CENTERS FOR DISEASE CONTROL AND PREVENTION
Volume 14 • Number 3 • Fall 2001

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Commentary

Public Health Demands Continuing Progress in Tobacco Control

These are unprecedented times in the field of tobacco control. The landscape began changing dramatically during 1997–1998 when four states—Mississippi, Florida, Texas, and Minnesota—successfully sued tobacco companies to recover the Medicaid costs of treating smokers. Then came the 1998 Master Settlement Agreement, which settled a similar lawsuit brought by the attorneys general of the remaining 46 states. These events marked a turning point in the battle against tobacco-related diseases. The total financial settlements with the states, about $246 billion, provide a historic opportunity to strengthen state tobacco control programs. The settlement comes at a time when we know that a comprehensive approach to tobacco control is effective. At the same time, the challenges remain formidable. Nearly one-quarter of Americans still smoke, and the percentage of young people who smoke increased dramatically in the early to mid-1990s. 

Significant efforts to curb tobacco use continue on the domestic front. Among the major domestic initiatives that CDC’s Office on Smoking and Health (OSH) is planning to strengthen is one to reduce exposure to environmental tobacco smoke (ETS). When the history of tobacco control is written, the movement to reduce exposure to ETS will be a major chapter. Each year, exposure to ETS causes as many as 3,000 lung cancer deaths and 35,000 or more heart disease deaths among nonsmokers and up to 300,000 respiratory tract infections among children. In recent years this movement appears to have lost some momentum. We need still to protect children from this health hazard as effectively as adults, as shown by recently released data from NHANES, the National Health and Nutrition Examination Survey. Although the Healthy People 2010 objectives regarding adult exposure to ETS aleady have been exceeded, the objective regarding children has not been achieved, and more than half of young people continue to be exposed. The July 2001 issue of Pediatrics reports on interventions to help parents who smoke; similar programs will be needed to protect the health of children.

Adult per Capita Cigarette Yearly Consumption and Major Smoking and Health Events, United States, 1900–1999

Sources: Centers for Disease Control and Prevention. Tobacco use—United States, 1900–1999. Morbidity and Mortality Weekly Report 1999;48(43):986; Department of Agriculture, Economic Research Service, Marketing and Trade Economics Division, Specialty Crops Branch, unpublished data; Department of Agriculture. Agricultural Outlook. Washington (DC): Department of Agriculture, Economic Research Service, 2001. USDA Publication No. ERS-AO-278.

Because tobacco control is a global health issue, our partners are international as well as domestic. These include the Tobacco Free Initiative of the World Health Organization (WHO), the World Bank and other United Nations agencies, and the Departments of State, Commerce, Trade, and Agriculture. On May 24, 1999, The World Health Assembly (WHA), the governing body of WHO, paved the way for multilateral negotiations to begin on a set of rules and regulations that will govern the global rise and spread of tobacco and tobacco products in the next century. The 
191-member WHA unanimously backed a resolution calling for work to begin on the Framework Convention on Tobacco Control—a new legal instrument that could address issues as diverse as tobacco advertising and promotion, agricultural diversification, smuggling, taxes, and subsidies. WHO and CDC have also partnered to develop and conduct the Global Youth Tobacco Survey, a school-based survey that measures tobacco-related attitudes, knowledge, and behaviors among teens aged 13–15 in a rapidly expanding number of countries around the world. (See related article.)

430,000 U.S. Deaths Attributable Each
Year to Cigarette Smoking*

*Average annual number of deaths, 1990–1994

To ensure that our goals, priorities, and strategies are most responsive to the current challenges and opportunities in tobacco control, OSH has been engaged in a rigorous strategic planning process and will soon issue a draft plan for review by our partners. In the meantime, major initiatives continue on topics such as preventing tobacco use among young people (in schools and through sports and entertainment), increasing cessation, addressing health disparities, building support for clean indoor air policies, and countering the effects of tobacco use on oral health. These and other tobacco-related health issues are the subject of this issue of Chronic Disease Notes and Reports. They reflect OSH’s continuing commitment to develop the science base of tobacco control; provide technical assistance and resources to states, voluntary organizations, and other partners; communicate effectively through schools, work sites, and the mass media; and protect all population groups from the health losses associated with tobacco-related diseases.

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