I had the opportunity yesterday to attend the event marking the release of the 31st Surgeon General's report on tobacco and smoking.
What struck me about this report-which focuses on tobacco use in youth and young adults--is that although we have made progress in the tobacco wars, we presently seem to be in a holding action. We are not making advances in reducing the incidence of smoking and use of smokeless tobacco products, although we are all well aware of their risks and harms.
The fundamental question remains: Although we have a pretty good idea of what works, when are we going to start reinvigorating our efforts to reduce the use of these killer products among our children?
As I have said many times before, tobacco is the one product readily and legally available in the United States that when used as intended will kill half the people who use it. 443,000 deaths a year, 1200 a day, $96 billion each year in direct medical costs and $97 billion in lost productivity. Those, my friends, are big numbers. And they are not just numbers: they are people. They are the people we love, the people we know, the people we work with.
According to the report, each and every day in this country 3800 young people under age 18 smoke their first cigarette. Every day 1000 young people become daily cigarette smokers. Whenever a smoker dies, there are two young people ready to take their place as regular smokers.
The brains and bodies of young people are different from us older folks. They aren't as developed physically or intellectually. The lure of tobacco is hard to resist. The quickness of addiction is accelerated in young people. Their lungs aren't fully developed, and tobacco will stunt that growth. Their blood vessels will be impacted, and even young people can start getting hardening of the arteries in their bodies at their tender ages when they become smokers.
Young people don't think about these things. After all, they are young. They are experimenting with life, setting down the habits that will carry them through life. Fitting in, being one of the crowd, emulating their favorite stars who may be smokers or may smoke in the movies. That's what tobacco and addiction is all about.
The list goes on and on. It is emulation and adoration that they think about, not whether or not they are going to wrinkle their skin, be unable to breathe, have a heart attack, or die prematurely in their 50's and 60's. Fitting in their social environment is what they care about, not what is going to happen to them 40 years off. To them, that's a long time away.
People like me know how quickly that time can pass, and how many things in our lives we now wish we "coulda, woulda, shoulda." I wonder how many smokers and former smokers wished they hadn't started smoking in the first place. I do know that many current smokers wish they could quit, but can't. Addiction is a powerful human force, and tobacco is a bad actor when it comes to addiction.
So we have rules and we have laws, and unfortunately we now have some folks trying to bend those rules and roll back those laws (think tobacco taxes). Like many things in medicine and life, we know what works. We know that tobacco taxes work. We know that focused messaging delivered consistently and in a culturally relevant manner work, especially for kids. We know that if we put our minds and efforts to work we will get results. But our resolve somehow seems to be weakening. We are stuck now with the same numbers of young smokers as we have had for many years. Progress has stalled, and that is what the Surgeon General is pointing out.
88% of adult smokers begin smoking by 18 years of age, and 99% by age 26. And don't think that smokeless tobacco is the answer: it is a gateway to smoking as an adult in many circumstances. One out of every four high school seniors is a regular cigarette smoker. 80% of those children will smoke into adulthood. Half of them will die 13 years prematurely than their non-smoking friends. Half of male youth using tobacco use more than one tobacco product.
So how do we fix this? How do we counter the immense amounts of money that the tobacco industry spends to lure children into their lair (reminds me of the big bad wolf in Little Red Riding Hood)?
We make a commitment to coordinate our efforts to reduce smoking among kids. We use mass media. We use social media. We implement effective tobacco tax policies, because these are especially effective among young folks. We institute school based policies that work.
What we don't do is believe that the tobacco companies are our friends. Their "anti-smoking efforts" as noted in this report may leave you with a positive impression, but they don't reduce tobacco consumption. They don't work. And the efforts to produce more products that create more addicts, including flavored cigars and cigarettes, just make matters worse. They are leaches sucking on our health and the lives of our societies. They make money, we die. What a deal. In fact, it is such a great deal that they are a cornerstone of many investment and retirement plans. You can run from them, but you can't hide. They are literally everywhere, even in our mutual funds.
So, it all comes down to this, as noted in the report:
"The efforts (to reduce tobacco use among youth and young adults) of the early 21st century need to be reinvigorated, and additional strategies considered, to end the tobacco epidemic. Providing and sustaining sufficient funding for comprehensive community programs, statewide tobacco control programs, school-based policies and programs, and mass media campaigns must be a priority. Taxing tobacco products is especially effective in reducing their use among young people. Greater consideration of further restrictions on advertising and promotional activities as well as efforts to decrease depictions of smoking in the movies is warranted, given the gravity of the epidemic and the need to protect young people now and in the future."
So ask yourself, then ask your legislators: If we know what to do, why aren't we doing it?
Remember that one life saved is saving a world. Nothing could save more worlds than diminishing the scourge of tobacco.