Don’t Forget Tobacco, Experts Say

Funding for tobacco prevention programs has dried up and — perhaps not coincidentally — progress against smoking in the U.S. has stalled, Steven A. Schroeder, M.D., and Kenneth E. Warner, Ph.D. wrote in a New England Journal of Medicine editorial that called for renewed attention to countermarketing efforts and other interventions.

Schroeder, in particular, knows whereof he speaks — he headed the Robert Wood Johnson Foundation during the period where it poured money into tobacco prevention. But Schroeder left RWJF in 2002 — he’s now a professor at the University of California at San Francisco and heads the school’s Smoking Cessation Leadership Center — and tobacco is no longer a major funding priority for the foundation. Billions of dollars from the 1998 tobacco settlement have been squandered by the states — only a fraction of that windfall ever was directed to stop-smoking efforts.

Schroeder and Warner, dean of the University of Michigan School of Public Health, note that if no further progress is made in preventing kids from starting smoking and getting smokers to quit, 13.5 percent of Americans will still be smoking in 2050. Most of them will be poor, many will have a variety of other health problems like diabetes and asthma, and people with addictions and mental illness will continue to smoke at rates higher than the general population.

“There is, however, strong evidence regarding ways of reducing tobacco use. Four policies have had documented success: raising tobacco taxes, extending laws regarding clean indoor air to additional sites, running countermarketing campaigns, and banning cigarette advertising and promotion,” wrote Schroeder and Warner.

“Renewing and accelerating the decline in smoking prevalence requires many synergistic activities,” they said. “These should include continued tax increases and expansion of laws regarding clean indoor air, which have not yet reached saturation levels. Countermarketing efforts should be revived and fully funded. Polls show that there is public support for earmarking a portion of tobacco taxes for tobacco-control programs targeted to young people, but politicians must be aware of that support or they will continue using the funds for other purposes.

“Smoking-cessation activities must be intensified, with particular focus on the most vulnerable populations — the mentally ill, substance abusers, prisoners, and the poor. Toll-free telephone quit lines are effective, yet few smokers and clinicians are aware of them; they require greater marketing and support. Moving smoking out of movies that are seen by young people would make the behavior less seductive. Identifying and supporting smoking-cessation champions in clinician groups would boost clinicians’ involvement in cessation, as would tapping peer groups and social networks that interact with smokers. We also need more research into ways of helping certain groups of smokers to quit — including young people, light and intermittent smokers, and those with mental or substance-use disorders.”