenditures and
another $97 billion per year resulting from lost productivity.

[image: Chart showing about 443,000 U.S. deaths attributable each year to
cigarette smoking. Text description below.]

[A text description of this
graph<http://www.cdc.gov/NCCDPHP/publications/aag/osh_text.htm#1>is
also available.]
The Tobacco Use Epidemic Can Be Stopped

A 2007 Institute of Medicine (IOM) report presented a blueprint for action
to “reduce smoking so substantially that it is no longer a public health
problem for our nation.” The two-pronged strategy for achieving this goal
includes not only strengthening and fully implementing currently proven
tobacco control measures, but also changing the regulatory landscape to
permit policy innovations. Foremost among the IOM recommendations is that
each state should fund a comprehensive tobacco control program at the level
recommended by CDC in *Best Practices for Comprehensive Tobacco Control
Programs–2007*.

Evidence-based, statewide tobacco control programs that are comprehensive,
sustained, and accountable have been shown to reduce smoking rates,
tobacco-related deaths, and diseases caused by smoking. A comprehensive
program is a coordinated effort to establish smoke-free policies and social
norms, to promote and assist tobacco users to quit, and to prevent
initiation of tobacco use. This approach combines educational, clinical,
regulatory, economic, and social strategies.

Research has documented the effectiveness of laws and policies to protect
the public from secondhand smoke exposure, promote cessation, and prevent
initiation when they are applied in a comprehensive way. For example, states
can increase the unit price of tobacco products; implement smoking bans
through policies, regulations, and laws; provide insurance coverage of
tobacco use treatment; and limit minors’ access to tobacco products.

If the nation is to achieve the objectives outlined in *Healthy People 2010*,
comprehensive, evidence-based approaches for preventing smoking initiation
and increasing cessation need to be fully implemented.
CDC's Response

CDC is the lead federal agency for tobacco control. CDC’s Office on Smoking
and Health (OSH) provides national leadership for a comprehensive,
broad-based approach to reducing tobacco use. A variety of government
agencies, professional and voluntary organizations, and academic
institutions have joined together to advance this approach, which involves
the following activities:

   - Preventing young people from starting to smoke.

   - Eliminating exposure to secondhand smoke.

   - Promoting quitting among young people and adults.

   - Identifying and eliminating tobacco-related health disparities.

Essential elements of this approach include state-based, community-based,
and health system-based interventions; cessation services; counter
marketing; policy development and implementation; surveillance; and
evaluation. These activities target groups who are at highest risk for
tobacco-related health problems.

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Vision2020 Post: Ted Moffett
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